Scotiabank Credit Card Application Form
P
lease indicate which Scotiabank credit card you are applying for:
M
y gross monthly income is over $33,000
V
isa
®
A
ADvantage Visa
®
G
old Visa
®
M
asterCard
®
M
agna
TM
M
asterCard
®
G
old MasterCard
®
P
latinum USD MasterCard
®
I
f you are already a member of MAGNA or AAdvantage Loyalty Programme, please enter your membership number here
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WWoouulldd yyoouu lliikkee aann aaddddiittiioonnaall ccaarrdd ffoorr yyoouurr ssppoouussee?? YYeess NNoo IIff yyeess,, ccoommpplleettee tthhiiss sseeccttiioonn..
Mr. Mrs.
Miss
F
irst Name Last name
DDMMYY
Single Married
Divorced Widow (er)
Own Rent
Other
Years Months Years Months
Date of Birth Marital Status Time at Current Residence If less than 2 years
Time at Previous Residence
Home Phone # Cel Phone # Passport / National ID Mother’s Maiden Name
( ) ( )
( )
Full-time Self-employed
Part time
Employer Occupation Work Phone #
Years Months Years Months
Time with present Company If less than 2 years Gross monthly Income Other monthly Income
Time at Previous Company
Name of Reference (Person not living in your household) Address City Country
$
$
( )
Occupation Telephone # TRN
First Name Last name
DDMMYY
( ) ( )
Passport / National ID Employer Occupation
( )( )
Work Phone # T
ime with Employer Monthly Income
Full-time Part-time
Self-employed
Years Months
$
$ $ $
Rent / Mortgage Payment Monthly If homeowner, Property Value Existing Mortgage on Home Name of Lender
$
Name of Lender Balance Monthly Payment
$
Name of Lender Balance Monthly Payment
$
Name of Lender (if, any) Value Monthly Payment
Credit card Yes No
Personal Loan? Yes No
Assets? Car Other
I am a Scotiabank Customer Yes No Chequing Savings
Investment
601
ScotiaCard # (If applicable)
Would you like to insure your Scotiabank Credit Cards? Yes No
If yes, will the coverage be Single Coverage Joint Coverage
You understand that to be eligible for coverage, you must be 18 years of age and under 70 to enroll; and that your coverage will be bound by the Terms and Conditions stated in your Certificate of Insurance. Furthermore you
authorise the Bank to provide the insurer with your Scotiabank Credit Card account number
, monthly statement balance and any other necessary information; and you authorise the insurer to charge monthly premiums to your
Scotiabank Credit Card account.
I (WE) hereby certify that above information to be true and complete. If this application is accepted by the Bank of Nova Scotia (The “Bank”) I (W
e) request Credit Card Cheques be issued to me (us) as designated above. I (W
e)
hereby authorise and consent to the Bank obtaining further information about me (us) and checking the information I (W
e) have given here and exchanging information about me (us) with other parties. I (W
e) agree to read and
be bound by the Scotiabank Credit Card Cardholder Agreement. I (We) authorise the Bank to debit my (our) credit card account with the amount of the annual fees in effect from time to time for the card.
Applicants’ Signature Date Co-applicant’s Signature Date
* Trademarks of The Bank of Nova Scotia. Trademarks used under authorization and control of The Bank of Nova Scotia.
® MasterCard is a registered trademark of MasterCard International Inc.
® Indicates a registered trademark of Visa International Service Association. Used under licence by The Bank of Nova Scotia
® AmericanAirlines and AAdvantage are marks of American Airlines, Inc.
™ MAGNA card, MAGNA Rewards and MAGNA Rewards Voucher are registered trademarks of MAGNA Rewards Inc.
Date of Birth Phone # Cel Phone #
Address City Country P.O. Box (If applicable)
OLZ00105
CUSTOMER DECLARATION REGARDING UNSECURED LOANS
TO IMMEDIATE RELATIVES OF EMPLOYEES
D
o you have any immediate relative (s) employed at any Scotiabank branch Yes No. If yes, please list names of immediate relatives and branch
Name Branch
Amount Branch
Name Branch
Name Branch
Do you have any unsecured loan outstanding at any Scotiabank branch Yes No. If yes, please list names of amount (s) and the branch
$
Amount Branch
$
Amount Branch
$
I (We) that approval for this application is made conditional upon the correctness of the information provided and that if any information provided is
incorrect then the Bank may at any time make a demand for payment of outstanding loan in full
Applicants’ Signature Date
DECLARATION BY OFFICERS APPROVING LOANS
The officers listed below declare that we are satisfied that enquiries have been made of the applicant whether any of his/her immediate relative is employed to
the Bank and to the best of my/our knowledge, information and belief there are no such immediate relatives other than those which may be disclosed by the
applicant in this application as provided below
.
Name of Owner Date Signature Date
