Share the powerful benefits of your Citibank Credit Card with your

Share the powerful benefits of your Citibank Credit Card with your loved ones 1 CITIBANK SUPPLEMENTARY CARD FORM Dear Cardmember, We are pleased to offer you upto three Supplementary Cards for your spouse, parents, brothers, sisters or children over 18 years. Please provide us details of your family member: 2 CITIBANK SUPPLEMENTARY CARD FORM Dear Cardmember, We are pleased to offer you upto three Supplementary Cards for your spouse, parents, brothers, sisters or children over 18 years. Please provide us details of your family member: Name of Supplementary Card Applicant: (As it appears in the CPR/Passport) PLEASE USE CAPITAL LETTERS Name of Supplementary Card Applicant: (As it appears in the CPR/Passport) PLEASE USE CAPITAL LETTERS FIRST NAME MIDDLE LAST NAME FIRST NAME MIDDLE LAST NAME Mr. Mrs. Ms. Others Mr. Mrs. Ms. Others Name: Your name as you would like it to appear on your Card (leave one space between names and underline surname) PLEASE USE CAPITAL LETTERS (19 CHARACTERS) Name: Your name as you would like it to appear on your Card (leave one space between names and underline surname) PLEASE USE CAPITAL LETTERS (19 CHARACTERS) Relationship: Date of Birth: DD MM YY Sex: Male Female Relationship: Date of Birth: DD MM YY Sex: Male Female Occupation Occupation Mother's maiden name: (This is a security feature for your protection) If I apply for a Photo card, I confirm that the photograph provided by me is my present true identity, which I authorise Citibank N.A. to apply to my credit card, and for which I accept full responsibility and agree not to make any claim against Citibank N.A. in respect thereto. As an acceptance of the above, I hereby include my signature below. Mother's maiden name: (This is a security feature for your protection) If I apply for a Photo card, I confirm that the photograph provided by me is my present true identity, which I authorise Citibank N.A. to apply to my credit card, and for which I accept full responsibility and agree not to make any claim against Citibank N.A. in respect thereto. As an acceptance of the above, I hereby include my signature below. Signature of Supplementary Card applicant Signature of Supplementary Card applicant Attach passport size photo in the box Attach passport size photo in the box (Please sign within the box provided with a black pen) (Please sign within the box provided with a black pen) Please do not staple Please do not staple The Supplementary Card fees will be billed in your statement. It will be the responsibility of the Primary Applicant as well as Supplementary Applicant to honour all charges incurred on a Supplementary Card. As the Supplementary Card is a special facility, continuation of the membership of the Supplementary Cardmember will be dependent on continuation of your membership. The Supplementary Card fees will be billed in your statement. It will be the responsibility of the Primary Applicant as well as Supplementary Applicant to honour all charges incurred on a Supplementary Card. As the Supplementary Card is a special facility, continuation of the membership of the Supplementary Cardmember will be dependent on continuation of your membership. PLEASE SIGN THIS AUTHORIZATION I hereby apply for the issue of a Citibank Supplementary Credit Card and declare that the information provided on this application is true and correct. I hereby authorize Citibank N.A. to verify any information from whatever sources it may consider appropriate. I acknowledge and agree that the use of the card will be deemed an acceptance of the terms and conditions of the Citibank Credit Card Terms and Conditions which accompany the card (s) and which are applicable to the basic as well as Supplementary Cards, if any. If the Supplementary Card Applicant is a minor, I hereby authorise Citibank N.A. to issue the applicant a card and authorise transactions carried out by the Supplementary applicant. I confirm that I am the Supplementary Applicant's guardian. I accept that Citibank N.A. is entitled in its absolute discretion to accept or reject this application without assigning any reason whatsoever. Upon approval, I agree to pay the prevailing annual fees. I and the Supplementary Card Applicant, by our signature below, understand and agree that we are jointly and severally liable for all charges incurred on the Basic card and/or the supplementary card for goods and services and cash advances obtained and all transactions generated by the use of the Basic Card and Supplementary Card. The Supplementary Card Applicant further acknowledges that the use of the card will be deemed an acceptance of the terms and conditions of the Citibank Credit Card Terms and Conditions which accompany the card. I also agree that documents presented to Citibank N.A. will remain the property of Citibank N.A. Annual Supplementary Card Fees (BD) Gold Silver Free for the first year Free for the first year PLEASE SIGN THIS AUTHORIZATION I hereby apply for the issue of a Citibank Supplementary Credit Card and declare that the information provided on this application is true and correct. I hereby authorize Citibank N.A. to verify any information from whatever sources it may consider appropriate. I acknowledge and agree that the use of the card will be deemed an acceptance of the terms and conditions of the Citibank Credit Card Terms and Conditions which accompany the card (s) and which are applicable to the basic as well as Supplementary Cards, if any. If the Supplementary Card Applicant is a minor, I hereby authorise Citibank N.A. to issue the applicant a card and authorise transactions carried out by the Supplementary applicant. I confirm that I am the Supplementary Applicant's guardian. I accept that Citibank N.A. is entitled in its absolute discretion to accept or reject this application without assigning any reason whatsoever. Upon approval, I agree to pay the prevailing annual fees. I and the Supplementary Card Applicant, by our signature below, understand and agree that we are jointly and severally liable for all charges incurred on the Basic card and/or the supplementary card for goods and services and cash advances obtained and all transactions generated by the use of the Basic Card and Supplementary Card. The Supplementary Card Applicant further acknowledges that the use of the card will be deemed an acceptance of the terms and conditions of the Citibank Credit Card Terms and Conditions which accompany the card. I also agree that documents presented to Citibank N.A. will remain the property of Citibank N.A. Annual Supplementary Card Fees (BD) Gold Silver Free for the first year Free for the first year Basic applicant's signature Basic Cardmember's Card Number Supplementary applicant's signature Basic applicant's signature Basic Cardmember's Card Number Supplementary applicant's signature Citibank Credit Cards. The Best Way to Pay.