First name......................................................Middle name.......................................................
Last name..................................................................................................................................
Name on card (as in your passport)
Name
Last name
Former name (if any)........................................................................................................
Former last name (if any)..........................................................................................................
Sex
Male
Female Date of birth
Age..........................years Nationality..........................
ID no/Passport no. ...........................................................................Expiry date.......................
Education
High school
Vocational
Certificate/Diploma
Bachelor’s degree
Master’s degree
Other, please specify..............................
Marital status
Married, name - last name of spouse....................................................
Single
Divorced
Widowed No. of dependants...........................
1 9
Name of company......................................................................................................................
Occupation/job title............................................................Years there............YY............MM
Office address.............Moo.............Building....................................................Floor...............
Department....................................Soi......................................Road........................................
Kwaeng.....................................District..................................Province.....................................
Post code
Office tel. ..........................................Ext. ...............Fax number..........................................
Business type
If you have been in your current job for less than 4 months, please state your previous employer
DD - MM - YYYY
Home address.............Moo.............Village/Apartment.....................................(Room..........)
Soi........................................Road.........................................Kwaeng.......................................
District.................................Province....................................Post code
Home tel. ............................Mobile tel. ................................E-mail.........................................
Time at present address.......................YY......................MM
Rented....................Baht/month
Mortgage under my name, monthly mortgage payment.....................Baht
Fully owned under my name With parents Company quarters
Permanent address*...............Moo............Village/Apartment.................................................
Soi........................................Road.........................................Kwaeng.....................................
District................................ Province....................................Post code
*For Thai nationals, permanent address must be same as the one in house registration only.
Your personal information
Address
Your employment details
Full name......................................................Relationship.........................................................
Home address.............Moo.............Village/Apartment............................................................
Soi........................................Road.........................................Kweang.......................................
District................................ Province....................................Post code
Home tel. .................................................................................................................................
Your personal reference (Person with telephone number and address that can be contacted)
I acknowedge that any transactions using the credit card related to the accounts mentioned above are correct and
binding upon me. I will be solely liable for any misuse of the card.
Account holder’s name.....................................................................................................
Account number...............................................................................................................
Account holder’s name.....................................................................................................
Account number...............................................................................................................
1
2
Bank name
Account type
Account number
Years with the bank
Credit card
Card number
Visa
MasterCard
American Express
Other...........................
Card delivery and billing address
Home
Office
Credit
limit (Baht)*
Member
since
*This information is crucial for credit card’s approval
Cash/Cheque Direct debit your account with HSBC in Thailand. Type of account:
HSBC Premier
Savings
Current
Account holder’s name.............................................................................................................
Account number
You may withdraw from your HSBC Thailand via ATM with HSBC credit card.
.......................................................................................................Account holder’s signature
.......................................................................................................Account holder’s signature
HSBC Premier
Savings
Current
HSBC credit cards