RBC Royal Bank (Trinidad & Tobago) Limited

Credit Card application

Form 8022-780 (07/2012)

I wish to apply for the following RBC Royal BankTM Credit Card: Customer Requirements
RBC Rewards Visa Platinum‡ Visa Gold Visa Classic Job letter(s) and pay slip(s)
Caribbean Airlines Frequent Flyer MasterCard Standard
‡
Two (2) forms of Government Identification
Copy of co-applicant’s Identification

1 PLEASE TELL US ABOUT YOURSELF Utility Bill

Mr. Mrs. MS. Marital Status

3 ... and YOUR CO-APPLICANT #1 (if you are applying for joint credit with another person)
First Name Middle Initial Surname Mr. Mrs. MS.

Home Address Street First Name Middle Initial Surname

City Date of Birth D M Y Home Address Street

Mailing Address (if different) City Date of Birth D M Y

Country of Birth Country of Residence Nationality Mailing Address (if different)

Home Telephone No. Business Telephone No. E-mail Address Nationality

Country of Birth Country of Residence

ID/DP/PP # (Two Forms of Identification Required) Home Telephone No. Business Telephone No. E-mail Address

Mother’s Maiden Name (for your security) No. of Dependants ID/DP/PP # (Two Forms of Identification Required)

Years at current address Own Rent Other Mother’s Maiden Name (for your security) Marital Status
Years at current address Own Rent Other
Previous Home Address (if less than 2 years at present address)
Previous Home Address (if less than 2 years at present address)
Name and Address of nearest Relative not living with you (if none, other reference)
Name of Employer
E-mail address Telephone No.

I authorise the Bank to contact me

Your Position
via my email address (Signature)
Employer’s Address

2 PLEASE TELL US ABOUT YOUR JOB

Employer’s Telephone No.

Retired Self-employed (please specify name and nature of business) Other

4 ... and YOUR CO-APPLICANT #2 (if you are applying for joint credit with another person)
Name of Employer Mr. Mrs. MS.

Employer’s Address First Name Middle Initial Surname

Employer’s Telephone No. Home Address Street

City Date of Birth D M Y

Position Years there

Previous Employer (if during the last three years) Mailing Address (if different)

Country of Birth Country of Residence Nationality

Position Years there
Home Telephone No. Business Telephone No. E-mail Address
... and ABOUT YOUR INCOME
(Co-applicant/s if applicable) Applicant Co-applicant #1 Co-applicant #2 ID/DP/PP # (Two Forms of Identification Required)

Gross Monthly Salary $ $ $ Mother’s Maiden Name (for your security) Marital Status
Years at current address Own Rent Other
Deductions at Source $( ) $( ) $( )

Net Take Home Salary $ $ $ Previous Home Address (if less than 2 years at present address)

Other Monthly Earnings $ $ $ Name of Employer

Total Monthly Earnings $ $ $

Your Position
Source of Other Earnings
Employer’s Address

Employer’s Telephone No.

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5 FINANCIAL INFORMATION 8 HOW DID YOU FIND OUT ABOUT THIS SERVICE
ASSETS VALUE BANKERS/OTHER
TV/RADIO/NEWSPAPER BROCHURE/POSTER INTERNET
BANK ACCOUNTS
FRIEND/RELATIVE MY BANKER
FIXED DEPOSITS

9 TELL US ABOUT YOUR FREQUENT FLYER MEMBERSHIP

OTHER SHARES/UNITS
CREDIT UNION SHARES
LIFE INSURANCE CSV
Are you currently a member of the Caribbean Airlines Frequent Flyer Programme?
OTHER ASSETS
No Yes
TELL US WHO ARE YOUR
REAL ESTATE MAIN BANKERS If yes, please quote Frequent Flyer No.
VEHICLE
FURNITURE/APPLIANCES
TOTAL

LIABILITIES BALANCE
OUTSTANDING
MONTHLY
PAYMENTS
BANK/
OTHER
10 PLEASE SIGN YOUR APPLICATION
Authorising Signatures:
BANK OVERDRAFTS
BANK LOANS I/We warrant that the information given herein on this Application is true
CREDIT CARD(S)
and correct. I/We also duly acknowledge receipt of the Credit Card
Cardholder Agreement in respect of this Application and have read and
CREDIT UNION LOANS
understand the terms and conditions of same and agree to be bound by
OTHER LIABILITIES
said terms and conditions.
MONTHLY RENT/MORTGAGE
HIRE PURCHASE
TOTAL DEBTS/PAYMENTS

TOTAL
(Applicant’s Signature) (Date)

6 TELL US HOW YOU WOULD LIKE TO PAY YOUR ACCOUNT

PAYMENT METHOD: Cash/Cheque Debit Account (indicate Branch and Account No.)
(Co-Applicant’s Signature) (Date)
Branch A/C No.

PAYMENT AMOUNT: Minimum Monthly Payment Fixed: $ Full Balance

7 BRANCH AT WHICH YOU WOULD LIKE TO COLLECT YOUR CARD (Co-Applicant’s Signature) (Date)

FOR OFFICIAL USE ONLY

BRANCH TRANSIT NO.

A.V. KNOWLES ACB/TRANSUNION CREDIT SCORE (INSERT) COLLATERAL HELD YES NO

CREDIT LIMIT: ACCOUNT NO:

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T24 CUSTOMER NUMBER:

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CARD NO. - MAIN APPLICANT:

1 16

CARD NO. CO-APPLICANT #1:

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CARD NO. CO-APPLICANT #2:

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APPROVED BY:
(Authorised Signature) (Print Name)

®/TM Trademark(s) of Royal Bank of Canada. Used under licence.

‡ All other trademarks are the property of their respective owner(s). 2 of 2