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- Citibank Clear Card Application Form
- Personal Details
- Employment Details
- Declaration
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- Submission of Documents
* Mandatory fields
Contacting you
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*Mobile Phone Number:
Your second level of authentication for online transactions will be sent by SMS to this mobile phone number
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*Email Address:
Where you live
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Residence:
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*House Block No.:
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Unit No.:
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*Street:
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Building:
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*Postal Code:
* Mandatory fields
Please fill in your employment details
- *Company Name:
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*Nature of Business:
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Others (Please Specify)
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*Job Status:
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Others (Please Specify)
- *Occupation:
- *Monthly Salary: S$
- Office Address
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*Blk/No.:
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Unit No.:
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Building:
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*Street:
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*Postal Code:
- *Office Telephone Number:
Extension:
- *Length of Employment:
years
months
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*Online CPF Submission:
Yes
No
Please note that you would have to submit your Payslips as supporting documents along with your completed and signed application form to us at sgcardsales2@citi.com
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To complete your Online CPF Submission now, please visit www.citibank.com.sg/cpf
Once you have completed your Online CPF Submission, please fill in the date and time of completion:
Date: / / - Time:
- *Send my bill to: Home Office
* Mandatory fields
Please fill in your education details
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*Education Institute:
NUS NTU SMU SIM -
Others
(Please Specify)
If you are a tertiary student, please note that tertiary students only from the following education institutions are eligible to apply: NTU, NUS, SMU, SIM, SUTD, SIT, University of Chicago Booth chool of Business, DigiPen, ESSEC, GIST-TUM Asia, INSEAD, SP Jain, Tisch, UNLV, Nanyang Polytechnic, Ngee Ann Polytechnic, Republic Polytechnic, Singapore Polytechnic, Temasek Polytechnic, LASALLE-SIA and NAFA.
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*Length of Course: years
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*Currently studying in: year
* Mandatory fields
Please fill in your parent's / guardian's details
Compulsory if applicant is below 21 years old.
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*Name of Parent/Guardian (as in NRIC/Passport) :
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*NRIC:
- Contact Number:
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Office:
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*Mobile Number:
* Mandatory fields
*Please fill in any Senior Public Figure Declaration
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No. I/my immediate family members do not hold and have never held a Senior Public Figure position and am/are not actively seeking and am/are not being considered as a Senior Public Figure position.
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Yes, I/my immediate family members:
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For a Senior Public Figure* position (Please elaborate)
Position Details:
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If not current, please state period when the Senior Public Figure was held:
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From:
/ / -
To:
/ /
- A "Senior Public Figure" is a senior official in the executive, legislative, administrative, military or judicial branches of a government, whether or not elected, a senior official of a major political party, or a senior executive of a government-owned or government-funded corporation, institution or charity.
- A "Senior Public Figure" also includes any entity that has been formed by or on behalf of a Senior Public
Figure, in which the Senior Public Figure is a beneficial owner (in part or in full) of the entity or exercise actual
or effective control over the entity.
In addition, a "Senior Public Figure" includes the immediate family of a Senior Public Figure and any close associate or relative of a Senior Public Figure. A close associate is a person who is widely and publicly known to maintain an unusually close relationship with and able to conduct financial transactions on behalf of a Senior Public Figure.
*Please fill in any Source of Revenue/Wealth from Cannabis Declaration
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Do you derive 10% or more of your total revenue or wealth directly from the production, sale or distribution of cannabis^?
Yes No
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If yes, please fill up this form and email it together with the rest of the relevant documents to sgcardsales2@citi.com
^Production, sale or distribution of cannabis includes handling cannabis at any point from seed to sale as well as the manufacture of cannabis drug paraphernalia, the manufacture of equipment used solely in the production of cannabis, and promotion of cannabis use.
Review your Credit Card Application
Please check all the information you have entered, in order to ensure accuracy. Please note that once you click "NEXT", you will not be able to access the details you have entered. Before you proceed to the next page to complete your application, you can use the "EDIT" button below if you need to make any changes.
