ªCredit Card Application Formº

SCBG

H/C

CAF/

21/1

.1

1st 5th 10th 15th 20th 25th

My Residential Details4

Visa Infinite Visa Platinum

Employer provided

Salutation/Title

My Personal Details

My Contact Details

1

2

Mr. Mrs. Ms. Dr. Prof. Others (please specify)

Others (please specify)

First Name

Middle Name

Last Name / Surname

Type of Identity DocumentPassport National ID Driver’s License Voter’s ID

ID Document Number

Date of Birth ID Expiry

Gender Male Female Others (please specify)

NationalityMarital Status Single Married Others (please specify)

Number of Children Number of Dependants Highest Educational Qualification Mother’s Maiden Name

My Employment / Business Details3

Employer Telephone

Others

Others

(please specify)

(please specify)

Name of Employer / Business

Employer / Business Address(Building / Street / Floor No.) P. O. Box

Town / City Country

Tel. (Mobile)

Office (Direct line if applicable)

Residential Telephone No.

Email AddressProvide Present Mailing Address (Including Country & City)

Salaried

Permanent

Self-Employed

Contract

Nature of Employment

Terms of Employment

D M M Y Y Y YD

Years Months

Date Employed D M M Y Y Y YD

Years Months

P. O. Box

In this application, we would like to know you better. We appreciate your time in sharing your information to help us have a comprehensive under-standing of your financial needs and assist in planning your future. Before you sign this application form, please read our Credit Card Terms and Conditions and other information related to the application as indicated on the IID and which are available on our website at www.sc.com/gh. You can request for a copy of these Terms and Conditions by calling our Toll Free number 0800 740100. We look forward to serving you better.

Mortgaged

Import Export Monthly Income (Local Currency)

Employment Sector (Salaried Employees)Others

Salary Receipt DateGH¢

Wholesaler (please specify)

Government Local Company

Name of previous employer (if less than 3 years with current employer)

Number of years with previous employerEmployment Sector (Salaried Employees)

Multinational

Minimum Amount Due Total Amount DueStanding Instruction

I have an existing loan facility with SCB.

Preferred Branch for card pick up

Loans with Other Banks / Financial Institutions

Please complete in BLOCK LETTERS with BLACK INK and tick “ ” in the appropriate box

Accommodation Type

Rented Owned Living with parents

Present Residential Address

Length of stay at present address

Area

Previous residential address (if less than 3 years at current residence)

Length of stay at previous address

Years Months

Years Months Permanent address (if different from present address. Foreign nationals, please address in home country)

My Bank Details

My Credit Details

5

6

Bank Name

Type of Account Account Number

Apply for

Credit Limit Required GH¢ Expiry

PurposeName as should appear on Card

Billing CycleRepayment Debit my account every month on due date

Contract Expiry

Contract Tenure

Occupation / DesignationEmployee / Staff NumberSSNIT NumberTax IdentificationNumber (TIN)Duration with current employer

(name with spaces must be 19 characters)

In the event that the amount approved varies from the amount applied for by GHS50.00 or less, the bank shall go ahead and credit your account without further recourse to you.However, where the amount applied for varies by more than 50 GHS, you have two options to choose from:

Contact me before producing my cardProduce my card without further recourse to me

(please tick one)

I understand that the Credit Limit approved is at the sole discretion of the Bank.

Last three month’s Bank statement (if applicable)

Latest Salary slipLetter of Undertaking

Completed Application FormI have attached the following documents:

Terms of agreement/ MIDOther

Personal Checklist8

Undertaking and Authority to Employer9

(please specify)

Number of years acquainted with Referee

For Referee 2

Full Name

Tel. (Mobile 1)

Tel. (Mobile 2)

Tel. (Work)

Relationship

Home Address

Code

BDO / BSSE / RM’s Name

BDO BSSE

For Bank Use Only11

RM

My Referees7

gh.standardchartered@sc.comFeedback.Ghana@sc.comwww.sc.com/gh

For all Customer Enquiries and Complaints

Contact

Call:0302 740 100 or Toll Free 0800 740 100

NB: eStatements will be sent monthly to the email address provided.

