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					                                        Share the powerful benefits of your
                                    Citibank Credit Card with your loved ones
1                      CITIBANK SUPPLEMENTARY CARD FORM                                                                            2                      CITIBANK SUPPLEMENTARY CARD FORM
    Dear Cardmember,                                                                                                                   Dear Cardmember,
    We are pleased to offer you upto three Supplementary Cards for your spouse,                                                        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                                                    parents, brothers, sisters or children over 18 years. Please provide us details
    of your family member:                                                                                                             of your family member:

    Name of Supplementary Card Applicant: (As it appears in the CPR/Passport)                                                          Name of Supplementary Card Applicant: (As it appears in the CPR/Passport)
    PLEASE USE CAPITAL LETTERS                                                                                                         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                                                                        Name: Your name as you would like it to appear on your Card
                (leave one space between names and underline surname)                                                                              (leave one space between names and underline surname)
    PLEASE USE CAPITAL LETTERS (19 CHARACTERS)                                                                                         PLEASE USE CAPITAL LETTERS (19 CHARACTERS)



    Relationship:                                                            Sex:        Male               Female                     Relationship:                                                            Sex:        Male               Female

    Date of Birth:                                                          Occupation                                                 Date of Birth:                                                          Occupation
                               DD             MM              YY                                                                                                  DD             MM              YY

    Mother's maiden name:                                                                                                              Mother's maiden name:
    (This is a security feature for your protection)                                                                                   (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           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               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.                      against Citibank N.A. in respect thereto. As an acceptance of the above, I hereby include my signature below.




                    Signature of                                                                                                                       Signature of
             Supplementary Card applicant                                                                                                       Supplementary Card applicant



                                                                                 Attach passport size photo                                                                                                         Attach passport size photo
                                                                                         in the box                                                                                                                         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       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                  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              special facility, continuation of the membership of the Supplementary Cardmember will be dependent on continuation of
    your membership.                                                                                                                   your membership.

                              PLEASE SIGN THIS AUTHORIZATION                                                                                                     PLEASE SIGN THIS AUTHORIZATION
    I hereby apply for the issue of a Citibank Supplementary Credit Card and declare that the information provided on this             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           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               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               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.                                                                                  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                 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               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          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.                                         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             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                    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                          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               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              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.                                                               presented to Citibank N.A. will remain the property of Citibank N.A.


                                                                                   Annual Supplementary Card Fees (BD)                                                                                                Annual Supplementary Card Fees (BD)
                                                                                        Gold           Free for the first year                                                                                            Gold            Free for the first year
                                                                                        Silver         Free for the first year                                                                                            Silver          Free for the first year




     Basic applicant's signature                                Supplementary applicant's signature                                     Basic applicant's signature                                Supplementary applicant's signature


    Basic Cardmember's Card Number                                                                                                     Basic Cardmember's Card Number




    Citibank Credit Cards. The Best Way to Pay.

				
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posted:12/2/2008
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