k-credit card application part 1 - หน้าหลัก · plastic furniture/sawmill ... for...

Residence type* House Commercial building/Townhouse Condominium/ Apartment/Dormitory Welfare residence

Own house Mortgaged/Monthly installment at Baht Parent’s house Relative/Other’s house

Welfare residence Rental residence/Monthly rent at Baht Having lived here for year(s) month(s)

Current address* Name of housing estate/Condominium Unit No. Floor

Address No. Mu Soi Road Khwaeng/Sub-district

Khet/District Province Postal code Tel. No. (Home) Mobile phone

E-mail

I would like to apply for K-eMail Statement Service to receive statements of all credit cards, including supplementary cards, via email

specified in the application form. I also acknowledge that paper statement will not be sent via postal mail henceforth.

I wish to receive paper statement via postal mail (for applicant who is not using for K-eMail Statement Service only)

Apply for Spending Alert service via SMS Apply for Due Alert service via SMS

Remarks: Upon approval of K-Credit Card, you are eligible to use K-Cyber Banking service to check credit card spending details.

Login password of K-Cyber Banking service will be sent to your mobile phone number specified in the application form.

Please fill out this application form completely to provide information for credit card approval

(*important information)

...............................

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Paper/Printing

Education

Communication/Communication equipment

Agriculture

Agricultural processing business

Transportation

Antique dealing

Jewelry/Gold trading

Weapons dealing

Chemical products

Machine/Metal products

Tourism/Guide

Finance/Pawnshop

Foreign exchange service

Service

Money transfer service

Petrochemical and products

Plastic

Furniture/Sawmill

Automobile/Parts

Construction

Convenient store

Hotel/Restaurant

Construction materials

Medical supplies/Hospital/Clinic

Entertainment venue

Utilities/Electricity

Textiles

Property/Land development

Food/Beverages

Electronic/

Electrical appliances

Immigration employment/

Overseas employment agency

Other (Mining/Leather

products/Shoes/Toys) or

please specify

Province Postal code

Address in home jurisdiction*

House registration address (in case it is different from current address)*

Application for Primary Card

Employer/Business address*

Name of employer/business Building

Floor Department/ Division

No. Mu Soi Road

Khwaeng/Sub-District Khet/District Province

Postal code Tel. No. Fax. No.

Position Tenure years

Convenient time to contact

8.30-12.00 hrs. 13.00-17.30 hrs. 17.30-20.00 hrs.

Please indicate name and telephone number of previous employer/business, if current tenure is less than 6 months.

Name of previous employer/business

Previous tenure years Tel. No

Type of business*

Type of Work*

Teacher/Instructor Police/Military Architect Engineer Lawyer Salesperson

Physician Nurse Pharmacist Judge/Attorney Production staff Other

Occupation*

Government employee with civil service level State enterprise employee Private company employee Owner of registered business

Stay-at-home husband/ housewife Self-employed Business owner Daily wager/Temporary worker

Nature of business* Retail Wholesale Manufacturer Service

2/K-Credit Card Application part 2

Education

Marital status Single Married (registered) Married (unregistered) Divorced Widowed Number of children person(s)

First name/Last name of spouse Maiden name of spouse

Name of spouse’s workplace Tel. No.

Spouse’s monthly income at Baht Position

Personal Information (applicant must be over 20 years old)*

First name/Last name in Thai Mr. Mrs. Ms. Other

First name/Last name in English Mr. Mrs. Ms. Other

(Please write in block capitals only, as in your passport)

First name

Last name

Date of Birth (B.E.) DD/MM/YYYY Nationality

National ID card No. Passport No.

K-Credit Card Application part 1

“ติดสติ๊กเกอร์ QR code#2”

Application for Primary Card (Please specify the preferred card type)* (An application can be used for up to 3 card types)

page 2/7

Card Level (Income in Thai Baht) Classic (15,000/Month) Titanium (15,000/Month) Gold (30,000/Month) Platinum (50,000/Month)

Government official/political position*

Do you hold a position of/have any relationship with persons holding a position of governmental department head, Commander-in-Chief of Royal Thai Army,

Royal Thai Air Force or Royal Thai Navy, Supreme Commander, Commissioner-General of Royal Thai Police or political officials?

