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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
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
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 billing address. I acknowledge that the Card has a fixed credit limit of S$500. Accordingly, by applying for the Card, I agree that my preferred credit limit for the Card is S$500. I agree that in the event the Citibank Credit Card(s) are not collected by me from you, the Citibank Credit Card(s) may be sent to me at my risk by mail to my billing 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. 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 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. "Privacy Circular" refers to the notification provided by Citibank to explain the purposes for its collection, use and disclosure of personal data (as defined in the Personal Data Protection Act 2012 of Singapore).
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 (https://www.citibank.com.sg/global_docs/pdf/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.
"Products" refers to products which Citibank may in its discretion agree to make available to me/us 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 in Citibank's online portal www.citibank.com.sg, and the term "Product" shall be construed accordingly.
"Services" refers to the services which Citibank may in its discretion agree to make available to me/us 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 in Citibank's online portal www.citibank.com.sg, and the term "Service" shall be construed accordingly.
Where I have indicated a Ready Credit SmartCash Preferred Credit Limit, I acknowledge and agree that you may assign me with a Ready Credit SmartCash Credit Limit which is equal to or lower than such indicated Preferred Credit Limit(s). Where I have not indicated my Ready Credit SmartCash Preferred Credit Limit, I consent to you assigning me with a Ready Credit SmartCash Credit Limit which is not more than the maximum credit limit permitted by law or your policies.
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/We understand that the EMV chip on all my/our 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/we have not activated such cards to be used for Overseas Transactions (please refer to Section 8).
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. 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.
In the event my Citibank credit card(s) and Citibank Ready Credit/Ready Credit Smart Cash application has/have rejected, I acknowledge that Citibank will not be updating their records with any personal details provided in this application form.
In the event Citibank receives an instruction: (1) to update to my contact details or (2) to issue a new TPIN/ATM PIN or Credit Card PIN to me; or (3) to mail cheque book to me, I agree that Citibank will (but shall not be obligated to) send an SMS and/or email alert to inform me accordingly. In connection with my application, I agree that by sending a SMS "citiapply" to 72484, I confirm that Citibank can contact me (including via my telephone) to follow-up on the application and my interest in Citibank products and services.
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 Citibank 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 Citibank considers appropriate.
Acknowledgement of Singapore Policy Force Advistory
I have read and agree to the following:
a) My account is for my own use only. I may be held criminally liable if my account is used by others, e.g. for criminal activities. I confirm that I will not:
- disclose the details of my account and/or credentials to anyone else.
- let anyone else access, operate or control my account.
- receive or transfer money for anyone else using my account, 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 is 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. A failure to do so would subject my account to additional risk mitigation measures, and in some cases, Citibank may terminate or restrict my use of my account and other related account I may have with Citibank.
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: