Customer Request Form
Name:*
CPR No: *
Mobile:*
Home:*
Office:
Fax:
Visa Card:
Select
Platinum
Gold
Classic
Corporate
Student
Internet
Card Number:
MasterCard:
Select
Platinum
Gold
Classic
Internet
Card Number:
JCB:
Select
Gold
Classic
Card Number:
Attachment:
Yes
No
Card
Payment Slip
Others
Please select at least one reason
Card Replacement:
Card Only
Card & Pin
Lost/Stolen
Magnetic/damaged
Security/Fraud
Reason:
(Subject to BD 5 fee)
Card Reactivation:
Reason:
Limit Increase:
Permanent Increase (attach copy of latest pay slip)
Temp Increase:
Amount Requested:
For:
Select
One Month
Two Month
Three Month
(Subject to BD 10 fee)
Limit Decrease:
Reason:
Amount Requested:
Fixed Deposit Release:
Reason:
Card Status Letter:
Select
Balance
Nil Balance
Cancellation
Others
Statement Copy:
Select
Original Copy
Reprint Copy
(Subject to BD 2 fee per copy)
Frequent Flyer Program:
Enrollment Existing Gulf Air:
Tele Bank Pin No.:
Select
New
Reset
This form was submitted to: *
CrediMax Main Office
BBK Branch.Please specify the branch:
Online
Fax
Attachments:
(Maximum 3 MB)
I declare that the information stated in this form is true and correct to the best of my knowledge.
Signature:
Date:
Fields Marked * are compulsory