Citibank Cash Back Card Request Citibank Cash Back 1300 301 304 (24 hrs) Fax completed Application to: Card Request
Fax completed Application to: 1300 301 304 (24 YES! I want to apply for a Citibank Cash Back Visa Card 5WZY5KYP hrs) YES! I want the form IN BLOCK CAPITALS. Before you complete this Application, please be sure you can say ‘yes’ to the initial approval criteria: Please completeto apply for a Citibank Cash Back Visa Card 5WZY5KYP
Are you P L E A S EyearsL Lage? A B O U T have U goodE L F rating? at least 18 T E of U S Do you YO a R S credit
Title Title intial Middle
PO Box not acceptable Middle intial PO Box not acceptable Home address no.
Citibank Pty Limited ABN 88 004 325 080 AFSL No. 238098 Citibank Pty Limited ABN 88 004 325 080 AFSL No. 238098
Please complete the years of age? form IN BLOCK CAPITALS. Before you complete this Application, permanentsure you can say ‘yes’ to the initialearn more criteria: please be Australian resident? approval than $20,000 p.a.? Are you at least 18 Do you have a good credit rating? Are you a Do you
Are you a permanent U R M O N T H LY F I N DoN C Iearn moreS I T I $20,000 p.a.? YO Australian resident? A you A L P O than O N
P L E A S E T E L L U S A B O U T YO U R S E L F
First name First name Surname Surname Street Street State State Postcode Postcode
YO will M O N T determine your ability L P O repayments This information U Rbe used to H LY F I N A N C I Ato make S I T I O N on this credit facility. This information will be used to determine your ability to make repayments on this $ 1. Show your Total Monthly Income (after tax) credit facility.
1. Show your Total Monthly Income (after tax) 2. Show your Total Monthly Personal Expenses 2. Show your Total Monthly Personal Expenses 3. _ $ $ $
Home address no. Suburb/Town Suburb/Town Home ( )
� Home � ( Mobile � ( Mobile � (
Include rent/mortgage, loan repayments (car, credit cards etc), _ personal living expenses (food, electricity etc), rates/body Include rent/mortgage, loan repayments (car, credit corporate and any other financial commitments. cards etc), personal living expenses Monthly Disposable (food, electricity etc), rates/body Income corporate and any other financial commitments.
= $
) ) )
E-mail address
I consent to being kept informed about products, services and I consent to being kept informed offers via e-mail and/or SMS. about products, services and offers via e-mail and/or SMS.
3. Monthly Disposable P R O F E S S I O N A L D E TA I L S = $ Income
P Are you self employed? R O F E S S I O N A L D E TA I L S Yes
Are you self employed? Current employer/trading name Current employer/trading name Employer/trading address no. Employer/trading address no. Suburb/Town Street Street State State Postcode Postcode Yes
No No
Yes, I would notifications. E-mail address like to/receive electronic statements and email no. Date of birth and agreed with the electronic Driver’s licence consent. / 19 I have read communications
Date of birth / Mother’s maiden name Mother’s maiden name Married Single Married name Your spouse’sSingle
/ 19
Driver’s licence no. Widowed Widowed Defacto Defacto
Divorced/Separated Divorced/Separated
Suburb/Town ( ) Work
� Work � ( current employer Years with )
Years with current employer Gross annual salary $ Gross annual salary $ Occupation
Years with previous employer Years with previous employer Other annual income $ Other annual income $
Your spouse’s name Number of dependents (including self) Number of dependents (including self) Own home Rent Own home Rent Years at current address Mortgage Boarding Boarding
Mortgage Years at previous address
I authorise my accountant to verify my details to Citibank (mandatory if self employed). Occupation I authorise accountant Name of my accountant to verify my details to Citibank (mandatory if self employed).