(Please select) No Yes In case of yes, please specify the following information:

Name Position Relationship to you

Time in Office: From (B.E.) To

Income*

In case of Employee with Permanent Income : Monthly Income Baht In case of Business Owner:Business Monthly Sales Volume Baht

In case of Self-Employed : Monthly Income Baht Net Profit/Month (for the part of the applicant only) Baht

Other Income (if any) Baht per month

Source of Other Income (with supplementary evidences) Bonus Commission Other (please specify)

Income receiving method*

Cash or Cheque in hand Cash in hand including some portion transferred to a bank account

Transfer to a bank account; please specify Bank’s name Branch Regular expenses Baht per month

Method of Payment (choose one)*

By Cash or Cheque

• The minimum payment is 10% of outstanding balance on the monthly statement, but not less than 1,000 Baht/month.

Automatic Account Deduction (with your KBank account only, “except Joint Account”)

Automatic deduction from account Current Savings

Account No. Name of Account

Conditions for Automatic Account Deduction:

Minimum account deduction: Deduct 10% of outstanding balance on the monthly statement, but not less than 1,000 Baht/month.

Full payment as shown in monthly statement

In order to gain access to ATM and telephone IVR (Interactive Voice Response) services, please provide your personal account

number – the account must be a KBank account only. (If two accounts are provided, they must be at the same branch.) (Annual fee

for using credit card to withdraw money from account via ATM will be charged according to the Bank’s notice.)

Current Account Savings Account

( ) Amway-KBank Credit Card

for which the Bank agrees to be a business partner with

Amway (Thailand) Limited

Please specify Amway Business Owner/Member Number

( ) Bangkok Hospital Group-KBank Credit Card


Bangkok Hospital Group

( ) Robinson-KBank Credit Card


Robinson Department Store Public Company Limited

( ) Thammasat University-KBank Credit Card


the Thammasat University Alumni Relations Office

( ) Mercedes-KBank Credit Card

for which the Bank agrees to be a business partner with Mercedes-Benz (Thailand) Limited

Please specify

Vehicle Identification Number (VIN)

( ) Other Co-Branded Group Card Name,

please specify

Please specify His & Her Plus Point Number


Net Asset Value (please specify)*

Where would you like your Credit Card/Card Statement and other documents sent?*

Home Office

Co-Brand Group Card Name( ) TCC&BoT-KBank Credit Card

for which the Bank agrees to be a business partner with the Thai Chamber of

Commerce and Board of Trade of Thailand

Please specify TCC Code

( ) CGA / SFT-KBank Credit Card

or which the Bank agrees to be a business partner with the Confederation of

Saint Gabriel’s Foundation of Thailand Alumni Association and the Salesian Families

of Thailand

Please specify Application Channel Code*/Educational Institution Code*

( ) His&Her & His&Her Plus Point - KBank Credit Card

for which the Bank agrees to be a business partner with ICC International Public

Company Limited

( ) Visa Card ( ) KBank-Visa payWave ( ) KBank-Visa payWave NFC ( ) Master Card ( ) KBank-Titanium (EverydayCard) (EverydayCard: No point collection, cash rebate ONLY)

( ) KBank UnionPay ( ) KBank Visa Home Smiles Club (for K-Home Loan customers ONLY)

Generic Group Card Name

( ) King Power & King Power Membership - KBank Credit Card

for which the Bank agrees to be a business partner with King Power International

Company Limited


For affixing barcode sticker of

His & Her Plus Point membership

number unless the number is

already entered.

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For KBank officer Project code

Recommended by (Name/Last Name) Branch code Employee code

Sales officer’s information (Name/Last Name) Branch code Employee code

Application inspector: Documents and information verified Customer authentication verified

Comment Signed

Please write name legibly Position Date

Please declare your intention to subscribe to the membership of Credit Shield Insurance

Credit Shield Insurance

Remarks :

• Details of the protection conditions will be specified in the Group Life Insurance Acceptance issued later by Muang Thai Life Assurance Public Company Limited, which will be delivered to you when the insurance

application is approved.

• The protection conditions according to the Credit Shield Insurance policy shall be completely effective when you have paid the premium, and this insurance shall be effective as long as you are

holding the membership of this credit card and joining the program, even if the card number is changed as a result of a new card being issued by the Bank.

• The premium shall be debited from the credit card account and covers only the outstanding balance at the date of death or the starting date of the absolute disability.

• The insured must be 20-64 years old on the insurance application date.

