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ALFAMEGA American Express
Selects
Sponsorship
Blue
Green or Gold Card
Terms and Conditions
Application for American Express Card
Please read
Terms and conditions of use of American Express Cards
[
*
Mandatory Fields ]
[ PERSONAL INFORMATION ]
Title:
Mr
Mrs
Dr
Surname:
*
Fore Names:
(in full)
*
Father's Name:
Date of Birth:
(eg. 31/12/1973)
*
Identity Card Number:
*
Passport No:
(for Non Cypriots only)
Country of Issue:
(for Non Cypriots only)
Nationality:
(for Non Cypriots only)
Sex:
*
Choose Sex
Male
Female
Marital Status:
*
Choose Status
Married
Not Married
Other
Number of dependant children:
None
1
2
3
4
5
6
7
8
9
10
[ BANKING DETAILS ]
Bank:
*
Branch:
Account:
(If Other - Specify AC)
Choose Account
Current
Savings
Loan
Credit Card
Other
-
Number of accounts at the Bank of Cyprus:
Years of cooperation with the Bank:
Persons who can give reference for you:
(name/address/tel/occupation)
[ FINANCIAL STATUS - MONTHLY INCOME ]
Net Salary:
CY£
Spouse's net salary:
CY£
Other Income:
CY£
[ MONTHLY EXPENSES ]
Rent:
CY£
Loan/Finance payments:
CY£
Other Expenses:
CY£
Residence:
Choose
Owned
Rent
Other
Loans/Obligation's:
(Amount)
CY£
[ EMPLOYMENT INFORMATION ]
Occupation:
*
Employer's Name:
Employers Address:
Postal Code:
Nature of Business:
Position:
Years of Employment:
Spouse's Employer:
Spouse's Employer's Address:
[ MAIL ADDRESS ]
Residence Address:
*
Residence Postal Code:
*
E-mail Address:
*
Tick here
if you
do not
wish to receive e-mails from Bank of Cyprus
Please send my mail at:
Residence Address
Employer's Address
[ APPLY FOR DIRECT BANKING ]
Apply for Direct Banking
Signature:
......................................
Date:
.......................................
(For the Print Option ONLY)
Fill-in, print the application, sign it and send it to:
Bank of Cyprus
Card Center
97, Kyrenias Avenue,
Platy, Aglantzia
P.O Box 21472
1599 Nicosia, Cyprus
Or hand it into any Bank of Cyprus Branch