Years and address details Years at previous address Name at current address of relative in Australia not living with you Name and address details of relative in Australia not living with you Home address no. Home address no. Suburb/Town Suburb/Town( Relative’s Street Street State State Postcode Postcode
Name of accountant Accountant’s trading name Accountant’s address no. Accountant’s trading name Accountant’s Suburb/Town address no. Suburb/Town Accountant’s Street Street State State Fax ( Fax ( Postcode
� Relative’s � (
) )
�( Accountant’s � (
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Postcode
PLEASE SIGN HERE
A B O U T YO U R A C C O U N T S
Existing or previous Citibank U T YO U R A C C Ocredit card number. A B O account number and/or U N T S Existing or previous Citibank account number and/or credit card number. Type of other credit card(s) held, e.g. Visa, MasterCard, American Express etc Type of other credit card(s) held, e.g. Visa, MasterCard, American Express etc Bank accounts currently open with your bank (please tick each type of account you hold) Investment Cheque Savings Bank accounts currently open with your bank (please tick each type of account you hold) Savings Cheque Investment
By signing below you confirm L E A S This loanN H E R E is for personal use (2) You P that: (1) E S I G application are an Australian resident and are over 18 years of age (3) The information you have By signing below you confirm that: (1) This loan application is read and agreed to the given in this application is truthful and complete (4) You havefor personal use (2) You are an Australianon the back of this form. years of authorise us information you have Privacy Consent resident and are over 18 (5) You age (3) The to verify information given in in this application including by contacting your have read and agreed to providedthis application is truthful and complete (4) Youemployer or accountant. the Privacy Consent on the back of this form. (5) You authorise us to verify information Date Signature provided in this application including by contacting your employer or accountant.
Date � To � assist us in approving your application, please include your most recent pay slip, Signature
current tax assessment or most recent group certificate with your application. To assist us in approving your application, please include your most recent pay slip, current tax assessment ) YO U R A D D I T I O N A L C A R D (O P T I O N A Lor most recent group certificate with your application.
� � The Primary Cardholder is responsible for all debts incurred by the Additional Cardholder. The Additional Card may be cancelled at any time by phoning Citibank.
First name Middle name Surname date of birth
The cancellation may not be effective until the Additional Card is surrendered or the Primary Cardholder has taken all reasonable steps to have the Additional Card returned to The Primary Cardholder is responsible for all debts years of age. Citibank. Additional Cardholder must be at least 16 incurred by the Additional Cardholder. The Additional Card may be cancelled at any time by phoning Citibank. The cancellation may not be effective until the Additional Card is surrendered or the Primary Cardholder has taken all reasonable steps to have the Additional Card returned to Citibank. Additional Cardholder must be at least 16 years of age. A N C E T R A N S F E R A U T H O R I S AT I O N BAL
Additional (O P T I O N I confirm the identity of, and apply for an Additional Card inU R name of: I O N A L C A R D Cardholder’s A L ) Signature of Additional Cardholder YO the A D D I T date of birth First name identity of, and apply forname Surname Middle an Additional Card in the name of: Additional Cardholder’s I confirm the Signature of Additional Cardholder
B A (ABN 88 T 325 080 AFSL A 238098) I transfer N Accounts to be transferred. I authorise Citibank Pty LimitedL A N C E004R A N S F E R No.U T H O RtoS AT I Othe following amounts from my nominated account to my
Accounts to be transferred. I authorise Citibank Pty Limited (ABN 88 004 325 080 AFSL No. 238098) to transfer the following amounts from my nominated account to my Amount to be transferred Account name Type of cheque/s as directed in accordance with the Declaration and Balance Transfer Terms and Conditions (over page). Citibank Credit Card Account or the following card/account ($ value must be specified-minimum $500) (eg. Mrs A.B. Smith) (eg. ANZ Frequent Flyer Visa) Card/Account number Amount to be transferred Account name Type of card/account $ 1. (eg. Mrs A.B. Smith) ($ value must be specified-minimum $500) (eg. ANZ Frequent Flyer Visa) Card/Account number 1. Name and address of issuing organisation 2. Name and address of issuing organisation 2. Name and address of issuing organisation 3. Name and address of issuing organisation 3. Name and address of issuing organisation Name and address of issuing organisation
$ $ $ $ $ Citibank Credit Card Account or the following cheque/s as directed in accordance with the Declaration and Balance Transfer Terms and Conditions (over page).