Personal Details
First Name : |
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Last Name : |
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Hanyupinyin Name : |
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Alias Name : |
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Hanyupinyin Alias Name : |
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Married Name : |
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Name to appear on your card : |
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NRIC : |
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Date of Birth : |
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Nationality : |
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Permanent Resident : |
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Residence : |
Owned |
Marital Status : |
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House Blk/No. : |
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Unit # : |
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Street : |
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Building : |
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Postal Code : |
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Mobile Number : |
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Number of Dependants : |
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Email Address : |
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Educational level : |
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Send my bill to : |
Senior Public Figure Declaration
Senior Public Figure Declaration : |
Position details : |
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From : |
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To : |
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Source of Revenue/Wealth from Cannabis Declaration
Source of Revenue/Wealth from Cannabis Declaration : |
Employment Details
Company Name : |
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Nature of Business : |
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Job Status : |
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Occupation : |
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Monthly Salary : |
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Company Address : |
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Office Number : |
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Length of Employment : |
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Online CPF Submission : |
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Education Details
Educational Institute : |
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Length of course : |
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Currently studying in : |
Your Parent's / Guardian's Details
Name of Parent/Guardian : |
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NRIC : |
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Office Number : |
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Mobile Number : |
Overseas Usage Activation
Overseas Usage Activation : |
Information on Products and Services
Your application is yet to be completed
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In order to complete your application, please print your form, sign and email it to us at sgcardsales2@citi.com along with the following supporting documents:
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- Front and back copy of your NRIC
- A copy of your matriculation card
Your application is yet to be completed
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In order to complete your application, please print your form, sign and email it to us at sgcardsales2@citi.com along with the following supporting documents:
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- Front and back copy of your NRIC
- A copy of your matriculation card
- Front and back copy of your parent's/guardian's NRIC
- Your parent/guardian must also sign the application form.
Your application is yet to be completed
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In order to complete your application, please print your form, sign and email it to us at sgcardsales2@citi.com along with the following supporting documents:
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- Your income documents. You can choose either one of the following options:
- Complete your Online CPF submission at www.citibank.com.sg/cpf (Please disregard this if you have previously completed your Online CPF submission) OR
- Submit a copy of your payslips to us at the email address stated above
- Front and back copy of your NRIC
- Your income documents. You can choose either one of the following options:
Just 3 more steps to complete your Credit Card Application
Step 1: Click here to PRINT THIS FORM
Step 2: Sign on the printed form and email it to us at sgcardsales2@citi.com along with your supporting documents.
If you do not have access to a printer, please click here to
SAVE YOUR FORM TO PDF
Step 3: IMPORTANT: To complete your submission, please agree to the terms of the Customer Declarations & Confirmation and click here to COMPLETE YOUR APPLICATION
* I agree to the terms of the Customer Declarations & Confirmation
By clicking "Submit" and providing your personal data, you consent to Citibank Singapore Limited contacting you to market Citibank products and services including via the telephone.
By clicking "Submit" and providing your personal data, you consent to Citibank contacting you to market Citibank products and services including via the telephone. You can find more information about Privacy here >>
Click here to view Cardmember Agreement.
Personal Details
First Name : |
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Last Name : |
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Hanyupinyin Name : |
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Alias Name : |
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Hanyupinyin Alias Name : |
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Married Name : |
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Name to appear on your card: |
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NRIC : |
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Date of Birth : |
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Nationality : |
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Permanent Resident : |
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Residence : |
Owned |
Marital Status : |
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House Blk/No. : |
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Unit # : |
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Street : |
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Building : |
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Postal Code : |
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Mobile Number : |
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Number of Dependants : |
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Email Address: |
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Educational level : |
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Send my bill to : |
Senior Public Figure Declaration
Senior Public Figure Declaration : |
Position details : |
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From : |
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To : |
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Source of Revenue/Wealth from Cannabis Declaration
Source of Revenue/Wealth from Cannabis Declaration : |
Employment Details
Company Name : |
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Nature of Business : |
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Job Status : |
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Occupation : |
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Monthly Salary : |
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Company Address : |
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Office Number : |
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Length of Employment : |
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Online CPF Submission : |
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Education Details
Educational Institute : |
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Length of course : |
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Currently studying in : |
Your Parent's / Guardian's Details
Name of Parent/Guardian : |
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NRIC : |
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Office Number : |
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Mobile Number : |
Overseas Usage Activation
Overseas Usage Activation : |
Customer Declaration
Any reference in this Declaration to "you", "your" "Citi" or "Citibank" shall mean Citibank Singapore Limited.
By signing below, I ask that a Citibank Clear Card ("Card") account be opened for me and a Card issued to me. I agree that the Card may be sent to me at my risk by mail to my home address.
I agree that my use of the Card account, shall be governed by the Citibank Clear Cardmember’s Agreement, and I agree to be bound thereby.
I acknowledge that you may at your absolute discretion and without giving any reason, delay the issuance of my Citibank Credit Card(s) and/or impose such conditions restricting my use of the Citibank Credit Card(s) to effect any card transaction and/or my operation of the card account. In connection thereto, I agree to accept and comply with any such conditions that you may impose.