Signed

(Primary Card Applicant)

Date Month Year

Signed

(Supplementary Card Applicant)

Date Month Year

Warning of Office of the Insurance Commission: An insurance applicant is obliged to answer all questions truthfully. Concealment of any fact could

be grounds for denial of any contractual claim payment by an insurance company, pursuant to Article 865 of the Civil and Commercial Code.

Credit Shield Insurance gives protection for the outstanding balance for K-Credit Card usage with an insurance premium rate of only 0.35% of the

outstanding balance. The maximum sum insured is 500,000 Baht, which will grant protection as follows:

• In case of death or permanent absolute disability, protection covers the total outstanding amount at the date of death or at the starting date of

permanent absolute disability or loss, or a maximum not exceeding the credit limit or a maximum not exceeding 500,000 Baht.

• In case of temporary absolute disability, protection covers 10% of the total outstanding balance at the starting date of temporary absolute disability

continuously for 10 months at a maximum not exceeding the credit limit or a maximum not exceeding 500,000 Baht, whichever is less.

I/We, the Primary Card Applicant and/or the Supplementary Card Applicant, request to apply to be a member of Credit Shield Insurance.

For Primary card Supplementary card

Type of card KBank-Visa KBank-MasterCard

I/We, the Primary Card Applicant and/or the Supplementary Card Applicant, certify that I/we am/are under 65 years old with perfectly good health and

have never been known to have HIV infection (Acquired Immune Deficiency Syndrome or AIDS), and have no handicap or disability on any part of the body.

If I/we am/are not satisfied with the conditions of this insurance plan, I/we can terminate my/our coverage by providing a written notice to KASIKORNBANK

at least seven days prior to the next billing cycle.

I/We allow the collection of premium payment from my credit card account, and I/we also acknowledge and accept that the coverage according to the

policy provisions of this Credit Shield Insurance Plan shall no longer be in effect on the termination date of my/our credit card membership.

Signed

Primary Card Applicant/Service Applicant/Actual Beneficiary

Date Month Year

Declaration and agreement of the Primary Card Applicant*

I, the Primary Credit Card Applicant, request KASIKORNBANK PCL (“The Bank”) to issue its Credit Card of which card type and card level

match the choice I made or in accordance with the Bank’s consideration (“Credit Card”) to me. I hereby certify that all statements and

data provided herein are true and complete to the best of my knowledge. I acknowledge and agree that by applying for the co-branded

credit card as I have expressed my intention herewith, I allow the Bank and the business partners with the above-stated names to reveal

my information to each other for the purpose of arranging promotional campaigns or activities for me in the future, and/or for other pur-

poses. Where supplementary Credit Cards are applied for, I hereby acknowledge that I will accept mutual responsibility for any liabilities

and/or expenses incurred with supplementary Credit Card usage. I consent to abide by the terms and conditions for usage of Credit Cards

issued by KASIKORNBANK PCL, which are attached to the Credit Card when delivered. I hereby agree to give the Bank authorization to

renew/cancel the Credit Card and/or issue a new card of other type for me/the supplementary credit card applicant as it deems fit, if my

qualifications/the supplementary credit card applicant’s qualifications are not in accordance with the Bank’s conditions for each card type.

Signed

Primary Card Applicant/Service Applicant/Actual Beneficiary

Date Month Year

I hereby authorize the Bank to reveal my information to any part of the KASIKORNBANK FINANCIAL CONGLOMERATE, any of the Bank’s assignees

and business partners* to use my information for the purpose of offering me products, services and other special offers, and/or any other purpose(s).


For Officer ICC Robinson Other Sales officer’s information (Name/Last Name) Employee code Partner branch code


Remark:

* KASIKORNBANK FINANCIAL CONGLOMERATE, any of the Bank’s assignees and business partners are; 1) KASIKORN LEASING Company Limited; 2) KASIKORN FACTORY AND EQUIPMENT Company Limited; 3) KASIKORN ASSET

MANAGEMENT Company Limited; 4) KASIKORN SECURITIES Public Company Limited; 5) KASIKORN RESEARCH CENTER Company Limited; 6) MUANG THAI BROKER Company Limited; 7) MUANG THAI LIFE ASSURANCE Public

Company Limited; 8) MUANG THAI INSURANCE Public Company Limited; 9) PROGRESS MULTI INSURANCE BROKER Company Limited; 10) KASIKORNBANK Company Limited (11) Other KASIKORNBANK FINANCIAL CONGLOMERATE

entities to be established in the future; 12) Business partner of syndicated loan or co-branded credit card or co-branded debit card that the applicant is applying for.

