PLEASE TELL US ABOUT YOURSELF
CITIBANK CREDIT CARDS
Which Card you would like to apply for :
VISA GOLD CARD
VISA SILVER CARD
Mr.
Your name as in your CPR/Passport (PLEASE USE CAPITAL LETTERS)
Mrs.
Ms.
Others
FIRST NAME
MIDDLE
LAST NAME
DD
MM YY
Years of Residence in the Bahrain
Your name as you would like it to appear on your Card (leave one space between names and underline surname)
PLEASE USE CAPITAL LETTERS (19 CHARACTERS ONLY)
DATE OF BIRTH
SEX
MARITAL STATUS
Male
Female
Single
Married
Other
NO. OF DEPENDENTS
NATIONALITY
Mother’s Maiden Name
(This is a security feature for your protection)
Name of Spouse
Your Educational Background
Graduate
Diploma
Residence
Office
Post-Graduate
Others
BILLING ADDRESS :
RESIDENTIAL ADDRESS :
House/Flat No. .................................................................................................................................................. Road No........................................................Bldg. No. .............................................................
Building Name ...................................................................................................................................................Block .........................................................................................................................................................
Nearest Landmark .......................................................................................................................................P.O. Box.......................................................City...............................................................................
Residence is
Rented
Owned
Company Accommodation
Others
Your Contact Numbers :
Residence No. ...............................................................
Mobile No. ..........................................................................
Fax ........................................................................................................................
E-mail ............