The TSB Bank American Express Gold Credit Card Application Form Note: Your application cannot be processed unless sections 1-5 and 9 are fully completed. 1 Personal Details 5 Other Credit Details YES, I am over 18 years of age YES, I have a good credit history* Issuer of Most Frequently Used Card (e.g. Bank, not American Express or Store Card) YES, I earn more than $35,000 p.a. YES, I have a regular source of income Card Type Diners MasterCard Visa Other: *American Express reserves the right to decline applicants who do not satisfy credit approval and income criteria. Mr / Mrs / Ms / Miss First Name Middle Initial Current Credit Limit of Most Frequently Used Card $ Surname Current Outstanding on Most Frequently Used Card $ Preferred name on the Card (maximum 20 characters). Additional Benefits 6 Membership Rewards® Programme Tick one box only. Date of Birth D D / M M / Y Y Either Membership Rewards MR: BØØ1ØØ12 Are you an American Express Cardmember? Present Former Never Fees apply and will appear on your first statement. Please do not send any money now. See Declaration overleaf for details. If you already hold or have held an American Express Card, please give the Account Number. OR Membership Rewards with TurboTM MR: BØØ1ØØ13 Fees apply and will appear on your first statement. Please do not send any money now. See Declaration overleaf for details. 3 7 Note: if you do not tick one of the options above, you will not be enrolled in Membership Rewards. Tick if you would like to cancel your existing American Express Credit Card and have the balance transferred to your new Card upon approval. You will also need to transfer any automatic payments (direct debits and 7 Additional/Supplementary Card with no Annual Card Fee recurring billings) and any Cash Advance facilities to your new account. Additional Card Name of friend or relative Would you like an Additional TSB Bank American Express Gold Credit Card to separate business and personal expenditure with no not living with you (living in NZ) Annual Card Fee (The letters “A/C” will be printed after your name on this card). Yes! Please send me an Additional TSB Bank American Express Gold Credit Card. Relationship Phone No. ( ) Supplementary Cardmember Give members of your family or close friends over the age of 18 a Supplementary Credit Card. The Basic Card Applicant has known the Supplementary Card Applicant for: 2 Confirmation of Identity 6-12 Months 12 Months or more For your security and to meet legal requirements, we need to verify the identity of all Cardmembers. To assist in this process we require your NZ Driver’s Licence Number and/or Car Registration number if held. Mr / Mrs / Ms / Miss First Name Middle Initial Surname NZ Driver’s Licence No. (Field 5a on your Licence) (Field 5b) Residential Street Address Car Registration No. Suburb Note: Your NZ Driver’s Licence No. and Car Registration No. will be verified with the LTNZ for confirmation of identity. Please note, American Express may need to contact you to gather additional information to verify your identity. Postcode City (required) 3 Address/Contact Details (PO Box not acceptable. Postcode required) Home Phone No. ( ) Please print how you would like your name to appear on the Card (max 20 characters). Home Street Address Suburb Date of Birth D D / M M / Y Y Postcode City (required) NZ Driver’s Licence No. (Field 5a on your Licence) (Field 5b) Residential Status Rent Own Mortgage Live with parents Time There Y Y / M M Car Registration No. Note: Your NZ Driver’s Licence No. and Car Registration No. will be verified with the LTNZ for confirmation of identity. Home Phone No. ( ) Mobile Phone No. Relationship to If you wish to receive important information about your Account, product offers and service updates from us via email, please Basic Card Applicant provide your email address below. Email 8 Transfer another credit card balance at 8.99% p.a. for six months1 Upon approval of my Credit Card please transfer $ 4 Professional Details (minimum amount $100) Cardholder’s Name Employed Self Employed Retired (as shown on your credit card) Name of Employer or Credit Card Account Number if Self Employed, Trading Name Occupation Credit Card Issuing Co/Bank Industry Card Type MasterCard Visa BT: DH81-P CP:30606 Current Work Address 9 Please Sign Suburb By signing below, I/We acknowledge that I/We have read and agreed to the Declaration overleaf. Postcode I authorise my accountant or employer to give information to American Express to confirm my address / employment / income and I City (required) Phone No. ( ) understand a copy of this authorisation may be given for that purpose. Basic Card Applicant’s Signature Gross Annual Income $ Time in Current Job Y Y / M M Include income from all sources, e.g: trusts, dividends. ✘ Date / / Name of Accountant Supplementary Card Applicant’s Signature Phone No. ( ) ✘ Date / / For Office Use Only Please fill in the form and post to American Express International (NZ), Inc. Freepost 1588, PO Box 2285, Auckland 1015, or fax to: 0800 372 458 Basic TSB No: PCT: 451R6LØØGP URN: SC: CIDB: CIDS1: Del: Nor Prod: 171 Cnty: 884 Proc: 3 Fee: 2 Bill: A Rev: Supp TSB No: TSB GOLD DM 06/08 1. See Balance Transfer Section on Declaration overleaf. DECLARATION Important: The Basic Card Applicant and each Supplementary Card Applicant must read the information and sign overleaf. To American Express International (NZ), Inc: • Seek from and exchange personal information with the organisation and TRANSFERS FROM A NEW ZEALAND ISSUED AMERICAN EXPRESS By signing on the previous page, I the Basic Card Applicant request you to issue credit providers named in this application or in a credit report issued by a CREDIT CARD. me with the Credit Card(s) specified in the application, and I declare that: credit reporting agency. If requested, your existing American Express Credit Card Credit Card will be • the information I have given on my application is true and complete and I This is for purposes including but not limited to: cancelled on approval of this application. Any outstanding balances, including authorise