WCredit Card Application Form - August - 2024

Please tick the card of your choice
Date: / / / / :
Mazeed Platinum Platinum Platinum Plus
PERSONAL INFORMATION
Preferred Language English
Title Mr. Mrs. Ms. Dr. / Other

First Name
Middle Name
Last Name
Mother's Maiden Name
Your name in English letters as you wish it to appear on your card: (20 characters) 20
Gender Male Female

Date of Birth Day Month Year
Marital Status Single Married No. of Dependants
Nationality Non-Saudi Saudi

ID No.
Place of issue
Date of Issue Day Month Year
Date of expiry Day Month Year
Tel. No. Mobile

E-mail Address
Masters or Bachelor's High School or
Education PhD or Diploma Lower
Hometown Address
NATIONAL ADDRESS
Residence Co. Provided Rented Owned
Street District
Additional No. Building No.
House No. City
Postal Code
EMPLOYMENT INFORMATION
Retired Self-employed Employed
Employer Job Title
Area Department
Street Years of Service
P.O. Box . City
Tel. No. Building No.
Postal Code
Please send the card and my statements to: :
Work Address National Address
INCOME INFORMATION
For Employees: :
Monthly salary and allowances
For Non-Employees: :
Total annual income
Other source(s) of income
Emirates NBD > Personal Banking > Page 3/16 EBR - 005 JANUARY 2024 V2018 16/3 < <
Source of other income
BANK ACCOUNT INFORMATION
Do you have an account with Emirates NBD? No Yes
Account Number
Other Bank (Name) ( )
Account Number
OTHER FINANCIAL INFORMATION

Do you have any other loan from another bank? No Yes
Do you have a Credit Card? No Yes If yes, how many?
Please debit my Emirates NBD Bank Account on the due date for: 5% 100% :
SUPPLEMENTARY CARD APPLICATION

Preferred Language English
Mr. Mrs. Ms. Dr. Other
Full Name
Mother's Maiden Name
Your name in English letters as you wish it to appear on your card: (20 characters) ( 20)
Gender Male Female

Date of Birth Day Month Year
Mobile Number
Relationship with Sister Brother Parent
Primary applicant Spouse Other
Nationality Non-Saudi Saudi
ID No.
What spending limit do you wish to setup for your supplementary card?
Credit limit Cash limit
Supplementary cardholder signature
MONTHLY EXPENSE DETAILS
Transportation Expense Food

Health Care Expense Housing expense (Rent) ( )
Insurance Expense Electricity, Water, and
Finance from a Relative, Friend or , Communication
Employer Domestic Labour Wages
Expected Future Costs or Education Expense
Expenses
Total
CREDIT SHIELD (Optional) ( )

I would like to enroll in the Credit Shield programme for a monthly fee of 0.49
0.49% of my outstanding balance
Yes No
PERSONAL REFERENCES
Name
Mobile .
FOR BANK USE ONLY

Promotional Code DSF/RBE Code Sourcing Channel
Bank Receipt Date Day Month Year
Final Status Date Day Month Year
Customer Signature
4.4
4.5
1
4.6
4.7
4.8
4.9
30
5
5.1
5.2
:(APR
5.3
2
2.1
6 2.2
6.1
2.3
6.2 2.4
2.5
6.3
6.4
30
4
4.1
4.2
4.3
14 6.5
6.6
6.7
11.3
7
7.1
11.4
24
24
11.5
60
180
11.6
8
8.1
1 30%
2 8.2
8.3
3
11.7
11.8
9
9.1
11.9
9.2
12 30%
12.1 9.3
10
23 5%
10.1
23
12.2
10.2
12.12
12.3
10.3
10.4
12.4
10.5
11 30
(4
11
11.1
12.5
30
12.6
12.7
Stamp and Authorised Signature Cardholder Signature

of the issuer
11.2
12.8
14.4
12.9
14.5
12.10
II I 14.6
IV III
90
14.7
12.11
14.8
14.9 12.12
13
13.1
13.2
13.3
13.4
14.10
13.5
14.11
14.12
14.13
13.6
14.14
14.15
13.7
VISA Airport Companion
13.8
1
13.9
15 1
13.10
Visa Airport Companion
15
30
13.11
(36 14.16
14.17
13.12
13.13
15
1,000 13.14
100,000 13.15
13.16
36 24 12 9 6 3 13.17
13.18
8007547777
13.19
13.20
100 13.21
14
14.1
14.2
14.3
18
15.1
18.1
30 15.2
2 1
18.2
(4 3
18.3
18.4
15.3
18.5
18.6
19 200 10%
200 5%
200 5%
20 200 5%
20.1
200 2%
0.5%
POS 15.4
Pay Chip & PIN
15.5
21 %0.5
10 21.1 15.6
21.2
30 1,000 15.7
.(14.9
21.3 15.8
14
15.9
21.4
15.10
90 21.5
21.6 15.11
15.12
21.7
100 100 15.13
10
15.14
30
21.8
16
16.1
45
69 18
.70 75 16.2
16.3
22
22.1
17
17.1
17.2
23
23.1
17.3
17.4

