Personal Details Personal details of Primary Account Holder Name Mr. Mrs. Ms. (as per passport) First name Middle name Last name Please provide either your Passport no. or Emirates ID no. Gender: M F Marital status: Single Married Family size (in UAE) Monthly salary Other monthly income Source of income Favourite city Contact details E-mail ID 1 E-mail ID 2 Courier Debit Card / Cheque book to Office Home Personal reference in UAE: Name Contact number Professional Details Name of organisation Designation Employee no. Date of joining Department Division Street name/no. Building name Flat/Villa no. Nearest landmark P.O. Box City/Emirate Telephone Mobile no. 1 Mobile no. 2 Fax Residence address in UAE / Country of residence (in case of non-resident customers) Building name Flat/Villa no. Street name/no. P.O. Box City/Emirate Nearest landmark Country Telephone Mobile no. Residence address in home country Building name Flat/Villa no. Street name/no. P.O. Box City Nearest landmark Country Telephone Mobile no. I/We hereby declare that the information provided above is accurate and true. I/We agree that my/our signature(s) below shall be deemed as an absolute acknowledgement of having received the original copy of terms and conditions booklet governing the relationship with the Bank, and further declare and acknowledge that I/we have read, understood and shall abide with the terms and conditions in the Booklet. I/We agree to abide with any other additional terms and conditions relating to any other products availed by me/us through the Telephone, Internet, ATM or any other alternate channels introduced by the Bank from time to time. In case of any mismatch of information on this application form with information provided on certified copies of the original documents, the information on the certified copies of the original document will be taken by the Bank as true and accurate, and will supersede the information on the application form for the purpose of opening the account, and updating the Bank's official records. In order to comply with the applicable laws and regulations and for the purposes of (i) getting my /our personal information, (ii) managing my / our account(s) and the transactions entered into by me / us and (iii) executing any product or service subscribed by me / us including but not limited to loans and credit cards, I / We hereby irrevocably and unconditionally agree, consent and authorize the Bank, its subsidiaries, agents and bank’s third party service providers, and any others as the Bank may deem appropriate and at its sole and absolute discretion, to: • Collect, seek, obtain, confirm and keep updated all information relating to me/us including but not limited to my/our personal details, details of my/our accounts, statements, Loans/Islamic Finances, current and previous credit card, banking transactions, repayment history and any default (the ”Information”), • Disclose and exchange the Information with any government authority and/or quasi government authority and/or private entities, including but not limited to Al Etihad Credit Bureau, or any other third party. I/We undertake to regularly provide the Bank with the requested Information and keep this Information updated as long as I/we shall remain Customer(s) of the Bank. For Bank use only CIF no. EDMS no. Customer type: Non-Resident Resident Branch name Islamic Banking Branch ID 091 Bank official signature Date d d m m y y y y Signature of Primary Account Holder Date d d m m y y y y d d m m y y y y Islamic Banking Division of Mashreqbank psc Formerly known as Badr Al Islami, Islamic Banking Division of Mashreqbank psc 23429-FormUpdates-MAIAccountOpeningFormCombined.indd 1 6/24/14 3:00 PM
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Personal DetailsPersonal details of Primary Account Holder
Name Mr. Mrs. Ms.(as per passport) First name Middle name Last name
Please provide either your Passport no. or Emirates ID no.
Gender: M F Marital status: Single Married Family size (in UAE)
Monthly salary Other monthly income Source of income
Favourite city
Contact details
E-mail ID 1 E-mail ID 2
Courier Debit Card / Cheque book to Office Home
Personal reference in UAE: Name Contact number
Professional Details
Name of organisation
Designation
Employee no. Date of joining
Department Division Street name/no.
Building name Flat/Villa no. Nearest landmark
P.O. Box City/Emirate
Telephone Mobile no. 1 Mobile no. 2 Fax
Residence address in UAE / Country of residence (in case of non-resident customers)
Building name Flat/Villa no. Street name/no.
P.O. Box City/Emirate Nearest landmark
Country Telephone Mobile no.