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Natural person (Please print/write legibly)

I Mr./Mrs./Miss............................................................................................................... Last Name .................................................................................................................

Date of Birth.................................................................................................................... Tel. No ...........................................................................................................................

National ID Card No

For Foreigner

Passport No.

Other (Please specify)............................................... No.

This consent has been voluntarily made on my own for sending to the National Credit Bureau Co., Ltd. (the Company) via facsimile as an evidence that I hereby agree and give consent to the Company to disclose or provide my information to KASIKORNBANK PCL., which is a member or service recipient/user of the Company, for the purpose of credit analyses, and issuance of credit card according to my application for credit/credit card which was given to the Bank/ the Company as mentioned above, including for the purpose of credit review, credit agreement extension/credit card renewal, as well as risk management and prevention in compliance with the Bank of Thailand’s requirements. I further agree that any duplication and any copy, photocopy, electronic data, or facsimile which has been made as a copy from this original consent letter by means of photocopying, image scanning, or recording in whatever form shall be deemed as evidence of my consent with the same effect as its original. In addition, before giving consent, I have been clearly informed of instructions and conditions of giving consent via facsimile which are prescribed above.

For Bank Use OnlyRef.No.KBank

Consent for Disclosure of Information via Fascimile

Made at .........................................................................................................................................Date.......................... Month .............................................................Year ...................................

Instructions for giving consent via facsimile1. Fill in the form correctly and completely, and sign.2. AttachacertififiedcopyofyournationalIDcard/passportwithyoursignature(fornaturalperson).3. Fax this form and the copy of national ID card / passport by yourself, or assign another person to do it on your behalf.

Conditions for giving consent via facsimilConsent given via facsimile is “electronic data” or a text which has been created, sent, received, kept or processed by electronic means, wherein a consent grantor is prohibited from refusing the legal obligation and enforcement by law of any text for the sole reason that such text is in the form of electronic data. Giving consent via facsimile shall thus be deemed as giving consent in accordance with laws pertaining to credit information business in all respects.

Remarks: Information which the Company discloses to a member or service recipient is one of the constituents for credit analysis of fifinancialinstitutions;butdisclosureofsuchinformationisatthediscretionoftheinformationowner.

Signed ...........................................................................................................

( ........................................................................................................ ) Legible handwriting

For Bank Off ificer/Representative

Signed ....................................................................

( .................................................................. ) Legible handwriting

Signed ....................................................................

( .................................................................. ) Legible handwriting

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Please read the terms and conditions for credit card use in the Cardholder Handbook as provided by the Bank.Details on Interest Rates, Service Charges, Fees and Other Expenses for Use of Credit Card

Remarks: • Interest rates and fees are subject to change with prior notice from the Bank. • In case of payment by cheque or at pay point service, please pay three business days in advance of the due date. • If the Cardholder makes cash advances at ATMs abroad, an ATM fee may be charged by the acquiring bank. • If the Cardholder has an overdue payment, the Bank shall authorize a juristic person to collect said debt. Such collection shall be subject to collection fee as announced by

theBank,andnotifiedtotheCardholderbytheBankorthedebtcollectionagency. 1 K-SMECreditCardholdersaresubjecttoaninterestrateof18%,p.a.forthefifirst24billingcyclesfromthecardapprovaldate.Subsequently,thenormalinterestrateas

announced by the Bank, now standing at 20%, p.a. shall be applied. 2 Interest rates: Interest on purchase amount shall be calculated from the posting date until the repayment date. Interest on cash advance amount shall be calculated from

the withdrawal date until the repayment date. No interest-free period is allowed for cash advance. 3 This service is not currently available. 4Debt collection fee is exclusive of 7% VAT. • K-SME Credit Cardholders who are in default on debt payment shall be liable for any debt collection fee charged by the Bank, in addition to fees of other credit cards held

by them. • Effective from the billing cycle of August 5, 2013. 5 Any expenses incurred from spending via card (including cash advance) in any foreign currency shall be charged to the Cardholder in Thai Baht at the exchange rate being

charged by the relevant credit card company of which the Bank is a member, as of the date on which such amount is charged to the Bank. If the transaction amount is not in US Dollars, such amount may be converted into US Dollars before conversion into Thai Baht. The Cardholder may check the exchange rate for reference as follows:

• For Visa card: http://corporate.visa.come/pd/consumer_services/consumer_ex_rates.jsp • For MasterCard: http://www.mastercard.com/us/personal/en/cardholderservices/currencyconversion/index.html • The Bank charges a hedging premium of 2.5 percent on expenses incurred as protection against currency conversion risk.