of the issuer 17.5
23.9
23.2
21.3
30
23.3
(GOSI
23.4
23.5
23.6
23.7
23.2
23.8
: 7 7 7 1
10 10,000 •
1 6,000 •
16,075 7 7
.( 75 + )
. 100% 5% 23
360 7 6,075 7
. *
29 3,000 . 16,117.3 , 7 2
: 7 ,
498.3 = ** 360 / 50 x 35.88% x 10,000 :( 29) ( 10) •
89.7 = ** 360 / 9 x 35.88% x 10,000 :( 7) ( 29) •
128.04 = 360 / 21 x 35.88% x 6,117.3 :( 29) ( 7) •
27.96 = 360 / 9 x 35.88% x 3,117.3 :( 7) ( 29) •
7
. **
: . 13,861.42 7 3
10 3,500 •
16 3,000 •
18 600 •
21.11 = 360 / 2 x 35.88% x 10,588.03 :( 10) ( 7) •

289.03 = 360 / 29 x 35.88% x 10,000 :( 7) ( 10) •
6.52 = 360 / 2 x 35.88% x 3,273.38 :( 10) ( 7) •
10.45 = 360 / 29 x 35.88% x 361.42 :( 7) ( 10) •
14.13 = 360 / 21 x 35.88% x 675 ( 7) ( 18) •
1,000 1,000
3.75 () < 3.75 () <
3,750 = 3.75 x 1000 < 3,750 = 3.75 x 1000 <
116.25 = 3.10% x 3,750 : < 116.25 = 3.10% x 3,750 : <
17.43 = 15% x 116.25 17.43 = 15% x 116.25
86.25 = 11.25 + 75 : < 17.43 116.25 + 3,750 : <
3,969.93 = 86.25 + 17.43 + 116.25 + 3,750 : < 3,883.68 =
/ <
/ < .
.
Example of minimum payment only*
Card Monthly Payment % Annual Interest Rate Balance
85 5% 35.88%
*if only minimum payment is made every month *
Renege Cards: If the cardholder fails to pay the Minimum Payment due in a given month, this will result
in fees and charges imposed at rates established by the bank In the initial disclosure. The bank will
also add the cardholder’s name to the delinquent list and will be reported to the Saudi Credit Bureau
(SIMAH). If the Minimum Payment Due is not paid for three consecutive months, the cardholder’s
Credit Card account will be permanently blocked.
Responsible Financing: -
.
.

of the issuer
INTERNATIONAL TAX TRANSPARENCY
–( )
Section A – Customer/Account Holder Information / -

Title: Mr. :
:
( / / )
:
( / / )
D D M M Y Y Y Y ( ):
Male :
:
)............................................................. ( ) .............................................................
( )............................................................. ( ) .............................................................
:( )
City ( )............................................................. ( ) .............................................................
)............................................................. ( ) .............................................................
( )............................................................. ( ) ............................................................. :
City ( )............................................................. ( ) .............................................................
)............................................................. ( ) .............................................................
:
( )............................................................. ( ) .............................................................
( )
City ( )............................................................. ( ) .............................................................
“ ”
( )
Section B – USA Tax Residents –
.
:
1
,(SSN) .1
2
,(ITIN) .2
3
.(ATIN) .3
:
(SSN) N N N - N N - N N N N .1
(ITIN) N N N - N N - N N N N .2
(ATIN) N N N - N N - N N N N .3
–( )
Section C – Tax Residency Information -

( ) /( )
.
1 1
2 2
3 3
If TIN is not available please choose one of the following reasons: :
/ .
.
)
:(
1: …………………….................................................………………… ........................................................................................................ :1
2: …………………….................................................………………… ........................................................................................................ :2
3: …………………….................................................………………… ....................................................................................................... :3
, ). .
Section D –Declaration and Signature –

/
/ /
( )
( )
30 ( )
30 .
( ) /
/ ( ) /
/
. /
/ ( ) /
/
. /
/
/
/
. ( )
( ) /
( )
/ /
/ /
/
/
.
Name of Signatory in Arabic
Name of Signatory in English
–( )
Capacity of Signatory: :
1 ( )
Signature
( )
Date D D M M Y Y Y Y
………………….............................................................................………………
…
To be Completed By the Relationship Manager/Customer Service Representative
( )
( /( )/ )
.
( )
U.S. Person
US Resident
( )
.
Green Card
) “ ”
.(
Born in the USA

“ ”
US Address
: .
Telephone number
. /
Standing Instructions
Hold mail address .
.
Substantial Presence Test
.
:
31 •
183 •
:
•
1/3 •
. 1/6 •
Tax Residency
. /
.
.
Tax Information Number
/ /
.
.
.
.
7001460414 – 1010191741
P.O. Box 8166, Telephone: 011 282 5555 011 282 5555 : 8166 : .
4380-12363 1 - 8152 :
www.emiratesnbd.com.sa
. 1/150 :
Tax ID Number 300000609300003 300000609300003
Initial Disclosure
Emirates NBD Credit Cards
SUMMARY OF THE CREDIT CARD AGREEMENT
CARDHOLDER INFORMATION
Cardholder Name
National ID No. or Resident Identity No. or Commercial
Registration No.
Date of Agreement D D M M Y Y Y Y
Reference No.
CREDIT CARD INFORMATION

