GBTI Classic and Gold form

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

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*
Personal Details
First Name*
Middle Name
Surname*
No of Dependants*
Salutation *MrMrsMs
Marital Status *DivorcedMarriedSingleWidowed
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)
No of years there
Type of Residence* FamilyOwnerParentsTenant
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

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
Marital Status
DivorcedMarriedSingleWidowed
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)
No of years there
Type of Residence FamilyOwnerParentsTenant
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