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Full Name of the Account Holder
Account No.
Name to be printed on Card
Branch where Account is Maintained
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ÜÉ°ùëdG ºbQ
ábÉ£ÑdG ≈∏Y ¬©ÑW ܃∏£ŸG º°S’G
ÜÉ°ù◊G ¬«a óLGƒàj …òdG ´ôØdG
Debit Card Application Form
DEBIT CARD REQUEST
º°üîdG ábÉ£H Ö∏W IQɪà`°SG
º°üîdG ábÉ£H Ö∏W
(∞∏ÿG ‘ ô¶fG) »H á°UÉîdG º°üîdG ábÉ£ÑH á≤∏©àªdG •hô°ûdG áaɵH ΩGõàdE’G ≈∏Y Éæ≤aGh/â≤aGh »dÉàdÉHh É檡a/⪡ah Éæ©∏WG/â©∏WG ób ÉæfCÉH/»æfCÉH ócDƒf/ócDhCG
I / We confirm that I/we have read, understood and agreed to abide by the Terms and Conditions covering
my Debit Card. (see overleaf)
Signature dfdfdfd
(All Parties to sign if Joint A/c)
™```«bƒàdG
∫õæªdG ∑ôëàªdG
Telephone: Office : Residence: Mobile:
Ö൪dG ∞JÉg
ácôà°ûªdG äÉHÉ°ùëdG »a ±GôWC’G ™«ªL ™«bƒJ
04/12
DEBIT CARD LINKING TO ACCOUNT
Please link my debit card
debit card number
to my account
AED
Account Type Currency Account Number
Authorised Signature(s) Authorised Signature(s)
C/A Signature S/A Signature F/A Signature
Verified Verified Verified
Daily Withdrawal Limit
Card Valid from Application approved
Card Serial No.
Card received
Card encoded
Card collected
DATE
INIT
For Bank use only
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»H á°UÉîdG º°üîdG ábÉ£H §HQ ≈Lôj
º°üîdG ábÉ£H ºbQ
»HÉ°ùM ≈dEG
»JGQÉeEG ºgQO
ÜÉ°ùëdG ´ƒf á∏ª©dG ÜÉ°ùëdG ºbQ
™«bƒàdÉH (ø«°VƒØªdG) ¢VƒØªdG
™«bƒàdÉH (ø«°VƒØªdG) ¢VƒØªdG
§≤a ∂æÑdG ΩGóîà°S’
áédÉ©ªdG AóH
ïjQÉàdG
ábÉ£ÑdG ∫ƒ°Uh
ábÉ£ÑdG õ«eôJ
ábÉ£ÑdG ΩÓà°SG
™«bƒJ øe ≥≤ëàdG ºJ
C/A
™«bƒJ øe ≥≤ëàdG ºJ
S/A
™«bƒJ øe ≥≤ëàdG ºJ
F/A
»eƒ«dG Ö°ùëdG óM
øe ájQÉ°S ábÉ£ÑdG
ábÉ£ÑdG π°ù∏°ùJ ºbQ
Ö∏£dG ≈∏Y áØbGƒªdG
