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The American Express® Platinum Credit Card - Application Form
• Please complete all fields using BLOCK CAPITALS in blue or black ink.
• Please note that we cannot guarantee the processing of this application if any section is not completed correctly.
• Please choose the billing currency you prefer SAR US$
Section 1 - Your personal details Section 4 - Your work details
(Please tick as applicable) (Please tick as applicable)
Mr. Mrs. Miss Dr. Other Employed Self-Employed Retired
Family Name Job Title
Employer or Company Name
Nature of Business
Date of Birth D D M M Y Y Y Y
Start Date D D M M Y Y Y Y
Gender Male Female Work Address
Marital Status Single Married No. of Dependents Building No. Area
Nationality Street P.O. Box
Passport No. City Postal Code
ID or Iqama No. Tel. No. Ext.
Please spell out your name in English as it appears in your passport and as you would Fax No.
like it to appear on your Card using no more than 26 letters and spaces. Email address
Please state your personal monthly income - SAR
Present/Former American Express® Card number A minimum salary of SAR 20,000 per month is required to apply for the Platinum Credit Card
If you earn additional income, please state the amount and source, and provide
the appropriate documentation. Additional Income - SAR
If you are a merchant that accepts American Express® please tick here
Please send me my monthly statement to Home Work
Section 2 - Your contact details Section 5 - Apply for an Additional Card
(Please tick as applicable) Please spell out in English the of the applicant as it appears in his/her passport and as
it is to appear on the Additional Card using no more than 26 letters and spaces.
Own Rent With Family Company Provided
If rent, state monthly payment - SAR
House No. Area Mr. Mrs. Miss Dr. Other
Street P.O. Box Family Name
City Postal Code First Name
No. of years at address Middle Name
Home Tel. No. Date of Birth D D M M Y Y Y Y
Mobile Tel. No. Relationship
ID or Iqama No.
Reference Person (does not live with you)
Mobile Tel. No.
Mobile Tel. No.
Section 3 - Your home country address (for non Saudis) Section 6 - Your finances
House Address Bank Name
House No. Area Branch
Street P.O. Box Bank Address
City Postal Code Building No. Area
Country No. of years at address Street P.O. Box
Home Tel. No. City Postal Code
IMPORTANT Fax No.
A minimum salary of SAR 20,000 per month is required to apply for the American Express® Direct Debit (optional)
Platinum Credit Card
Please indicate whether you will settle your account by direct debit Yes No
Please enclose documents required along with the completed and signed application form: The direct debit option makes your Card payments absolutely hassle free! When you opt for the service, the payment amount that
is due will be deducted automatically from your account.
• Photocopy of your passport and ID/IQAMA
Please tick the % of monthly outstanding amount you prefer settled from the following options:
• Employment Certificate confirming date of employment, annual income and position held.
If self employed, please enclose a copy of your Commercial Registration 5% 50% 100% Others %
To activate direct debit, American Express will send you a mandate that you need to sign. Once received, we will send it to your
• Personal bank statements for the last 3 months bank for approval. Once we receive the approval from your bank, the direct debit option will be activated and you will be informed
accordingly. Please note that direct debit will not be active unless we receive approval from your bank. We request you to settle your
• Please enclose a recent business card if available statement in your usual way before the due date till we inform you the direct debit is active.
Page 1 Mail to: Amex (Saudi Arabia) Ltd. P.O. Box 6624, Riyadh 11452, Saudi Arabia. Tel.: 800 124 2229 or (+9661) 474 9035, (+9661) 474 8023 Please sign Page 2
Terms and Conditions
The American Express® Platinum Credit Card
This account will be billed in Saudi Riyals or US Dollars. The SAR 900 (US$ 240) Annual Subscription Fee (c) We will apply commissions on all balances that result from all Transactions at a rate of 2.5% per month,
for the American Express® Platinum Credit Card will be included on your first statement of Account. on a daily basis. Commissions will be charged on the amount you owe in respect of the Transactions from
Additional American Express® Platinum Credit Cards are SAR 450 (US$ 120$) per year. The use of the Card the date you make them until payment is received by us. If the payment of the whole of the statement
is subject to local rules and regulations. closing balance on a credit card is received by Amex (Saudi Arabia) Ltd. on or before the payment due
The American Express® Platinum Credit Card offers revolving credit. Therefore, the minimum payment date, no commissions will be payable. If you wish to utilize the credit facility and pay Amex (Saudi Arabia)
amount must be settled by the due date shown on the front of the monthly statement. Detailed Ltd. an amount less than the statement closing balance, the balance of amount outstanding from the
conditions governing the use of the American Express® Platinum Credit Card are found on our website date of the transaction will attract a commissions. All transactions will attract a service charge from the
www.americanexpress.com.sa. The signature of, or the use of the Card(s) shall be deemed as formal date of transaction at the prevailing rate once the account uses the credit facility. This commissions will
approval of the said Terms & Conditions with any subsequent amendments. Upon its approval by Amex be debited on the last day of the billing date and will be applied on daily outstanding balances.