Residence address in home country
Building name Flat/Villa no. Street name/no.
P.O. Box City Nearest landmark
Country Telephone Mobile no.
I/We hereby declare that the information provided above is accurate and true. I/We agree that my/our signature(s) below shall be deemed as an absolute acknowledgement of having received the original copy of terms and conditions booklet governing the relationship with the Bank, and further declare and acknowledge that I/we have read, understood and shall abide with the terms and conditions in the Booklet.I/We agree to abide with any other additional terms and conditions relating to any other products availed by me/us through the Telephone, Internet, ATM or any other alternate channels introduced by the Bank from time to time.In case of any mismatch of information on this application form with information provided on certified copies of the original documents, the information on the certified copies of the original document will be taken by the Bank as true and accurate, and will supersede the information on the application form for the purpose of opening the account, and updating the Bank's official records.In order to comply with the applicable laws and regulations and for the purposes of (i) getting my /our personal information, (ii) managing my / our account(s) and the transactions entered into by me / us and (iii) executing any product or service subscribed by me / us including but not limited to loans and credit cards, I / We hereby irrevocably and unconditionally agree, consent and authorize the Bank, its subsidiaries, agents and bank’s third party service providers, and any others as the Bank may deem appropriate and at its sole and absolute discretion, to:• Collect, seek, obtain, confirm and keep updated all information relating to me/us including but not limited to my/our personal details, details of my/our accounts,
statements, Loans/Islamic Finances, current and previous credit card, banking transactions, repayment history and any default (the ”Information”),• Disclose and exchange the Information with any government authority and/or quasi government authority and/or private entities, including but not limited to Al
Etihad Credit Bureau, or any other third party.
I/We undertake to regularly provide the Bank with the requested Information and keep this Information updated as long as I/we shall remain Customer(s) of the Bank.
For Bank use only
CIF no. EDMS no.
Customer type: Non-Resident Resident Branch name Islamic Banking Branch ID 091
Bank official signature Date
d d m m y y y y
Signature of Primary Account Holder
Date d d m m y y y y
d d m m y y y y
Islamic Banking Division of Mashreqbank psc Formerly known as Badr Al Islami, Islamic Banking Division of Mashreqbank psc
عنوان ال�صكن يف اإ ع م/ دولة االإقامة )يف حالة العمالء غري املقيمني(
ا�سم/ رقم ال�سارع رقم ال�سقة/ الفيال ا�سم البناية
اأقرب معلم رئي�سي املدينة/ الإمارة �ص. ب.
هاتف متحرك هاتف الدولة
عنوان ال�صكن يف البلد االأم
ا�سم/ رقم ال�سارع رقم ال�سقة/ الفيال ا�سم البناية
اقرب معلم رئي�سي املدينة �ص. ب.
هاتف متحرك هاتف الدولة
اأنا/ نحن نقر اأن املعلومات املذكورة اأعاله دقيقة و�سادقة. اأنا/ نحن نوافق اأن توقيعنا اأدناه �سيعترب اإقرارًا مطلقًا باأننا ا�ستلمنا الن�سخة الأ�سلية لكتّيب ال�رسوط والأحكام الذي يحكم العالقة مع البنك كما نقر اأي�سا ونعلن اأننا قراأنا وفهمنا
و�سنلتزم ب�رسوط واأحكام الكتّيب.
اأنا/ نحن نوافق على اللتزام باأي �رسوط واأحكام اإ�سافية متعلقة باأي منتج اآخر يتم ا�ستخدامه بوا�سطتنا عرب الهاتف، الإنرتنت، جهاز ال�رساف الآيل اأو اأي قنوات بديلة م�ستخدمة بوا�سطة البنك من وقت لآخر.
