Form to be used for the issuing of a Visa card to an account with

Trusted Novus Bank, 76 Main Street, P.O. Box 143, Gibraltar

Client no. (max. 7 digits): ___________________________

Bank account name: ___________________________

1. Name of cardholder

☐ Mr. ☐ Mrs. ☐ Miss ☐ Ms.

Name on Card (Max 14 letters): ___________________________

2. Address of cardholder

House No. & Street Address: ___________________________

Town/City: ___________________________

Post code: ___________________________ Country: ___________________________

3. Visa card

(Please tick the relevant box; for the issuing of more than one Visa card, please complete separate application forms.)

Type of card:

☐ Visa Debit	☐ Visa Credit ☐ Visa Gold (Credit)

Card currency:

☐ GBP ☐ EUR ☐ USD

Spending limit:

GBP	EUR	USD
Visa Debit	1,500	2,500	3,000
Visa Credit	1,500	2,500	3,000
Visa Gold (Credit)	8,000	12,000	14,000

Please note: Visa Debit will be subject to a daily spending limit

Please note: Visa Credit will be subject to a monthly spending limit

Debiting account (account designated for debiting of card transactions):

Account no.: _________ - _________ - ____________

Mandatory security information

Cardholder’s mobile tel.: ___________________________

Cardholder’s email address: ___________________________

4. Cardholder’s signature / Account Holder’s signature

I/We accept and agree to be bound by the 'Visa Card Conditions of Use' as stated in the General Business Conditions and as amended from time to time.

I/We declare that all information is true and correct to the best of my/our knowledge.

Place: ___________________________ Date: _______________

Name of cardholder: ___________________________

Signature: __________________

Name(s) of account holder(s):	___________________________	Signature: __________________
___________________________	Signature: __________________

5. For office use only (Do not write below this line)

Approved by:	___________________________
Type of card approved:	☐ Visa Debit ☐ Visa Credit ☐ Visa Gold (Credit)

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