you to check that information. I acknowledge that you rely on - assessing my credit worthiness, this application and any subsequent previous balance transfers on the existing Credit Card will be transferred to this information to consider my application; application by me for credit; the new Credit Card. From the date of transfer, these balances will attract the • I am financially solvent and able to pay all my debts as they fall due; standard interest rate applicable to the new Credit Card. Any promotional - notifying other credit providers of a default by me; Balance Transfer interest rate will not apply to these balances. • if my application is approved, I will comply with the Card Conditions and - exchanging information about my Card Account where I am in default; Financial Table that you will send me with the Credit Card and will pay all - your approval process as to any transactions I wish to make with the fees and charges referred to in the Financial Table; BALANCE TRANSFER(S) Card; and The promotional rate specified commences from the date the balance transfer • if I already hold an American Express Credit Card you can cancel this Card - your administration of my Account. and transfer the balance to the new Credit Card specified on this is approved. All payments to your Credit Card Account will first reduce the application upon approval; • Exchange personal information with any person whose name I give you amount of your balance transfer, before reducing other outstanding amounts, from time to time. This includes, for example, for the purpose of such as new purchases. Minimum payment requirements of the Card Account • I understand and agree that I will be liable for all charges on the Basic confirming my employment and income details with any employer, also apply to balance transfers (refer to the American Express Credit Card Credit Card, all Supplementary Credit Cards and any Additional Cards. This landlord/mortgagee, accountant, financial adviser or tax agent named in Terms and Conditions). There are no interest free days on balance transfers. includes charges incurred at any time until each Card is cut in half and this application. Subject to any specific promotional offer, balance transfers are not eligible for returned to American Express and no longer used; Membership Rewards® points. • If I am in default under my Card Account, notify and exchange personal • I acknowledge that TSB Bank Ltd is in receipt of commission for the information with your collection agent. provision of this Card and its usage. After 6 months, the rate will change to the interest rate for purchases at that time. • Exchange personal information with the organisation for marketing, • you may produce this application or a copy or other reproduction of it as planning, product development and informational purposes including for evidence of my application for the Credit Card and my agreement to this These Balance Transfer Conditions shall form part of the Credit Card the administration of a rewards programme, if any. Declaration. Conditions governing the use of the Credit Card and shall be read • Use personal information for marketing purposes. This includes putting accordingly. my name and contact details on marketing lists for the purposes of PRIVACY AND PERSONAL INFORMATION customer research and offering me goods or services of an American In this section ‘personal information’ means information about you and any Express company or of any third party acting on behalf of American Restrictions on transfers of other card balances: Supplementary Card Applicant, including financial circumstances, credit Express, by mail, email or telephone or having your related companies do • We reserve the right to refuse any balance transfer request. worthiness, credit history, credit standing, credit capacity, use of the Card and so directly. After approval of this application, I understand that I can call • You can make up to 12 balance transfers in a 12-month-period. conduct of the Account and 'organisation' means the organisation, if any, 0800 333 151 to remove my name from your marketing lists. I • The minimum balance transfer amount we accept is $100. whose name, logo or trademark appears on your application or on the Card acknowledge my request may take 6-8 weeks to be processed. • We can only accept balance transfers from cards issued in New Zealand. issued to you. • Transfer personal information confidentially to your related companies • We can not accept balance transfers from, by way of example but not To confirm your identity and the identity of any Supplementary Card and other organisations which issue or service American Express Cards or limited to: Applicants, and to assess your application, and, if it is approved, to establish provide services to you, subject to appropriate conditions of and manage your Card Account, American Express International (NZ),Inc. confidentiality. This includes transferring personal information to the USA - other American Express Card Accounts, including Line of Credit needs to: Accounts (except at the discretion of American Express); or or other countries for data processing and servicing. • collect personal information about you and any Supplementary Card - store cards; or • Monitor and record my telephone conversations with you from time to Applicants in this application form and from other sources, and time for training, quality control or verification purposes. - Diners Club Card; or • obtain your agreement and the agreement of any Supplementary Card - a card account that is in overdue status or the outstanding balance on Applicants in relation to using this personal information. that card has reached or exceeded 95% of its credit limit. I also agree that where I have provided you with information about another If you or any Supplementary Card Applicants do not provide the individual in this application form, I will make sure that the individual is • We will not process balance transfer requests: information requested or give your agreement below, we may decline your aware of: - if at the time of