(Saudi Arabia) Ltd. this application and all supporting documents shall constitute integral parts of the (d) All cash advances attract a transaction fee at the prevailing rate. A charge of 3.5% of the amount
Terms & Conditions. I agree that American Express® have the right to keep all the documents supplied (subject to a minimum of SAR 40 (US$ 10)) will be charged and billed to your Account along with the
with this application. amount you have withdrawn. The fee will be debited to the Account at the time of posting of the
Declaration: I undertake to pay you all amounts falling due from me, by the due date, as a result of membership cash advance. Cash advances on credit cards will also be subject to a commission calculated on daily
in or use of the Card(s) as shown on each monthly statement from Amex (Saudi Arabia) Ltd., which constitutes balances from the date of withdrawal until the entire amount along with the charges are cleared. A
due notice that such amounts have become due and payable. The microfilm copies of receipts sent to me by commission of 2.75% will be debited to the Account on the last day of the billing cycle.
Amex (Saudi Arabia) Ltd. evidencing the amount due from me consequent upon my use of the Card(s) shall be (e) We will send you a regular monthly statement so that you know how much you owe on your
conclusive evidence of my indebtedness. And I hereby waive the right of objection thereto and agree to deeming Account. However, it is clearly understood and agreed upon we will not issue said statement for the
said microfilms as original receipts. My domicile and residence is shown as above and I hereby irrevocably submit month(s) during which no transactions has been recorded on your Account and the opening and
to the non-exclusive jurisdiction of the competent courts or other bodies in my country of residence, including closing balances of your account were nil. Each statement will show the minimum amount you need
but not limited to the Committee for Settlement of Banking Disputes of SAMA, in all respects in relation to my to pay us which will be 5% of the total amount owing or SAR 200 (US$ 50), whichever is more. You
obligation to Amex (Saudi Arabia) Ltd. and undertake to comply with decisions and judgements and orders made can also pay anything up to the full amount you owe, if you wish.
thereby providing for payments of amounts owed by me to you as well as loss of profits arising from delay (f) A grace period of 22 days will be granted to settle the amount, and the payment due date will be
on my part in making payments together with fees, expenses and attorney's fees. I further affirm that I fully indicated on your statement.
understand that I may be subject to criminal liability in the event that any cheque made by me to your order is
(g) All Transactions including Cash Withdrawals, incurred in currencies other than the billing currency of
returned unpaid by the drawee bank and that you shall be entitled to pursue criminal proceedings against me.
the Account (“Non-Billing Currency”), will be converted into the Account’s billing currency (“Billing
I warrant that the information stated above is true and correct and I authorize Amex (Saudi Arabia) Ltd. and/or
Currency”). Unless the applicable laws require a specific conversion rate, the American Express® Global
its authorized representatives to contact my bankers or any other source either before or at any time after this
Network, will use conversion rates based on interbank rates, which they select from customary
application is processed to obtain any information required. I understand that Amex (Saudi Arabia) Ltd. reserves
industry sources on the business day prior to the date of processing the transaction. A nominal
the right to decline this application without giving any reason and that no correspondence will be entered into
conversion fee of 2.5% on the converted amount will be added by Amex (Saudi Arabia) Ltd. (“Amex”),
these circumstances and I further understand that Amex (Saudi Arabia) Ltd. reserves the right to require a bank
the Issuer of your Card. The conversion will be made on the date of processing the transaction, which
guarantee acceptable to Amex (Saudi Arabia) Ltd., or a cash margin (which shall be held as collateral and will not
may not be the same date when the transaction was made since this depends on the time when the
be used towards settlement of my Card account) as a condition for approving the application. If my application is
transaction was submitted to American Express® Global Network. The conversion rates may also vary
approved, I undertake to settle the minimum payment due on my Card account by the due date, as shown on each
accordingly. At the time of conversion, all transactions, which are incurred in currencies other than
monthly statement. The undersigned individual(s) join in this application and understand that we will be jointly
US Dollars, will be converted to US Dollars before being converted to the Billing Currency. Amounts
and severally liable for payment of all charges on any additional American Express® Platinum Credit Cards.
converted by independent third parties are billed as converted by them.