يف حالة اأي تناق�ص بني املعلومات املذكورة يف طلب التقدمي هذا مع املعلومات املبّينة يف الن�سخ امل�سدقة للم�ستندات الأ�سلية، فاإن املعلومات املبّينة يف الن�سخ امل�سدقة للم�ستندات الأ�سلية �ستعترب دقيقة و�سادقة بوا�سطة البنك و�ستن�سخ
املعلومات املذكورة يف طلب التقدمي لأغرا�ص فتح احل�ساب وحتديث ال�سجالت الر�سمية للبنك
لغايات الإلتزام بالقوانني والأنظمة املتبعة ولأجل : )1( احل�سول على املعلومات ال�سخ�سية، )2( اإدارة احل�ساب/ احل�سابات اخلا�سة بي/ بنا، والعمليات التي تتم عليها من قبلي/ قبلنا )3( احل�سول على اأو التقدم بطلب لأي منتج اأو خدمة
مبا يف ذلك على �سبيل املثال ل احل�رس القرو�ص/التمويل الإ�سالمي، بطاقات الئتمان، مبوجبه نقبل ونوافق و نفو�ص تفوي�سًا نهائيا وغري قابل لالإلغاء اأو الرجوع فيه ، كل من البنك و ال�رسكات التابعة له وووكالءه واأي طرف ثالث متعاقد
مع البنك لأداء خدمة اأو اأي �سخ�ص / جهه اأخرى وح�سب ما يراه البنك منا�سبًا مبح�ص اختياره املطلق للقيام بـ :
ا�ستالم و طلب واحل�سول على وتاأكيد و جتديد كافة املعلومات املتعلقة بي/ بنا على �سبيل املثال ل احل�رس املعلومات ال�سخ�سية اخلا�سة بي، تفا�سيل احل�سابات، ك�سوف احل�سابات، القرو�ص، بطاقات الئتمان احلالية وال�سابقة، -
Currency Cheque book*: Yes No Debit Card*: Yes No*If applicable (no profit on Current Accounts, no Cheque Book applicable for Savings Accounts and no Debit Card for Easy Saver Accounts)
Name as it should appear on Debit Card (21 character limit)
Currency Cheque book*: Yes No Debit Card*: Yes No*If applicable (no profit on Current Accounts, no Cheque Book applicable for Savings Accounts and no Debit Card for Easy Saver Accounts)
Name as it should appear on Debit Card (21 character limit)
**Mudarib fee form to be filled and signed.
d d m m y y y y
Mudarabah Term Investment Account**
Deposit Account no. Deposit Account Title
Amount Amount (in words)
Currency Tenure: From to Exchange rate (if applicable)
Mode of payment Debit A/C no.
Maturity Instruction A Rollover principal with accrued profit for the same tenure
B Rollover principal for same tenure credit the profit to A/C no.
C Principal + accured profit to be credited to A/C no.
I/We hereby agree that the above Accounts will not be used for commercial purposes.
For Bank use only
CIF No. Campaign Code
Bank official signature Date
CATS Code: / / / EDMS no.
Deposit Details
Signature of Primary Account Holder
Date d d m m y y y y
Signature of Joint Account Holder 1
Date d d m m y y y y
Signature of Joint Account Holder 2
Date d d m m y y y y
Islamic Banking Division of Mashreqbank psc Formerly known as Badr Al Islami, Islamic Banking Division of Mashreqbank psc
Detailed terms and conditions related to Mudarabah term investment accounts are covered in the terms and conditions form. I/We do hereby acknowledge having received an original copy of terms and conditions booklet governing the relationship with the Bank, “The Booklet”, and further declare and acknowledge that I/we have read, understood, and shall abide with the terms and conditions in the Booklet.
The profits share allocation for Savings and Term Investments accounts based on the Mudarabah Contract will be as follows:
Type of Account Mudarib’s (Bank) Share Customer’s Share
Mudarabah Savings Account
70% 30%
1 Month Mudarabah Term Investment
3 Months Mudarabah Term Investment
6 Months Mudarabah Term Investment
9 Months Mudarabah Term Investment
1 Year or more Mudarabah Term Investment
Mudarabah profit sharing and any variations thereof shall be determined by the Bank’s management and shall be notified/displayed at the Bank’s head office and its branches.
Profit rates are announced quarterly and displayed in the branches and on the website.