Credit limit will appear on the account
Credit Limit (Saudi Riyals)
statement or with the new Credit Card
Foreign Currency Exchange Fee Depends on the country of transaction
Minimum Amount Due

whichever is higher
Settlement Date As mentioned in the account statement
CREDIT CARD FEES & CHARGES
Annual Percentage Rate (APR)* Platinum Platinum Plus *(APR

44.32% 45.08% 42.82% 48.07%
Annual Fee (SAR) 200 300 Free 700

Monthly Interest Rate 2.99% 2.99% 2.99% 2.99%
Late Payment Fee (SAR) 100 100 100 100
75 75 75 75
300 300 300 300

3% up to SAR 300 3% up to SAR 300 3% up to SAR 300 3% up to SAR 300
Card Replacement Fee 50 50 50 50
Dispute Fee 50 50 50 50
Credit Shield (Optional) 0.49% 0.49% 0.49% 0.49%
International Transaction Rate 3.10% 3.10% 3.10% 3.10%
Installment cancellation fee 100 100 100 100
MAJOR PROVISIONS OF THE CREDIT CARD AGREEMENT

Article
Implications of transactions in foreign (4.5) (4.5)
currency (Refer to schedule of charges)
Implications of paying the minimum amount
(12.4) (12.4)
due
Implications of default (12.8 & 12.10) (12.8 & 12.10)
Cash advance fees is applied
Consequences of cash advance/cash transfers
(Refer to schedule of charges)
Account statement errors/disputed
(11) (11)
transactions
Cash Advance Limit (8.1) (8.1)
All Charges are subject to Value Added Tax 15%. .15
*APR Calculated on Credit Limit Amount SAR 30,000 and is inclusive of VAT. .15 , 30,000 *
*APR is subject to change depending on the card’s credit limit and outstanding balance. . *
- Emirates NBD reserves the right to make changes to the above mentioned prices/fees/ -
30 .
communication at least 30 days prior to effective date. . / -
- No additional fees will be charged if due amount is paid in full prior to/on the due date. - -
- Disclaimer: Please note that this initial disclosure has been created to highlight important .
features and charges related to this product. All customers are required to read the .
Terms and Conditions and appendices found in the agreement before signing. / -
.
disclosure and have received and kept an electronic copy for my record and reference.
Stamp and Authorised Signture Cardholder Signature

of the issuer

WCredit Card Application Form - August - 2024

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WCredit Card Application Form - August - 2024

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Please tick the card of your choice

Mazeed Platinum Platinum Platinum Plus

Title Mr. Mrs. Ms. Dr. / Other

Gender Male Female

Marital Status Single Married No. of Dependants

Nationality Non-Saudi Saudi

Date of Issue Day Month Year

Date of expiry Day Month Year

Tel. No. Mobile

BANK ACCOUNT INFORMATION

Do you have an account with Emirates NBD? No Yes

Other Bank (Name) ( )

OTHER FINANCIAL INFORMATION

SUPPLEMENTARY CARD APPLICATION

Gender Male Female

MONTHLY EXPENSE DETAILS

Transportation Expense Food

CREDIT SHIELD (Optional) ( )

FOR BANK USE ONLY

Bank Receipt Date Day Month Year

Final Status Date Day Month Year

Stamp and Authorised Signature Cardholder Signature

Stamp and Authorised Signature Cardholder Signature

128.04 = 360 / 21 x 35.88% x 6,117.3 :( 29) ( 7) •

27.96 = 360 / 9 x 35.88% x 3,117.3 :( 7) ( 29) •

21.11 = 360 / 2 x 35.88% x 10,588.03 :( 10) ( 7) •

Example of minimum payment only*

Card Monthly Payment % Annual Interest Rate Balance

*if only minimum payment is made every month *

Stamp and Authorised Signature Cardholder Signature

Section A – Customer/Account Holder Information / -

Section B – USA Tax Residents –

Section C – Tax Residency Information -

If TIN is not available please choose one of the following reasons: :

Section D –Declaration and Signature –

Name of Signatory in Arabic

Name of Signatory in English

Born in the USA

Hold mail address .

CREDIT CARD INFORMATION

Minimum Amount Due

CREDIT CARD FEES & CHARGES

Annual Percentage Rate (APR)* Platinum Platinum Plus *(APR

Annual Fee (SAR) 200 300 Free 700

Late Payment Fee (SAR) 100 100 100 100

300 300 300 300

Credit Shield (Optional) 0.49% 0.49% 0.49% 0.49%

International Transaction Rate 3.10% 3.10% 3.10% 3.10%

Installment cancellation fee 100 100 100 100

MAJOR PROVISIONS OF THE CREDIT CARD AGREEMENT

Stamp and Authorised Signture Cardholder Signature

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