the request you have drawn the maximum Cash application. Advance permitted on your American Express Credit Card Account; or • My supplying their information to you and the purposes why you have collected the information. - if your American Express Card Account(s) is/are not in good standing 1. Basic Card Applicant • Their ability to access that information in accordance with the Privacy Act or in overdue or over limit status. I agree that, subject to the Privacy Act, you and your agents may do the following (and to advise you if they think the information is inaccurate, incomplete (and provided my application is approved, this agreement continues until such or out-of-date). Conditions applying once a balance is transferred: time as the Account is closed and any credit provided to me is repaid): • The contact details of your Privacy Officer. • You must continue to make payments to any card account from which you • Obtain credit reports about me from credit reporting agencies to confirm transfer a balance until you receive a statement confirming that the my identity and to assess my application or to collect overdue payments account has been credited. We will not be liable for any overdue payment from me, and from a business that provides commercial credit worthiness 2. Supplementary Card Applicant or interest incurred. information. I agree that, subject to the Privacy Act, you and your agents may do the • We will charge interest on any balance transferred at the applicable • Verify with the LTNZ, driver's licence and car registration information following (and providing this application is approved, this agreement Annual Percentage Rate on a daily basis from the date your balance provided by me. continues until such time as the Account is closed and any credit is repaid): transfer is approved until you repay the transferred amount in full. • Disclose personal information to credit reporting agencies and the • obtain credit reports about me from credit reporting agencies to confirm • If an increase in your credit limit is required to complete your balance organisation before, during or after providing credit to me. This includes, my identity and to assess this application, and from a business that transfer, you request us to make an increase by up to 50% of your current but is not limited to: provides commercial credit worthiness information; and credit limit (unless a specific increase offer is made by us). Any increase - the fact that I have applied for a Card and the credit limit, and that you • verify with the LTNZ, drivers licence and car registration information will be subject to a review of your Account and we reserve the right to are a credit provider to me; provided by me. decline your balance transfer application should we decide not to increase - advice about Card payments which are in collection (and advice that your limit. Any increase will be advised on your statement and will be payments are no longer overdue); Contacting our Privacy Officer rounded up to the nearest $100. - advice that cheque(s) drawn by me, or direct debit requests to my In accordance with the Privacy Act, you can access personal information bank account which I have authorised you to make have been about you held by us, and advise if you think it is inaccurate, incomplete or Please note: dishonoured; out-of-date. • Payments to other credit card issuer(s) will normally be completed within - your opinion that I do not intend to meet my credit obligations; To arrange access to personal information about you, or enquire generally 14 working days from approval of your Card Account. We will advise when - that credit provided to me has been paid or otherwise discharged; and about privacy matters, write to – The Privacy Officer, American Express the payment is sent. - sharing my Card application and whether it was successful. International (NZ), Inc., PO Box 4005, Shortland Street, Auckland 1140. AMERICAN EXPRESS MEMBERSHIP REWARDS® PROGRAMME your Account is in good standing. A fee may be applicable for participation with Corporate Cards, PGG Wrightson American Express Card, ProPharma Enrolment and participation in Membership Rewards is subject to the in partner airline programmes. A transfer fee of $35 per transfer of points to Gold Business Card, Allied Liquor American Express Gold Business Card, Membership Rewards Terms and Conditions and partner terms and one of our airline partner programmes will apply. Tasman Liquor American Express Gold Business Card, Low Interest Gold conditions. An annual $50 Membership Rewards fee applies. Only purchases An annual $99 Turbo fee applies and is in addition to the standard annual Credit Card, American Express Platinum Card, American Express Platinum are eligible for Membership Rewards points - balance transfers and cash Membership Rewards, transfer and Card fees. You will earn 2 Membership Membership Rewards Credit Card and any Card linked to either type of advances are ineligible. Membership Rewards points do not expire while Rewards points for every $1 you spend on your Card. Turbo is not available Platinum Card. ANNUAL CARD FEES A $90 Annual Card fee applies for the basic TSB Bank American Express Gold Credit Card after the first year. TSB Bank American Express Gold Credit Card members are eligible for Supplementary Cards and Additional Cards with no Annual Card Fees. The introductory interest rate for purchases and other charges on the TSB Bank American Express Gold Credit Card is 13.95% p.a. for the first six months. After six months the interest rate will change to the standard interest rate of 20.45% p.a. as at 1 July 2008. This offer is valid until 31 Decomber 2008. RETURN SIGNED FORM EITHER BY: • post to American Express International (NZ), Inc. Freepost 1588 (no postage required), PO Box 2285, Shortland Street, Auckland 1140 or • fax to 0800 372 458. www.americanexpress.co.nz American Express International (NZ), Inc. Incorporated in Delaware, USA. Principal Place of Business in New Zealand, 600 Great South Road, Ellerslie, Auckland, 1051. ®Registered trademark of American Express Company.