Signature 1 Name
Signature 2 Name
Signature 3 Name
Date
Annexure1 – Mudarib Share
Islamic Banking Division of Mashreqbank psc Formerly known as Badr Al Islami, Islamic Banking Division of Mashreqbank psc
Mashreq Al Islami account details (Mandatory for existing Mashreq Al Islami account holders)
Account no. Current Savings
Auto payment amount Minimum (5%) Full
Relationship with other Financial Institutions
Product Name of the Bank Bank Account/Credit Card no. Credit Limit/Monthly Payment
Credit Card/Loan
Credit Card/Loan
Credit Card/Loan
Credit Card Declaration
In order to comply with the applicable laws and regulations and for the purposes of (i) getting my /our personal information, (ii) managing my / our account(s) and the transactions entered into by me / us and (iii) executing any product or service subscribed by me / us including but not limited to finances and credit cards, I / We hereby irrevocably and unconditionally agree, consent and authorise the Bank, its subsidiaries, agents and bank’s third party service providers, and any others as the Bank may deem appropriate and at its sole and absolute discretion, to:
- Collect, seek, obtain, confirm and keep updated all information relating to me/us including but not limited to my/our personal details, details of my/our accounts, statements, finances, current and previous credit card, banking transactions, repayment history and any default (the ‘Information’),
- Disclose and exchange the Information with any government authority and/or quasi government authority and/or private entities, including but not limited to Al Etihad Credit Bureau, or any other third party.
I/We undertake to regularly provide the Bank with the requested Information and keep this Information updated as long as I/we shall remain Customer(s) of the Bank. In consideration of my application for a Mashreq Al Islami Platinum Credit Card, I hereby declare that all statements made in this application are true and correct to the best of my knowledge and authorise Mashreq Al Islami to make any and all credit investigations that are deemed appropriate including contacting my bank/branch to verify my bank statements. I understand that Mashreq Al Islami can decline this application without assigning any reason and that the application and its supporting documents (including security cheque) will become part of Mashreq Al Islami records and will not be returned to me. I also understand that the Mashreq Al Islami Platinum Credit Cardholder Agreement and Statement of Disclosure will be made available to me along with the Mashreq Al Islami Platinum Credit Card and/or on the Mashreq Al Islami website and that my acknowledgement of the Card(s) constitutes agreement that I have read the same. I understand and agree to the Mashreq Al Islami Platinum Credit Cardholder Agreement and Statement of Disclosure. I further agree that the contents of the Mashreq Al Islami Platinum Credit Cardholder Agreement and Statement of Disclosure including amendments which Mashreq Al Islami may make from time to time will be binding upon me. I am fully aware that this application constitutes an application for credit and that I will have to repay all outstanding liabilities through the use of the Mashreq Al Islami Platinum Credit Card, and that I have the necessary means to repay these amounts within the prescribed period. I hereby authorise the Bank to select and debit any of my Mashreq Al Islami/Mashreq Current Accounts or Savings Accounts against the Credit Card amount due. I understand that the right of assigning credit and/or cash limit is upon the sole discretion of the Bank.
I hereby agree and give my consent for the disclosure by Mashreq Al Islami - an Islamic Banking arm of Mashreq (Mashreq Al Islami Finance Company pjsc and Islamic Banking Division, MashreqBank psc) (the ‘Bank’), from time to time, of all or any information and data relating to me and any credit facility availed or to be availed by me (including but not limited to details of credit card transactions, repayment history and defaults) as the Bank may deem appropriate to any member of the Bank’s group, any other bank or financial institution, credit bureau, agency and/or any other institution that the Bank in its sole discretion may determine.