1. Interest rate, penalty fee, other fees or Interest (All types of cards) 20% per annum1

service charges Credit line fee None Late payment fee None Other fees or service charges None Interest calculation date2 Interest on purchase amount: Starting from posting date / Interest on cash advance: Starting from transaction date2. Minimum payment 10% of outstanding balance in monthly credit card statement, which must not be less than 1,000 Baht/accounting period

3. Cash advance fee 3% of cash withdrawn, and each withdrawal must be a minimum of 2,000 Baht

4.Graceperiodforpaymentdue Maximumof15daysfromstatementdate

(For full payment only) Maximum of 25 days from statement date (for K-SME Credit Card only)

Service fee KBank-Visa and KBank-MasterCard Credit Card

Platinum Gold/Titanium Classic5. Fee for each type of credit card Primary card Supplementary Primary card Supplementary Primary card Supplementary (Baht/year) card card card

Application fee 2,000 None 1,100 None 600 None

Annual fee 3,500 3,500 1,600 1,600 1,050 1,0506. Payment fee Account debit None Cheque or money order None Bank counter None ATM None IVR None Internet None Pay point service Subject to each provider Other bank counters3 None

7. New card issuance fee (lost/damaged) Platinum 500 Baht /incident Gold/Titanium 300 Baht/incident Classic 200 Baht/incident

8. Statement request fee 50 Baht/issuance except for request via IVR for statement sent by fax

9. Copy of sales slip request fee 100 Baht/slip for domestic transactions 200 Baht/slip for overseas transactions

10. PIN issuance fee (to replace the existing PIN) 100 Baht/issuance

11.Transactionverificationfee None

12. Tax and fee paid to government agencies Up to 2%

13. Collection fee 88 Baht/accounting period4

14.Hedgingpremium Mid-rateplus2.5%5



Primary Cardholder’s Name and Last Name

Primary Card Number

Relationship to the Primary Cardholder

Spouse

Sibling

Child

Other (please specify)

Parent

Application for Supplementary Card (Please specify the preferred card type)* (An application can be used for up to 3 card types)

Current Account

Savings Account

Method of Payment (choose one)*

By Cash or Cheque

• The minimum payment is 10% of outstanding balance on the

monthly statement, but not less than 1,000 Baht/month.

Account Debit (with your KBank account only, “except Joint Account”)

Debiting from account

Current Savings

Account No.

Name of Account

Conditions for Account Debit:

Minimum deduction: Deduct 10% of outstanding balance on

the monthly statement, but not less than 1,000 Baht/month.

Full payment as shown in monthly statement

Declaration and agreement of the Supplementary Card Applicant*

I, the Supplementary Credit Card Applicant, hereby certify that

all statements and data provided above are true and complete to

the best of my knowledge. I agree to allow KASIKORNBANK PCL

to reveal information related to spending via the co-branded card

that I am applying for, or other information related to me, to the

Bank’s business partner jointly issuing this co-branded card, for

the purpose of arranging marketing activities and/or other activities

in the future. I consent to abide by the terms and conditions for

usage of Credit Cards issued by KASIKORNBANK PCL, which

are attached to the Credit Card when delivered. I hereby agree to

give the Bank authorization to renew/cancel the Credit Card and/

or issue a new card of other type for me/the supplementary credit

card applicant if my qualifications/the supplementary credit card

applicant’s qualifications are not in accordance with the Bank’s

conditions.

Signed

Supplementary Credit Card Applicant/Service Applicant/Actual Beneficiary

Date Month Year

Signed

Supplementary Credit Card Applicant/Service Applicant/Actual

Beneficiary/Consent Provider

Date Month Year

I hereby authorize the Bank to reveal my information to any part of the KASIKO-

RNBANK FINANCIAL CONGLOMERATE, any of the Bank’s assignees and business

partners* to use my information for the purpose of offering me products, services

and other special offers, and/or for any other purpose(s).

Please specify His & Her Plus Point Number

page 6/7

Personal Information of Supplementary Cardholder (must be over 15 years old)*

Name and Last Name in Thai Mr. Mrs. Ms. Other

Name and Last Name in English Mr. Mrs. Ms. Other

(Please write clearly in block capitals the name and surname exactly as they appear on your passport)

Name

Last Name

Date of Birth (B.E.) DD/MM/YYYY Nationality

National ID Card No.