TOTAL AMOUNT TO BE TRANSFERRED TLP59N1 Please note that, subject to your acceptance you will be billed at a later date an annual account fee which is currently $69TO BE TRANSFERRED $19 for an Additional Card. Allow up to TOTAL AMOUNT for the Primary Card, and TLP59N1 to process your Application subject to verification. Citibank may check employment details/income with your employer or accountant named above. Income of $20,000 p.a. 15 working days
required for that, subject toCard. Upon approval of your Credit at a laterwill notify you ofaccount meet the “100 Point Identification Check” as required $19 FederalAdditional Card. Allow up to Please note the Cash Back your acceptance you will be billed Card we date an annual how to fee which is currently $69 for the Primary Card, and by for an legislation. Existing Citibank Credit Cardholders are not eligible to apply for this introductory offer. Ready Creditcheck employment details/income with your employer or accountant named above. Income of $20,000 p.a. MCG 6165 10/05 15 working days to process your Application subject to verification. Citibank may Customers are subject to Citibank credit criteria. required for the Cash Back Card. Upon approval of your Credit Card we will notify you of how to meet the “100 Point Identification Check” as required by Federal legislation. Existing Citibank Credit Cardholders are not eligible to apply for this fax completedReady Credit Customers are subject to Citibank creditFax this end first criteria. MCG 6165 10/05 Please introductory offer. application to 1300 301 304
Please fax completed application to 1300 301 304
Fax this end first
ELECTRONIC COMMUNICATIONS CONSENT
1. You consent to Citigroup Pty Limited (‘us”) communicating electronically with you about the account(s) you nominate and authorise us to act on instructions it has received electronically. This consent and authority will apply to all communications permitted to take place electronically by law (including any applicable industry Code or Code of Conduct) including but not limited to: (a) statements of your account; (b) notices and other documents from us to you about your account; (c) variations to the contract relating to your account; and (d) notices from you to us. 2. We will rely on this consent to communicate with you by: (a) electronic mail to the e-mail address that you have notified to us; (b) making a notice or other document available for you to access on our website; (c) any other method of electronic communication; and/or (d) ordinary mail to the address on our records. 3. By giving this consent, we are no longer required to send you notices or other documents in paper form for the account. 4. You must ensure that: (a) you check your email regularly for notices and other communication from us; (b) your email address remains current (or otherwise notified to us); and (c) emails from us to your email address are not blocked. 5. We rely on you to keep your nominated e-mail or physical (street) address details up-to-date and to notify us when they change. 6. Providing you with electronic statements does not alter your obligations under any terms and conditions of the account. You should print and save a copy of any notice or other document provided to you electronically. You are responsible for ensuring that you maintain the appropriate software and hardware, including printer, to access, view, retrieve, print and save a copy of such documents. To see and keep the information subject to this consent, you will need a web browser that meets our site security requirements. If you are a PC user, you will need Netscape Communicator/Navigator 4.06 (or higher) or Microsoft Internet Explorer 4.0 (or higher). You can go back to receiving paper notices and other documents contacting us via CitiPhone Banking on 13 24 84. If you decide to return to paper notices and other documents, you are asking to receive those documents on paper, delivered by post to your nominated street address.