Islamic Banking Division of Mashreqbank psc Formerly known as Badr Al Islami, Islamic Banking Division of Mashreqbank psc
احلد الئتماين / دفعات ال�سداد ال�سهري رقم احل�ساب البنكي/ رقم البطاقة الئتمانيةا�سم البنكاملنتج
بطاقة ائتمانية /
قر�ص
بطاقة ائتمانية /
قر�ص
بطاقة ائتمانية /
قر�ص
اإقرار بطاقة االئتمان
لغايات اللتزام بالقوانني والأنظمة املتبعة ولأجل: )1( احل�سول على املعلومات ال�سخ�سية، )2( اإدارة احل�ساب/ احل�سابات اخلا�سة بي/ بنا، والعمليات التي تتم عليها من قبلي/ قبلنا )3( احل�سول
على اأو التقدم بطلب لأي منتج اأو خدمة مبا يف ذلك على �سبيل املثال ل احل�رس القرو�ص، بطاقات الئتمان، مبوجبه نقبل ونوافق ونفو�ص تفوي�سًا نهائيا وغري قابل لالإلغاء اأو الرجوع فيه، كل من
البنك وال�رسكات التابعة له ووكالءه واأي طرف ثالث متعاقد مع البنك لأداء خدمة اأو اأي �سخ�ص / جهه اأخرى وح�سب ما يراه البنك منا�سبًا مبح�ص اختياره املطلق للقيام بـ:
ا�ستالم وطلب واحل�سول على وتاأكيد وجتديد كافة املعلومات املتعلقة بي/ بنا على �سبيل املثال ل احل�رس املعلومات ال�سخ�سية اخلا�سة بي، تفا�سيل احل�سابات، ك�سوف احل�سابات، القرو�ص، -
الت�رسيح وتبادل املعلومات مع اأي من اجلهات احلكومية و�سبه احلكوميه و/اأو اجلهات اخلا�سة على �سبيل املثال ل احل�رس الحتاد للمعلومات الئتمانية اأو اأي جهة كانت. -
و اأتعهد / نتعهد وبانتظام بتزويد البنك بكافة املعلومات التي يطلبها مني/ منا وجتديدها طوال فرتة كوين/ كوننا عميال لدى البنك. بناء على الطلب املقدم من قبلي للح�سول على البطاقة البالتينية
الئتمانية من امل�رسق الإ�سالمي، مبوجبه اأقر باأن كافة البيانات الواردة يف هذا الطلب �سحيحة وفقا لعلمي واأفو�ص مبوجبه امل�رسق الإ�سالمي باإجراء اأي وكافة التحقيقات الئتمانية التى يراها مالئمة
والتى ت�سمل التوا�سل مع البنك /الفرع الذي اأتعامل معه للتحقق من �سحة ك�سوفاتي البنكية. اأنا اأدرك باأن لبنك امل�رسق الإ�سالمي احلق يف رف�ص هذا الطلب بدون حتديد اأي اأ�سباب وباأن الطلب
وامل�ستندات الداعمة له ) �سامال �سيك ال�سمان ( �ست�سبح جزءا من �سجالت امل�رسق الإ�سالمي ولن يتم اإرجاعها يل. كما اأدرك اأي�سا باأن اتفاقية حامل البطاقة البالتينية الئتمانية من امل�رسق الإ�سالمي
وبيان الإف�ساح �سيتم توفريها يل مع البطاقة البالتينية الئتمانية من امل�رسق الإ�سالمي و/اأو على موقع امل�رسق الإ�سالمي ب�سبكة الإنرتنت وباأن اإقراري بالبطاقة / البطاقات ميثل اإقرار من جانبي
على اأنني قد قراأتهما. اأنا اأفهم واأوافق على اتفاقية البطاقة البالتينية الئتمانية من امل�رسق الإ�سالمي وبيان الإف�ساح. كما اأوافق اأي�سا على اأن حمتويات اتفاقية البطاقة البالتينية الئتمانية من امل�رسق
الإ�سالمي وبيان الإف�ساح �سامال التعديالت التى قد يجريها بنك امل�رسق الإ�سالمي من وقت لآخر �ستكون ملزمة يل. اأنا مدرك بالكامل اأن هذا الطلب ميثل طلبا للح�سول على ائتمان وباإنه �سيتوجب
علي رد جميع اللتزامات البنكية مع بنك امل�رسق عرب ا�ستعمال البطاقة البالتينية الئتمانية من امل�رسق الإ�سالمي، وباإنني اأمتلك الو�سائل ال�رسورية لت�سديد هذه املبالغ �سمن املدة املقررة. مبوجبه
اأفو�ص البنك يف اختيار واخل�سم من اأي من احل�سابات اجلارية اأو ح�سابات الدخار اخلا�سة بي لدى امل�رسق الإ�سالمي / امل�رسق مقابل املبلغ امل�ستحق على بطاقة الئتمان. اأنا اأدرك باأن حق حتديد
الئتمان و/اأو احلد النقدي هو بناء على خيار البنك املطلق.
