• 
Preferred Card Type :
Do you wish to access your Credit Card Account online ?
     
• 
Title :
Postal code:
  Other, please specify :     *
 
Name in full :
 
Duration at the above address :
  *    
• 
Name to appear on card :
 
Telephone No. :
  *     Home : Mobile:
• 
Date of birth :
  • 
Emergency contact telephone No:
     
• 
Sex :
  • 
Correspondence address:
      (All your correspondence including your monthly statements will be delivered to this address)
• 
Marital status :
     
 
Single Married Divorced Widowed
    *
• 
Nationality
   
     
• 
Number of dependants :
  •  Postal code:
     
•  NIC No:   •  E-mail Address:
  *      
•  Passport No:   •  Mother's maiden name:
      *
•  Details of your residence:   •  Deatils of a relative not living with you:
      Name:
  Other, please specify :    
    •  Relationship:
  Monthly mortgage/rental :    
      Home Address:
• 
Education :
    (line1)
      (line2)
  Other, please specify :     (line3)
• 
Your Qualifications :
  •  Employed at: as
  *   •  Telephone No:
• 
Home address :
    (Home) (Office)
  *     (Mobile)
       
       
         
  Fields denoted by * are mandatory      
•  Employment status : •  Previous employment details
If the duration of your current employment is less than six months:
  Other, please specify     Name of previous employer :
•  Occupation :    
  *   •  Address
•  Designation :     (line1)
  *     (line2)
•  Employer/Business name :     (line3)
  *   •  Telephone No.:
•  Address :    
  *   •  Designation :
     
    •  Annual salary :
•  Telephone No.: (Office)    
  Ext.:   •  Length of service :
•  Nature of business :    
       
  Other, please specify     If self-employed:
•  Length of service at current employment :   •  Name of business :
     
•  Number of years the organization has been in business :   •  Capital invested :
     
•  Number of employees :   •  Annual turnover :
     
             
  Fields denoted by * are mandatory          
•  Your monthly income
  Basic salary :
  *
  Fixed allowances :
   
  Other income :
 
  Sources :
 
   
•  Your assets and liabilities :
  Please provide the total market value of each of the following, where applicable.
  Total Fixed/Call Deposits Rs:
 
  Shares/Debentures Rs:
 
  Properties Rs:
 
  Other, please specify
 
  Do you have a vehicle?
  If yes :
  If rented, monthly rental:
 
  Type of vehicle :
  Other, please specify
  Approximate current market value :
 
•  Details of Your Bank Account(s):
   
Name of Bank Branch : Account Number : Account Type : Duration (Months):
  •  Details of Your Overdraft(s):
   
Name of Bank Branch : Account Number : Limit Rs: Present O/S Rs :    
  •  Details of your Credit Card(s):
   
Bank Issued Card Number Credit Limit : Card Since Present O/S Rs :        
  •  Details of any Shares/Debentures you own in listed companies :
   
Company Number of Shares/Debentures : Face Value Rs: Present Market Value Rs :            
  •  Details of your loan(s)
   
Type of Loan Bank Loan Amount Rs: Installment
Rs :
Present O/S
Rs :
           
Housing loan :
Vehicle loan :
     
Fields denoted by * are mandatory    
•  Title : •  Company address :
  Other, please specify :     (line1)
•  Name in full :     (line 2)
      (line 3)
•  Monthly income :   •  Telephone No :
      Home :
•  Company :    
      Office :
•  Designation :    
      Mobile :
       
         
         
•  Do you wish to offer a supplementary card to your immediate family member? •  Employer/Business name :
     
•  Title :   •  Company address :
  Other, please specify :     (line1)
•  Name in full :     (line 2)
      (line 3)
•  Date of birth :   •  Telephone No :
      Home :
•  Sex :    
      Office :
•  NIC No. :    
      Mobile :
•  Passport No. :    
    •  Name to appear on card :
•  Nationality :    
      (Maximum 20 characters including spaces)
•  Relationship :      
       
•  Designation :      
       
•  Do you wish to settle credit card bills on the payment due date automatically, by debiting your account at Nations Trust Bank?    
       
•  If yes Account number :      
       
•  Percentage to be settled :      
       
         
 
     
         
 
         
         
         
•  Are you an existing FlySmiles Memeber?    
       
     
       
     
 
         
 
     
         
 
 
 
 
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