PRIVACY CONSENT
By signing this application form, you consent as follows. In this section, ‘We/us’ means Citigroup Pty Limited (“Citibank”) and ‘you/your’ means all borrowers named in this application. Personal information and credit information 1. We collect your personal information to assess this application and to manage and administer the credit facility and related services. If you do not provide us with the information we ask for or the information provided is incorrect or incomplete, we may not be able to assess your application or provide or administer the products or services that you are seeking. 2. To provide you with products and services and manage your account and relationship with us, we share your personal information with other Citibank affiliates, sales agents and other parties below. If you have applied for a credit card facility, we will also share your information with other entities and organisations involved in any Citibank Rewards Programme. 3. We obtain your personal credit and commercial credit information from a credit reporting agency or other organisation that provides personal credit and commercial credit information. 4. We may give or obtain your personal information, including your personal credit or commercial credit information, about your credit worthiness, credit standing, credit history or credit capacity with: (a) other credit providers; (b) any signatory to the facility for which you are applying; (c) any broker, financial, legal or other adviser acting in connection with your facility or application;(d) a credit reporting agency or other business or other organisation that provides personal credit or commercial credit information (Information that we provide may include: (a) your identity particulars; (b) (for borrower only) you have applied for personal or commercial credit and the amount; Citibank is your current credit provider; your payments are overdue by more than 60 days and collection action has commenced; payments are no longer overdue (borrower only); cheques for $100 or more that you have drawn have been dishonoured more than once; in Citibank’s opinion you have committed a serious credit infringement; credit provided to me/us has been discharged); e) any insurer relating to your facility including consumer credit insurance to arrange and administer consumer credit insurance or any trade insurer for any purpose relating to an application for commercial credit; any person in connection with funding financial accommodation by securitisation; (f) organisations wishing to acquire an interest in any part of Citibank’s business for assessing any proposed acquisition; and(g) organisations that carry out functions on our behalf including mailing houses, data processors, researchers and collection agents, some of which may be located outside Australia. 5. We may use your personal credit and commercial credit information: (a) to assess an application for credit; (b) to assess an applicant or guarantor; (c) to assist in avoiding any defaults under any credit obligations; (d) to tell other credit providers about defaults made by me/us; (e) to assess your credit worthiness. 6. You can view the Citibank Privacy Policy on our website www.citibank.com.au or attain a copy by calling us on 13 24 84. You can access your personal information we hold by contacting us on the number above. A charge may apply for this access.
PRIVACY PREFERENCE
Citibank, Citi affiliate companies, Diners Club and their partners may use your information to keep you informed about other products, services and offers which may be of interest to you. Citi and Diners operate in several different lines of business including banking, credit cards, consumer finance, securities, and insurance. If you do not wish these communications to be made to you please notify Citibank in writing or by telephone on 13 24 84 *Important note: If you have indicated that you wish to receive these communications by phone, you may be contacted even if you have registered your phone number on any governmental do not call register. Verification By submitting this application you acknowledge that these acknowledgements and consents remain in force until the product(s) or facility(ies) to which they relate is/are at an end. Call recording Your telephone calls and conversations with a Citibank representative may be recorded and monitored for quality, training and verification purposes.
BALANCE TRANSFER TERMS & CONDITIONS
1. Each Balance Transfer (BT) must be for at least $500. BTs from your Account to any other Citibank account are excluded, as are foreign currency BTs and BTs to offshore accounts. 2. Citibank will transfer the BTs specified by you, in the order nominated [overleaf/above/below], in their full amounts, as determined by Citibank and your available Credit Limit. Citibank will contact you should your BT request exceed your available credit limit, in order to receive further instruction. In this event Citibank will be unable to process your request until further instructions are received. 3. BTs are repaid first and are treated as a Special Promotion under your Account Terms and Conditions. BTs will attract interest from the day of transfer. 4. Only one BT request form will be processed on any Account. 5. Subject to paragraph 2, Citibank reserves the right to refuse any request for a BT, for the full or part amount. 6. BTs will not be processed until you have activated your Account. Please allow 10 days from the date your Account is activated. Delays may occur in processing BTs, so it is vital you continue making payments on your other accounts, in ordance with those accounts’ terms and conditions. Citibank will not be responsible for any overdue payments or interest incurred on any other accounts. Any remaining balance after the BT will be your responsibility.
BALANCE TRANSFER DECLARATION
If I have completed the Balance Transfer (BT) section on the front of this form, I authorise Citibank to process this request and advance funds by cheque. I confirm that I have read and agree to the Balance Transfer Terms and Conditions above.
For faster processing, fax your completed form today to 1300 301 304. If you have requested a PhotoCard or prefer to mail your form, please send, no stamp required, to: Citibank Card Services, Reply Paid 1625, Sydney NSW 2001.