Where I have existing unsecured credit facilities with you, I agree and consent to your reviewing and adjusting the credit limit of such unsecured facilities in your absolute discretion in accordance with regulatory requirements and your credit and risk management policies.
I understand that the EMV chip on all my Citibank Credit Card(s) and Ready Credit Card remains active for any Overseas Point of Sale EMV transactions and such transactions will be processed even if I have not activated such cards to be used for Overseas Transactions (please refer to Section 05).
In the event this application is rejected, I acknowledge that Citi will not be updating their records with my personal details provided in this application form.
General Representations, Warranties and Acknowledgements
1. I warrant that all information and documents furnished by me are true and accurate. I acknowledge that in considering my application, you will rely on such information and that you may in your absolute discretion reject my application without assigning any reason therefore.
2. I confirm that at the time of this application, I am not an undischarged bankrupt and to my knowledge, there are no current or pending or threatened legal or bankruptcy proceedings against me or statutory demands served on me. I further confirm that no debt repayment scheme under the Bankruptcy Act (Chapter 20) is applicable to me.
3. In the event Citi receives an instruction: (1) to update my contact details or (2) to issue a new TPIN/ATM PIN or Credit Card PIN to me; or (3) to mail a cheque book to me, I agree that Citi will (but shall not be obligated to) send an SMS and/or email alert to inform me accordingly.
4. I agree to provide proof of my residential address in Singapore in connection with my application, failing which, I agree that Citi may reject my application or close any or all of my Citi account(s) (as the case may be) without further reference to me.
5. I understand that I am solely responsible for my own tax affairs and obligations.
6. I have not been convicted of any tax crime in any jurisdiction and, as far as I am aware, I am not under any ongoing investigation by any tax authority or law enforcement agency for alleged criminal or fraudulent conduct related to tax evasion.
7. Any assets deposited, or to be deposited, in my account(s) do not represent the proceeds of any criminal conduct (including tax crimes).
8. My new and existing account(s), and the assets deposited into them, including income with respect to such assets have been, and will continue to be, declared to the relevant tax authorities, or are not legally required to be disclosed to the relevant tax authorities.
9. I will notify Citibank promptly upon any change in the representations and warranties set out herein.
10. Each beneficial owner has authorized me to make the representations and warranties set out herein on their behalf.
11. Acknowledgement of Singapore Police Force Advisory
I have read and agree to the following:
(a) My account(s) is/are for my own use only. I may be held criminally liable if my account(s) is/are used by others, e.g. for criminal activities. I confirm that I will not:
• disclose the details of my account(s) and/or credentials to anyone else.
• let anyone else access, operate or control my account(s).
• receive or transfer money for anyone else using my accounts(s), unless I know him/her and know where he/she is.
(b) I can be convicted for the relevant offences under the Corruption, Drug Trafficking and other Serious Crimes (Confiscation of Benefits) Act 1992 (“CDSA”) if my account(s) is/are used for criminal activities. I understand that any person convicted of an offence under the CDSA may be liable for a fine up to S$250,000, or imprisonment of up to five years, or both.
(c) I should make the necessary application to Citibank if I wish to authorize a third party to operate, access and/or control my account(s). A failure to do so would subject my account(s) to additional risk mitigation measures, and in some cases, Citibank may terminate or restrict my use of my account(s) and other related account(s) I may have with Citibank.
I shall be aware of the laws, regulations and rules in my country of citizenship, domicile or residence (including where I am a resident for tax purposes), applicable to my use of Citi's products, banking and financial advisory services, including any tax, foreign exchange or capital controls, and for all payment, reporting or filing requirements. Citi shall not be liable for any loss or liability imposed by my country of citizenship, domicile or residence (including where I am a resident for tax purposes), on me as a result of my non-compliance with any such regulations, laws, rules or legal process.
#Applicable to individuals who are non-Singapore citizens or are domiciled or residing outside Singapore (including individuals who are residents outside of Singapore for tax purposes).
Banking Secrecy Waiver/Privacy Circular/Privacy Preference
1. I authorise you to obtain and verify any information about me as you deem fit in your absolute discretion. I authorise your transfer and disclosure of any information relating to me (including information you obtain from third parties such as any credit bureau recognised by the Monetary Authority of Singapore (”MAS”) under or pursuant to the Banking Act (Chapter 19)), to and between the branches, subsidiaries, representative offices, affiliates and agents of Citi, N.A. and third parties selected by any of them or you, wherever situated, for confidential use (including for use in connection with the provision of any Products or Services to me and for data processing, statistical and risk analysis purposes, global cash services and dealings in securities on the Singapore Exchange Securities Trading Limited and any other relevant authorities and agencies pertaining thereto). You and any of Citibank, N.A.’s branches, subsidiaries, representative offices, affiliates, agents or third parties selected by any of them or you, shall be entitled to transfer and disclose any information as may be required by applicable law, court, regulator or legal process.