In consideration of Standard Chartered Bank granting me a Credit Card, 1. I authorize my employer to provide and confirm any employ- ment details that may be required for the processing of this facility.2.

3.

4.

I further authorize my employer to forward my monthly salary to Standard Chartered Bank towards the repayment of my loan until facility is fully paid. I further undertake to promptly notify you in the event of my employment with my current employer being terminated.I understand that I must make enough funds available in my account on my Payment Due Date each month to cater for repayment of the limit I utilised which has been billed to me. I also authorize my employer to assign to the bank my terminal or end of service benefits which I may be entitled to towards the permanent reduction of my outstanding limit should my employment cease. Such monies should be paid directly to the bank and I hereby confirm notification of this assignment to my employers.I will act responsibly not to prejudice recovery of the credit facilities advanced to me.I shall notify the bank of my transfer to another station and ensure that I keep to the agreed arrangement for repayment. This arrangement will remain in force for as long as I hold the Credit Card.

For Referee 1

Full Name

Tel. (Mobile 1)

Tel. (Mobile 2)

Relationship

Home Address

Number of years acquainted with Referee 10 Employer's Consent

Is the applicant under any current or intended disciplinary action? Yes No

Is the applicant’s residence as indicated in the application form? Yes No

We confirm that based on the above instructions (Authority toEmployer), we will pay the monthly salary amount directly to Standard Chartered Bank. In the event of the applicant leaving the company, we confirm that we will pay any other allowances/ benefits towards settlement of the limit outstanding/interest and charges directly to Standard Chartered Bank. We also confirm that we will not accept any change to these instructions without prior written confirmation from Standard Chartered Bank. We also confirm that we will inform the Bank about the employee’s resignation or termination of his or her employment.

Company NameName of Company Official (First)

SignatureTitle

Date

Name of Company Official (Second)

Title Signature

Date

Company Stamp

5.

6.

7.

8.

I confirm that I have read and understood the Client Terms, Credit Card Terms and Conditions, the Product Brochure and all otherCainformation related to my Credit Card Application. By signing below, I confirm my agreement to these Terms.

I confirm that I have been provided with all the information on the product and have been given sufficient time to consider the suitability of the product before signing up. This document does not replace the terms mentioned above.

Signature of Applicant

Business Banking

All Branches 8:30 am - 3 pmMonday - Friday

* Contact us on 0302 610750 or 0302 633393 to be connected to any branch

Business Banking CentreIndependence Avenue

Business Banking CentreHarper Road

* Contact us on 0302 610750 or 0302 633393 to be connected to our Business Banking Centres

Ahodwo

AchimotaAchimota Retail Centre

West HillsWest Hills Mall

Banking Hours

Tema HarbourHarbour Roundabout

Tema Community 1, Tema

Abeka-LapazAbeka

Accra High Street

East Legon

DansomanDansoman Market

Spintex RoadNear Hydraform EstatesJunction

KNUST

Tamale

Independence Avenue

Harper RoadAdum, Kumasi

LegonNear University Bookshop

Liberia RoadOpposite TUC Building

Liberation Road - TakoradiNorth Industrial Area Accra NorthObuasiOpposite Methodist ChurchOpeibea HouseAirport, Accra

OsuOsu Oxford Street

KumasiAccra

ªBranch DirectoryºPriority Banking Lounges:Kumasi Harper Road Priority Lounge Harper Road Branch

Liberia Road Priority Lounge1st Floor Liberia Road Branch

North Industrial Area Priority Lounge North Industrial Area Branch

* For Priority Clients only

Branches

Opeibea House Priority Lounge1st Floor Liberia Road Branch

Osu Priority Lounge1st Floor Osu Branch

Tema Priority LoungeTema Branch

Tema Harbour Priority LoungeTema Harbour Branch

For Enquiries / Feedback / Complaints / Compliments call our 24 hour Client Care Centre on Toll Free number 0800 740100 or +233 302740100 or send us an email onGH.StandardChartered@sc.com or visit our website www.sc.com/gh

Alternatively, you may speak to our staff in any branch.

If you wish to unsubscribe from our marketing materials, please write to us via GH.StandardChartered@sc.com