I hereby agree to provide Amex (Saudi Arabia) Ltd. with any information that it requires for establishing and / An illustrative example is given below.
or administering my accounts and facilities with Amex (Saudi Arabia) Ltd. and I authorize Amex (Saudi Arabia)
Transaction value (Non-billing currency) Euro 100
Ltd. to obtain and collect information as deemed necessary or in regard of me, my accounts and facilities
American Express® Global Network exchange rate Euro 1 = USD 1.3572
with Amex (Saudi Arabia) Ltd. from the Saudi Credit Bureau (SIMAH) and to disclose that information to
USD equivalent USD 135.72
SIMAH or to any other agency approved by Saudi Arabian Monetary agency (SAMA).
Currency conversion fee (@ 2.5%) USD 3.39
Initial Disclosure Statement Total transaction value in USD (If US$ is the billing currency) USD 139.11
Please read the following important information carefully and sign below if you are in agreement with this. USD to SAR conversion rate 3.75
If you have any questions then please call our customer service numbers, on Total transaction value in SAR (If SAR is the billing currency) SAR 521.67
Toll free 800 124 2229 or (+9661) 474 9035, (+9661) 474 8023.
(h) We provide credit information relating to our Cardmembers to The Saudi Credit Bureau (SIMAH)
(a) Applicable fees on a monthly basis. The information provided reflects the status as at the previous month-end
The American Express® and includes information regarding whether the card account is regular or delinquent. To avoid any
Types of Fees
Platinum Credit Card
adverse credit history with SIMAH, Cardmembers should ensure that they make timely payment of
Annual Subscription Fee SAR 900 (US$ 240)
the amount due on the Card account.
Supplementary Card Fee (optional) SAR 450 (US$ 120)
(i) Detailed conditions governing the use of the American Express® Platinum Credit Card are found on our
Monthly Commissions on Outstanding Balance (purchases*) 2.5%
website www.americanexpress.com.sa. The signature of, or the use of the Card(s) shall be deemed as formal
Monthly Commissions on Outstanding Balance (cash withdrawals*) 2.75%
approval of the said Terms & Conditions with any subsequent amendments. The Terms & Conditions shall
SAR 40 (US$ 10) or 3.5%
Cash Withdrawal Fee be unilaterally and periodically reviewed, updated and amended by Amex (Saudi Arabia) Ltd., at any time.
which ever is higher
The up-to-date version displayed on the website shall contain any such amendment(s), and shall therefore
Late Payment Fee SAR 150 (US$ 40)
be deemed valid, entering into full effect, automatically replacing and superseding the previous provision(s)
Over Limit Fee SAR 100 (US$ 30)
whether contained in the Terms & Conditions in written form accompanying the card(s) when delivered
Conversion Fee (for spend in currencies other than billing currency) 2.5%
to you or previously displayed on the website, merely and immediately upon the occurrence of such
Fee for Dishonoured Cheque or Direct Debit Rejection Fee SAR 150 (US$ 40)
update. You are invited to logon this website regularly to be informed of such amendments, therefore
Statement Request Fee (more than three months) SAR 40 (US$ 10)
we hereby draw to your kind attention that your use or possession of the Card(s) after the occurrence of
Refund of Credit Balance SAR 100 (US$ 27)
such amendment (s) reflected by our update as provided for hereunder, shall be deemed as your formal
Dispute Handling Fee SAR 150 (US$ 40)
and absolute approval to such Terms & Conditions and their subsequent amendment(s).
* Commission (Cash) / Commission (Purchases) are payable only if revolve card bill is not paid in full on
(j) Upon its approval by Amex (Saudi Arabia) Ltd., this application and all supporting documents shall
or before the payment due date. APR for purchases is 30% and for cash withdrawals 33%.
constitute integral parts of the Terms & Conditions. I agree that American Express® have the right to
(b) This account will be billed in Saudi Riyals or US Dollars. The annual subscription fee of SAR 900 (US$ keep all the documents supplied with this application.
240) will be included on your first statement of account. Additional American Express Platinum Credit
I hereby declare that I read and understood ‘The Initial Disclosure Statement’ given in this
Cards are only SAR 450 (US$ 120) (optional).
PLEASE SIGN HERE
SIGNATURE OF MAIN APPLICANT SIGNATURE OF ADDITIONAL APPLICANT
SIGNATURE DATE OF SIGNATURE SIGNATURE DATE OF SIGNATURE