Form ID:: Card Type
Form ID:: Card Type
Card Type
Corporate Business Individual
(GST Invoice is applicable)
Basic Information
Name*:
NTN Number: - CNIC/Sales Tax Number*:
Gender*: Male Female ` Mother’s Maiden Name (as per NADRA record):________________________________
Date Of Birth*: D D / M M / Y Y Y Y
Occupation/Industry/Sector: _________________________________________________________________________________________
Contact Information
Residence Address*:_____________________________________________________________________________________________________
Office Address:_____________________________________________________________________________________________________
Email:____________________________________________________ Fax:
I want to subscribe SMS Alerts: Please select the frequency of alerts (Select One): Day-End Transaction-wise Weekly Monthly
Schedule Charges plus taxes will be applicable
I want to subscribe NFR Products (Non-Retail Fuel Products e.g. Lubricant, Tuck Shop, Tyre Shop & Lube Xpert): Yes No
Schedule Charges plus taxes will be applicable
__________________________
Authorized Signatory*
CNIC No.* - -
Vehicle No.*:
Card Limit Information
How would you like to set your Attock Smart Fuel Card Limits? Quantity Amount
Please fill the below table in accordance with your selection for the above question; (that is, setting limits in either Amount or Quantity)
(By default, your card will be acceptable at all retail outlets of Attock Petroleum Limited)
__________________________
CNIC No.* - -
Authorized Signatory*
Note:
Declaration
The Card applicant is requested to kindly read the following clauses before completing this application.
1. By signing below, the applicant acknowledge that he/she/company is responsible for payment of all charges and liabilities
billed by APL in the statement of account.
2. The undersigned applicant confirms that the information given in this application form is complete and accurate, authorizing
APL to check with credit reporting agencies, credit references and other sources to authenticate and confirm the information
disclosed in the form.
3. The applicant agrees to abide by the terms and conditions set forth in the agreement provided with this application. Use of
any card pursuant to this application confirms that applicant’s agreement to the said terms and conditions.
4. The applicant agrees that in the event the outstanding amount is not paid as agreed, APL may report the undersigned’s liabil-
ity for the status of the account to financial institutions and credit bureaus and other who may lawfully receive such infor-
mation.
Name: Signature:
Date: D D / M M / Y Y Y Y
9. SUCCESSORS BOUND
The terms and conditions shall be binding upon the heirs, personal representatives permitted assigns and successors-in-interest of the Client / Cardholder, the successors –in-title and
assigns of APL.
__________________________
Authorized Signatory*
CNIC No.* - -