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The American Express® Corporate Card Joint & Several Liability Employee Application Form – Joint & Several Liability Company Name: ________________________________________________________ Declaration by Applicant Please quote your Company’s Corporate Account Number: (existing accounts only) I, the Corporate Card applicant, hereby apply to Amex (Saudi Arabia) Ltd. for an American Express® Corporate Card. I agree to comply with the terms and conditions that will accompany the Corporate Card when issued. I certify that the information given in support of Applicant Details my application is true and correct. I understand and agree that I will be jointly and severally liable for all charges incurred on the Corporate Card, issued to me. Please Tick: I hereby agree to provide Amex (Saudi Arabia) Ltd. with any information that is requires Title Mr. Mrs. Miss Dr. Other ___________________ for establishing and/or administering my accounts and facilities with Amex (Saudi Arabia) Ltd. and I authorise Amex (Saudi Arabia) Ltd. to obtain and collect information as deemed Full Name as it appears in your Passport: necessary or in regard of me, my accounts and facilities with Amex (Saudi Arabia) Ltd. from the Saudi Credit Bureau (SIMAH) and to disclose that information to SIMAH or to any other ________________________________________________________________________ agency approved by Saudi Arabia Monetary agency (SAMA). I have read and understood the Please insert your name as you would like it to appear on the Card initial disclosure statement given in this application. (Max. of 20 letters and spaces) To help in the prompt processing of the Corporate Card application, please ensure you have enclosed a copy of your ID / iqama and a copy of your passport. Date of Birth: Day Month Year Employee's Signature: _________________________________ Date:_____________ Nationality: __________________________ Passport No: _______________________ EMPLOYEE APPLICATION FORM ID number / Iqama: Home Address: P.O. Box: ________________ Postal Code: _________________ Manager's Approval: ___________________________________ Date:_____________ City:____________________________________________________________________ Home Tel: ________________________ Mobile: ______________________________ Declaration by Company Signatory Email: __________________________________________________________________ On behalf of the company, named in this application (the Company), we hereby request Position held in Company: ___________________ Employee Number __________ issuance of an American Express Corporate Card to the individual named above and certify that the named individual is an employee of the Company. We confirm that the information Company Address: P.O. Box: ________________ Postal Code: _________________ given in this application form is to the best of the company’s knowledge true and correct. We understand and agree that the Company will be jointly and severally liable for all charges City: ______________________________ Country: _____________________________ incurred on the Card issued to the Applicant. We also understand that American Express Company Tel: _______________________________ Fax: _______________________ reserves the right to decline any application without giving a reason and that no correspondence will be entered into these circumstances. The Company hereby agrees to be bound by the Have you ever held an American Express Card? American Express Corporate Cardmember agreement which will accompany the Card when issued upon its approval by Amex (Saudi Arabia) Ltd. The company also declares that the ID Present Member Former Member No documents provided are genuine and represent a true copy of the original. Card Number 3 7 It is essential that the form is counter-signed by an authorised signatory. *Please tick to enroll in the Membership Rewards® Programme Signature of Authorised Signatory: ______________________ Date: _____________ *Please tick to enroll in the Express Cash Service *These options only valid if the company has approved them. Name of Authorised Signatory: ____________________________________________ Position held in Company: ________________________________________________ Monthly Card Limit: ______________________________________________________ Company Stamp: ________________________________________________________ Amex (Saudi Arabia) Ltd, P.O. Box 6624, Riyadh 11452, Saudi Arabia, Toll Free: 800 440 0004, Fax: (+966) 1 201 9449, www.americanexpress.com.sa Joint & Several Liability Initial Disclosure Statement Please read the following important information carefully. If you have any questions, please f) Applicable fees call our customer service toll-free number on 800 440 0004 or (+966 1) 474 9034. Types of Fees a) This account will be billed in the currency that you have chosen, either in US Dollars Late payment fee 2.5% or SAR 150 / US$ 40 which ever is higher or Saudi Riyals. As applicable, the annual subscription fee will be included on your first statement of account. Cash withdrawal fee 5% or SAR 55 / US$ 15 which ever is higher Currency conversion fee 2.5% b) All charges are due for payment in full immediately on receipt of your monthly statement Cheque returned fee SAR 150 or US$ 40 and before the payment due date shown on your statement. If the outstanding balance is not settled the Late Payment Charges on overdue balances monthly in arrears is at the Statement request fee (more than three months) SAR 40 or US$ 10 rate of 2.5% or US$ 40 (SAR 150), whichever is higher, of all outstanding sums. Refund of credit balance SAR 100 or US$ 27 c) Your monthly statements can be viewed upon activating your Corporate Interactive Direct debit rejection fee SAR 150 or US$ 40 application on the website. g) Detailed conditions governing the use of the Corporate Card are included in the Terms EMPLOYEE APPLICATION FORM d) A grace period of 25 days will be granted to settle the amount, and the payment due date & Conditions, which will accompany the Card(s) when issued. The signature of, or the will be indicated on your statement. use of the Card(s) shall be deemed as formal approval of the said Terms & Conditions with any subsequent amendments. The Terms & Conditions shall be unilaterally and e) All transactions including Cash Withdrawals, incurred in currencies other than the billing periodically reviewed, updated and amended by Amex (Saudi Arabia) Ltd, at any time. The currency of the Card account («Non-Billing Currency»), will be converted into the Card up-to-date version displayed over this web page shall contain any such amendment(s), account’s billing currency («Billing Currency»). Unless a specific conversion rate is required and shall therefore be deemed valid, entering into full effect, automatically replacing and by the applicable laws, the American Express Global Network will use conversion rates superseding the previous provision(s) whether contained in the Terms & Conditions in based on interbank rates which they select from customary industry sources on the written form accompanying the card(s) when delivered to you or previously displayed business day prior to the date of processing the transaction. A nominal conversion fee of over this web page, merely and immediately upon the occurrence of such update. You are 2.5% on the converted amount will be added by Amex (Saudi Arabia) Ltd. («Amex»), the invited to logon to this website regularly to be informed of such amendments, therefore issuer of your Card. An illustrative example is given below. we hereby draw to your kind attention that your use or possession of the Card(s) after the occurrence of such amendment(s) reflected by our update as provided for hereunder, shall Transaction value (Non-billing currency) Euro 100 be deemed as your formal and absolute approval to such Terms & Conditions and their subsequent amendment(s). American Express Global Network exchange rate 1 Euro = 1.3572 US$ US$ equivalent US$ 135.72 h) We provide credit information relating to our Card members to The Saudi Credit Bureau (SIMAH) on a monthly basis. The information provided reflects the status as at the Currency conversion fee (@ 2.5%) US$ 3.39 previous month-end and includes information regarding whether the card account is Total transaction value in US$ (If US$ is the Billing Currency) US$ 139.11 regular or delinquent. To avoid any adverse credit history with SIMAH, cardholders should ensure that they make timely payment of the amount due on the card account. US$ to SAR conversion rate 3.75 Total transaction value in US$ (If SAR is the Billing Currency) SAR 521.67 i) Upon its approval by Amex (Saudi Arabia) Ltd, this application and all supporting documents shall constitute integral parts of the Terms & Conditions. I agree that American Express have the right to keep all the documents supplied with this application.
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