VISA Gold and Classic Card Application

All Fields marked with * are Mandatory

CREDIT CARD REQUIRED: GBTI VISA GOLD - US$10,000 (Maximum) | GBTI VISA CLASSIC - US$5,000 (Maximum)

Print in the boxes below how you would like your name to appear on Card. Spell last name completely. Full name must not exceed 20 spaces.

Full name must not exceed 20 spaces*

PRINCIPAL APPLICANT

Branch*

Reason for applying for GBTI VISA Credit Card*

How did you hear about this?*

Personal Details

First Name*

Middle Name

Surname*

No of Dependants*

Date of Birth (dd/mm/yy): *

Place of Birth Country*

Nationality*

National Identification No

Date of issue

Passport No*

Country*

Date of issue*

Expiry Date*

Drivers Licence No

Country

Date of issue

Expiry Date

Tax Payers Identification No

Contact Details

Home Address*

Mailing Address (if different from home address)

Other please state

Email address *

Confirm Email address *

Country Code *

Home No *

Country Code

Work No

Country Code

Cell No

Country Code

Fax No

Telephone details when overseas:

Country Code

Number

Name a contact person who we may contact in the event you are overseas:

Full Name

Full Address

Country Code

Home No

Country Code

Work No

Country Code

Cell No

Email address

Confirm Email address

Relationship

Employment Details

Status*
EmployedSelf EmployedStudent

Other: Please state

Occupation*

Employers Name

Employers Address

City

No of years there

Monthly Salary/Income

Banking Information

Account No*

Account Class*

Safe Deposit Box

Other VISA cards held

Security/Collateral*

My Financial Summary
Assets	Description		Value/Balance $
Property(ies)
Vehicle(s)
Equipment
Cash/Bank/Shares
Trader Debtors/ Receivables
Other
Total Assets $
Liabilities	Description/Name	Monthly Payments	Balance
GBTI
Other Banks
Hire Purchase/Trade Creditors
Bank Credit Card
Rent
Utilities
Insurance
Other
Total Monthly Payments/Total Liabilities
Gross Monthly Income
From my Employer $	From My Co-Applicant $		Other Income $
Sources:	Total Monthly Income $

CO-APPLICANT

Branch

Reason for applying for GBTI VISA Credit Card

Personal Details

First Name

Middle Name

Surname

Salutation
MrMrsMs

Date of Birth (dd/mm/yy):

Place of Birth Country

Nationality

National Identification No

Date of issue

Passport No

Country

Date of issue

Expiry Date

Drivers Licence No

Country

Date of issue

Expiry Date

Tax Payers Identification No

Contact Details

Home Address

Mailing Address (if different from home address)

Other please state

Country Code

Home No

Country Code

Work No

Country Code

Cell No

Country Code

Fax No

Email address

Confirm Email address

Telephone details when overseas:

Country Code

Number

Name a contact person who we may contact in the event you are overseas:

Full Name

Full Address

Country Code

Home No

Country Code

Work No

Country Code

Cell No

Email address

Confirm Email address

Relationship

Employment Details

Status
EmployedSelfEmployedStudent

Other: Please state

Occupation

Employers Name

Employers Address

No of years there

Monthly Salary/Income

Banking Information

Account No

Account Class

Safe Deposit Box

Other VISA cards held

VISA Gold and Classic Card Application

Please fill out the following form and print before your visit or click here to download the form

PRINCIPAL APPLICANT

CO-APPLICANT