Customer Authorization Form

Please complete all required fields. Fields marked with * are mandatory.

Important: Ensure all customer information is entered exactly as per official documents. Any errors may result in application delay or rejection.

Application Details *

APPLICATION DATE *

STAFF NAME *

TL NAME *

SEGMENT *

CARD CATEGORY *

PRODUCT TYPE*

Personal Details

CUSTOMER FULL NAME (AS PER PASSPORT) *

NAME ON CARD (24 CHARACTERS MAX) *

Mobile Number *

Date of Birth *

Passport Number *

EMIRATES ID *

PERSONAL EMAIL *

Residence Details

VILLA / APARTMENT NO *

BUILDING / COMPOUND NAME *

STREET NAME *

AREA NAME *

EMIRATE NAME *

LANDMARK *

MOBILE 2 *

PO BOX *

ACCOMMODATION TYPE *

ACCOMMODATION PROPERTY TYPE *

Work Details

COMPANY NAME *

OFFICE / SHOP / WAREHOUSE NO *

BUILDING / COMPOUND NAME *

STREET NAME *

AREA NAME *

EMIRATE NAME *

LANDMARK *

OFFICE LANDLINE NUMBER *

CUSTOMER OFFICIAL EMAIL *

HR EMAIL ID *

COMPANY PO BOX *

DATE OF JOINING *

Customer Bank Details

BANK NAME *

IBAN *

ACCOUNT NUMBER *

SALARY (AED) *

Additional Information

FAMILY IN UAE *

MARITAL STATUS *

EMPLOYMENT TYPE *

NUMBER OF DEPENDANTS *

Home Country Address (Expats Only)

HOUSE / APARTMENT NO *

BUILDING / COMPOUND NAME *

STREET / AREA NAME *

LANDMARK *

CITY *

COUNTRY *

PHONE NUMBER (WITH COUNTRY CODE) *

Reference Details in UAE

Reference 1 Optional

FULL NAME (FIRST & LAST)

MOBILE NUMBER

Reference 2 Optional

FULL NAME (FIRST & LAST)

MOBILE NUMBER

Supplementary Card Details (Optional)

Supplementary Card 1 Optional

FULL NAME (FIRST & LAST)

MOBILE NUMBER

CREDIT LIMIT

RELATIONSHIP

Supplementary Card 2 Optional

FULL NAME (FIRST & LAST)

MOBILE NUMBER

CREDIT LIMIT

RELATIONSHIP

Document Attachments

File Size Limit: Photos (camera/gallery): up to 10 MB. PDF documents: up to 2 MB. Ensure documents are clear and fully visible before uploading.

Attach Customer Original EID (Front & Back) *

PDF or Photo

Choose File No file chosen

Attach Visa *

PDF or Photo

Choose File No file chosen

Attach Passport

PDF or Photo

Choose File No file chosen

Attach 3 months Payslip or Salary Certificate with Bank Statement

PDF or Photo

Choose File No file chosen

Attach Latest 3 Month Bank Statement

PDF or Photo

Choose File No file chosen

Attach Additional Document

PDF or Photo

Choose File No file chosen

Meeting Address

MEETING ADDRESS *

Fill address below and also share your location using the map — both are required.

SHARE GOOGLE LOCATION *

Application Submitted!

Customer Authorization Form

Application Details *

Personal Details

Residence Details

Work Details

Customer Bank Details

Additional Information

Home Country Address (Expats Only)

Reference Details in UAE

Supplementary Card Details (Optional)

Document Attachments

Meeting Address