I&M Visa Infinite Credit Card

Name

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PERSONAL DETAILS

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Card*

First Name*

Second name*

Last name*

Preferred name on card*

ID/Passport No*

Nationality*

KRA PIN*

P.O Box*

Postal Code*

Physical Address*

Occupation*

Maritial Status*

No. of Dependants*

Education Level*

Current Residence*

Email (For card statements)*

Mobile No.*

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NEXT OF KIN DETAILS

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Full Name

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Relationship

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Email

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Mobile No.

CARD DETAILS

Amount applied for in figures (KES)*

Please enter a number greater than or equal to 1.

Amount applied for in words*

Select branch for card collection*

EMPLOYMENT /INCOME DETAILS

Are you employed or self employed?*

Employed

Self-Employed

FOR SALARIED INDIVIDUALS ONLY

Name of Employer*

Company Email Address*

Terms of Employment*

Contract Expiry Date*

Employed From*

Employed to*

Net Income Per Month*

Position Held*

FOR SELF EMPLOYED INDIVIDUALS ONLY

Name of Business*

Nature of Business*

Physical Address*

Annual Turnover*

Please enter a number greater than or equal to 1.

Retail trade listing*

Wholesale trade listing*

Service listing*

Manufacturing listing*

FINANCIAL DETAILS AND REFEREES

FINANCIAL DETAILS
Please provide details of loans/advances and other accounts held with other banks

Bank*

Branch*

Other account number(s)*

Loan/Advance account numbers

Bank

Branch

Other account number(s)

Loan/Advance account numbers

REFEREES (Should be different from next of kin)
Please provide details of loans/advances and other accounts held with other banks

Name*

Email Address*

Relationship*

Mobile No.*