Passport No. Marital Status

Current Contact Address/Mailing Address*Name of housing estate/condominium

Unit No. Floor Address No. Mu Soi

Road Khwaeng/Sub-district Khet/District

Province Postal Code Tel. No.

Mobile Phone No. Occupation

Name of Employer Tel. No.

Office Address

Register for Spending Alert service via SMS

Register for Due Alert service via SMS

In order to gain access to ATM and IVR (Interactive Voice Response)

services, please provide your personal account number – the account

must be a KBank account. (If two accounts are provided, they must be

at the same branch.) (Annual fee for using credit card to withdraw money

from account via ATM will be charged according to the Bank’s notice.)


Card Level (Income in Thai Baht)

Classic (15,000 Baht/Month) Titanium (15,000 Baht/Month)

Gold (30,000 Baht/Month) Platinum (50,000 Baht/Month)

(Must be the same type as primary card)

Co-Brand Group Card Name

( ) Amway-KBank Credit Card

Please specify Amway Business Owner/Member Number

( ) Bangkok Hospital Group-KBank Credit Card

( ) Robinson-KBank Credit Card

( ) Thammasat University-KBank Credit Card

( ) TCC&BoT-KBank Credit Card

Please specify TCC Code

( ) CGA / SFT-KBank Credit Card

Please specify Application Channel Code*/Educational Institution Code*

( ) Mercedes-KBank Credit Card

Please specify Vehicle Identification Number (VIN)

( ) Visa Card ( ) KBank-Visa payWave ( ) KBank-Visa payWave NFC

( ) Master Card ( ) KBank-Titanium (EverydayCard)

( ) KBank UnionPay ( ) KBank Visa Home Smiles Club

Generic Group Card Name

( ) His&Her & His&Her Plus Point - KBank Credit Card

( ) King Power & King Power Membership - KBank Credit Card

( ) Other Co-Branded Group Card Name, please specify

Remark:

* KASIKORNBANK FINANCIAL CONGLOMERATE, any of the Bank’s assignees and business

partners are: (1) KASIKORN LEASING Company Limited; (2) KASIKORN FACTORY AND

EQUIPMENT Company Limited; (3) KASIKORN ASSET MANAGEMENT Company Limited;

(4) KASIKORN SECURITIES Public Company Limited; (5) KASIKORN RESEARCH CENTER

Company Limited; (6) MUANG THAI BROKER Company Limited; (7) MUANG THAI LIFE

ASSURANCE Public Company Limited; (8) MUANG THAI INSURANCE Public Company Lim-

ited; (9) PROGRESS MULTI INSURANCE BROKER Company Limited; (10) KASIKORNBANK

Company Limited (11) Other KASIKORNBANK FINANCIAL CONGLOMERATE entities to be

established in the future; (12) Business partner of syndicated loan or co-branded credit card

or co-branded debit card that the applicant is applying for.

For affixing barcode sticker of His & Her

Plus Point membership number unless

the number is already entered.


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Primary applicant must have the following qualifications:

At least 20 years old but not more than 45 years old with minimum monthly income of 15,000 Baht

but not exceeding 20,000 Baht, or;

At least 20 years old but not more than 80 years old with minimum monthly income of 20,000 Baht.

*Fixed-income earners must have worked at their present workplace for at least six months.

*Savers must have fixed deposit account(s) and/or savings account(s) with commercial banks

containing at least 1,000,000 Baht for more than six months.

*Business owners must have been in business for at least one year.

*Expatriates working in Thailand must have monthly income of at least 50,000 Baht.

*Applicants for Amway-KBank Credit Card must be an Amway Business Owner/Member Number

*Applicants for Mercedes-KBank Credit Card must own a Mercedes Benz purchased from an authorized

dealer of Mercedes-Benz (Thailand).