2. Without prejudice to the generality of the foregoing, where you are a member of, or subscriber for, the information sharing services of, any credit bureau recognised by the MAS under or pursuant to the Banking Act (Chapter 19), I expressly authorise:
(a) you to transfer and disclose to any such bureau; and
(b) any such bureau to transfer and disclose to any fellow member or subscriber as may be recognised as such by MAS, any information relating to me and/or any of my account(s) with you (and for such purposes) as may be permitted under or pursuant to the Banking Act (Chapter 19).
3. I have read, understood and agree to the terms of, and that you may collect, use and disclose information about me in the manner and for the purposes as described, in the Privacy Circular FINAL_CSL_PDPA_Circular.pdf, also available at Citibank website (Footer)>Privacy> Personal Data Protection and You>Privacy Circular). A copy of the Privacy Circular will be provided to me upon my request. Further, if I am a foreign national/resident and where a data privacy circular applicable to my country of nationality/residency has been prepared by Citi (whether now or in the future) to address applicable data privacy requirements, I acknowledge that I agree to the terms of such data privacy circular as set out in the Citibank Singapore Website (Website Footer > Privacy) which may be updated by Citi from time to time.
4. “Privacy Circular” refers to the notification provided by Citi to explain the purposes for its collection, use and disclosure of personal data (as defined in the Personal Data Protection Act 2012 of Singapore.
5. “Products” refers to products which Citi may in its discretion agree to make available to me from time to time, including but not limited to those products listed under the general section in the Citibank Singapore Global Consumer Banking Terms and Conditions entitled “PRODUCTS” and as set out on our Citibank website, and the term “Product” shall be construed accordingly.
6. “Services” refers to the services which Citi may in its discretion agree to make available to me from time to time, including but not limited to those services listed under the general section in the Citibank Singapore Global Consumer Banking Terms and Conditions entitled “SERVICES” and as set out on our Citibank website, and the term “Service” shall be construed accordingly.
7. I request that you introduce, offer or provide me with information relating to Products and Services which you consider may be of interest to me. I agree that Citi will from time to time communicate information in relation to such Products or Services to me either specifically or generally to all customers like me via such communication modes as Citi considers appropriate.
8. I agree that Citi may call/contact me regarding this application and any such calls may be recorded for quality and training purposes.
Information on Products and Services
Please sign as you would for all future transactions
Date:
Parent's/Guardian's Consent
I authorise you to obtain and verify any information about me as you deem fit in your absolute discretion. I authorise the transfer and disclosure of any information relating to me (including information you obtain from third parties such as any credit bureau recognised by the Monetary Authority of Singapore (”MAS”) under or pursuant to the Banking Act (Chapter 19)), from you to and between the branches, subsidiaries, representative offices and affiliates and agents of Citibank, N.A. and third parties selected by any of them or you, wherever situated, for confidential use (including for use in connection with the provision of any products or services to me, and for data processing, statistical and risk analysis purposes, global cash services and dealings in securities on the Singapore Exchange Securities Trading Limited and any other relevant authorities and agencies pertaining thereto). You and any Citibank, N.A. branch, subsidiary, representative office, affiliate, or third party selected by any of them or you may transfer and disclose any information as may be required by any applicable law, court, regulator or legal process.
Without prejudice to the generality of the foregoing, where you are a member of, or subscriber for the information sharing services of, any credit bureau recognised by the MAS under or pursuant to the Banking Act (Chapter 19), I expressly authorise:
(a) you to transfer and disclose to any such credit bureau; and
(b) any such bureau to transfer and disclose to any fellow member or subscriber as may be recognised as such by MAS, any information relating to me and/or any of my account(s) with you (and for such purposes) as may be permitted under or pursuant to the Banking Act (Chapter 19). I also expressly consent and agree, on behalf of the Applicant to the release, disclosure and/or other use of information relating to the Applicant as set out above and in the Citibank Clear Cardmember’s Agreement. I warrant that all information and documents furnished by me are true and to documents and that you may in your absolute discretion reject my application without assigningany reason therefore. I confirm that at the time of this application, I am not an undischarged bankrupt and to my knowledge, there are no current or pending or threatened legal or bankruptcy proceedings against me or statutory demands served on me. I further confirm that no debt repayment scheme under the Bankruptcy Act (Chapter 20) is applicable to me.
Date:
