egy_atm_app.pdf

Application for HSBC ATM Card Branch Date Please Complete all sections in English and place a in the appropriate box Card Type International New Card Local Change Information Replacement Card Delete Card Your Current Account or Savings Account Number Other Current or Savings Accounts in your name which you would like to access with your Card Name ( Mr. / Mrs. / Miss ) The language you would like your screen instructions to appear in English Arabic Please indicate which identity document (s) you will bring to the Bank to support this application National ID Passport Military ID Document Number Address Employer Name Reason for Card Replacement Date and time lost / stolen Contact Telephone Number I / We the Applicant (s) hereby authorise and request HSBC Bank Egypt to issue me/ us an HSBC ATM Card. I/ We confirm that the infor- mation given above is true and complete and that i/ We have read and accept the Terms and Conditions overleaf. I/ We hereby authorise the Bank to change my / our above account for the Card’s annual fee each year in advance and any transaction charges determined by the bank from time to time without objection from us or prior notice. Signature FOR BANK USE ONLY Branch Section Waived from Annual Fees TML# Branch Authorised Signature Customer Signature Verified NSC Section D C A R Card Type NSC Authorised Signature ATM 012 ≠ ‡‡‡ ‡ ‡d Ÿ « ∞ ∑ U̧ ¥a © KV «∞∫ B u‰ ́ Kw °D UÆ W C B SH ∞ KB d «· «ü ∞w ¥d§ w ± Kv ¡ § L Ol «_ Æº UÂ ° Uù ≤π KOe ¥W Ë Ë{ l ́ ö ± W ≠ w « ∞L d °l « ∞L M Uß V ≤u Ÿ « ∞∂D UÆ W œ Ë ∞O W °D UÆ W § b ¥b … ±∫ KO W ¢G Od ° O U ≤ U‹ °D UÆ W °b ¥ KW ≈ ∞G U¡ « ∞∂D UÆ W ¸ Æ r • º U°J r « ∞π U̧ Í √Ë • º U» « ∞∑ u ≠ Od « ∞ª U’ °J r «∞∫ º U° U‹ « ∞π U̧ ¥ W √Ë • º U° U‹ « ∞ ∑ u ≠ Od «_ î dÈ « ∞L H ∑u• W ° Sß L J r Ë « ∞ ∑w ¢ d̈ ∂ u Ê ≠ w « ∞ ∑ F U± q ́ KO N U ° ∂D UÆ ∑J r «ù ß r ( « ∞º Ob / « ∞º Ob … / «ü ≤º W ) « ∞ K ‡G ‡W « ∞ ∑w ¢ ‡d̈ ‡ ‡∂ u Ê ≠ w √Ê ¢ ‡E ‡N d °N U ¢ F ‡‡‡K O L U ¢J r ́