Required documents for primary card application

A copy of valid National ID card, or;

A copy of valid government official ID card and household registration;

A copy of valid passport, visa stamp or work permit (for expatriates working in Thailand)

A copy of Amway Business Owner/Member Number ID card;

A copy of vehicle registration plate for a Mercedes/delivery certificate issued by an official dealer,

or in case of owning a classic Mercedes-Benz must enclose a copy of written proof of membership

of Mercedes-Benz Club Thailand (for application of Mercedes-KBank Credit Card)

Certificate of employment or a copy of employee ID card (for application of TCC&BoT – KBank

Credit Card)

Income documents

(for fixed-income earners, i.e., company employees, government/state enterprise workers)

A pay slip or income certificate (issued not more than three months prior to submission);

- Applicant receiving income or salary in cash must present the Personal Income Tax Form

50 Bis. of the latest tax year or for at least the past six months.

- Applicant receiving income or salary via bank account must present the Personal Income

Tax Form 50 Bis. for the latest tax year or for at least the past six months, or bank statement

for the last three months showing salary crediting.

For an applicant who is an earner of fixed income and other income:

Pay slips of the past three months including the present month (a total of three documents)

or income certificate (issued not more than three months prior to submission);

- Applicant receiving income or salary in cash must present the Personal Income

Tax Form 50 Bis. for the latest tax year or for at least the past six months.

- Applicant receiving income or salary via bank account must present the Personal Income

Tax Form 50 Bis. for the latest tax year or for at least the past six months, or bank statement

for the past three months showing salary crediting.

Please completely fill in the application form and attach all documents required.

Please sign all documents with a pen and all signatures must correspond to that in the application form.

Applicant qualifications and required documents

For retired government officials:

Pay slip or income certificate (issued not more than three months prior to submission), or;

A photocopy of pension recipient card or document enclosed with the payment

order form, or;

A copy of bank statement of the last three months including the present month

showing pension crediting.

For freelancers, e.g., singers, actors, insurance brokers, direct sales agent:

The Personal Income Tax Form 50 Bis. showing income of the latest year or at least

for the past six months.

For business owners/self-employed:

For owners of a business registered under the name of a natural person:

A copy of Commercial Registration Certificate, and;

A copy of personal bank statement of business’s main operating account for the last

six months

For owners of a business registered under the name of a juristic person (PCL, LC, LLLP,

Partnership):

A copy of Registration Certificate and Memorandum of Association issued not more than

six months prior to submission, and;

A copy of a list of shareholders’ names issued not more than one year prior to

submission (applied to PCLs and LCs), and;

A copy of bank statement issued under the name of juristic person for the past

six months.

For owners of a business registered under the name of Registered Ordinary Partnership

(ROP), Group of Person:

A copy of Commercial Registration Certificate, and;

A copy of Request for Registration Form/Letter of Establishment of a Group of Person, and;

A copy of bank statement issued under the name of Ordinary Partnership or Group

of Person for the past six months

For savers:

A copy of bank statement of savings or fixed deposit account for the past six months

For valid K-Credit Cardholders

Please supply a photocopy of the credit card front to facilitate approval.

Supplementary card applicants must be at least 15 years old.

Required documents for supplementary credit card application:

A copy of valid National ID Card

A copy of valid passport, visa (for expatriates working in Thailand)

A copy of Amway Independent Business Owner or member ID card.

In case your application is rejected, to find out why, you can contact our staff at the

branch where you have applied for the credit card, or contact the K-Contact Center at

02 888-8888 for a letter of explanation. Documents sent with the application can also be

retrieved at any KBank branch within 30 days from the date of application.


The Primary Credit Cardholder consents to share the following proportion of total credit line with the Supplementary

Cardholder:*

The entire credit line of the primary card 25% of the primary card credit line

50% of the primary card credit line Specify credit line Baht

(The combined amount of credit of the primary credit card and all supplementary cards must not exceed the total credit

line of the primary credit card.) I, the Primary Credit Card Applicant, consent to have the above applicant as a supplementary

cardholder, and request KASIKORNBANK PCL (the “Bank”) to issue a credit card per the type and level chosen by the

Supplementary Credit Card Applicant or per the Bank’s consideration (the “Card”) to the Supplementary Credit Card Applicant.

I also certify that all statements and data provided above are true and complete to the best of my knowledge. Also, I hereby

acknowledge all liabilities and/or expenses to be incurred from the use of the supplementary credit card.

Please submit the application and required documents to at any KBank branch at your convenience, or send by postal mail to:

• KASIKORNBANK PCL Unsecured Credit and Merchant Product Service Fulfillment Department

47/7 Mu 3, Popular Road, Ban Mai Sub-District, Pak Kret District, Nonthaburi 11120

For more information, please contact K-Contact Center at 02-888-8888 www.kasikornbank.com

Signed

Primary Card Applicant/Consenting Party

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