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Corporate Card

Employee Application - Joint & Several Liability

Applicant Details
Company Name: Please quote your Companys Corporate Account Number:

Declaration by Applicant
I, the Corporate Card Applicant, hereby apply to AMEX (Middle East) B.S.C. (c) [AEME] for an American Express Corporate Card. I agree to comply with the Terms and Conditions and Cardmember Agreement available on the website of AEME, www.americanexpress.com.bh. I certify that the information given above as well as the copies provided in support of my application are true and correct. I understand and agree that I will be jointly and severally liable for all charges incurred on the Corporate Card issued to me.

Applicant Details
Please Tick: Title: Full Name:
(as it appears in your Passport)

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Ms Miss

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Dr. Other


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By signing below I confirm that I have read and agree to the declaration stated above. Signature of Applicant: Date:

Date of Birth (DDMMYY) Nationality: Passport No.: Physical Home Address:

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Declaration by Company Signatory

On behalf of the company, named in this application (the "Company"), we hereby request issuance of an American Express Corporate Card to the individual named above and certify that the named individual is an employee of the Company. We confirm that the information given in this application form is to the best of the Companys knowledge true and correct. We also warrant that the copies of the identification and all other documents provided with this application are true copies of the originals. We understand and agree that the Company will be jointly and severally liable for all charges incurred on the Card issued to the Applicant. We also understand that AEME reserves the right to decline any application without giving a reason and that no correspondence will be entered into these circumstances. The Company hereby agrees to be bound by the American Express Corporate Cardmember Agreement and Terms and Conditions available on the website of AEME, www.americanexpress.com.bh, including any subsequent amendments that may be made from time to time by AEME. It is essential that the form is counter-signed by an authorised signatory. Signature of Authorised Signatory: Date: Name of Authorised Signatory:

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Country of Origin Contact Address:

Home Tel.: Office Tel.: Mobile: E-mail: Position held in Company: Years with Company: Employee ID. No.:

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Have you ever held an American Express Card? Present Member

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Former Member No

Position held in Company:

Company Stamp

Card Number: For individually billed accounts, please indicate where you would like to be billed? Office Office Address: Home

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* To help in the prompt processing of your application please ensure you have attached:
A photocopy of your passport, including residence permit and a second photo ID.

* Please allow up to 10 calendar days for processing.

Code: CC-JSL-EF-01

P.O. Box 5990, Manama, Bahrain, www.americanexpress.com.bh, e-mail: ccu@americanexpress.com.bh