مبوجبه اأوافق واأوكد موافقتي على الإف�ساح من قبل امل�رسق الإ�سالمي – فرع املعامالت البنكية ال�سالمية ببنك امل�رسق ) �رسكة امل�رسق الإ�سالمي املالية �ص م ع ( من وقت لآخر عن جميع واأي من
املعلومات والبيانات املتعلقة بي واأي من الت�سهيالت الئتمانية التي ح�سلت عليها ) والتي ت�سمل ول تنح�رس يف تفا�سيل معامالت بطاقة الئتمان، تاريخ ال�سداد والتخلف يف ال�سداد ( ح�سبما يراه
البنك مالئما اإىل اأي ع�سو من جمموعة البنك، اأي بنك اآخر اأو موؤ�س�سة مالية، مكتب ائتماين وكالة و/اأو اأي موؤ�س�سة اأخرى قد يحددها البنك بناء على اختياره املطلق.
I further authorise the Bank to obtain and/or verify, from time to time, any information or data relating to me (including but not limited to details of previous credit card transactions, repayment history and defaults) as the Bank may deem appropriate from any third party as the Bank in its sole discretion may determine.
Signature of Principal Card Applicant
This application is signed in the Emirate of* Date
(Mandatory for applications signed in Abu Dhabi)
This application has to be filled and submitted in original.
In case of any mismatch of information on this application form with information provided on certified copies of the original documents, the information on the certified copies of the original document will be taken by the Bank as true and accurate, and will supercede the information on the application form for the purpose of opening the account and updating the Bank’s official records. I hereby agree and give my consent to Mashreqbank psc to communicate various offers and promotions undertaken by the bank from time to time and also send alerts if any, on the Supplementary Cardholder’s mobile number and e-mail id provided by me.
كما اأفو�ص البنك اأي�سا باحل�سول على و/اأو التحقق من �سحة، من وقت لآخر، اأي معلومات اأو بيانات تت�سل بي )والتي ت�سمل ولتنح�رس يف معامالت بطاقة الئتمان ال�سابقة، تاريخ الت�سديد
اأو التخلف يف الت�سديد ( ح�سبما يراه البنك مالئما من اأي من الأطراف الأخرى ح�سبما يحدده البنك بناًء على اختياره املطلق.
توقيع حامل البطاقة الرئي�سي
التاريخ مت التوقيع على هذا الطلب يف اإمارة *
) اإلزامي للطلبات التي يتم توقيعها يف اأبوظبي (
يجب تعبئة هذا الطلب وتقدميه يف الن�صخة الأ�صلية
يف حالة عدم تطابق املعلومات الورادة بهذا الطلب مع املعلومات الواردة بالن�صخ املعتمدة من امل�صتندات الأ�صلية، فاإن املعلومات الواردة بالن�صخ املعتمدة من امل�صتندات الأ�صلية �صيتم اأخذها كمعلومات
�صحيحة ودقيقة بوا�صطة البنك، و�صوف تن�صخ وتلغي املعلومات الواردة بالطلب لأغرا�ش فتح احل�صاب وحتديث ال�صجالت الر�صمية للبنك. مبوجبه اأوافق واأقبل قيام بنك امل�رشق �ش م ع تقدمي
كافة العرو�ش واحلمالت الرتويجية التي يتم تنفيذها بوا�صطة البنك من وقت لآخر بالإ�صافة اإىل اإر�صال اإ�صعارات تنبيه، اإن وجدت، على رقم الهاتف املتحرك حلامل البطاقة امللحقة وعنوان بريده