I&M Visa Gold Credit Card

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

Hidden

Relationship

Hidden

Email

Hidden

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.*

ATTACHMENTS FOR SALARIED INDIVIDUAL

Certified copy of latest payslip*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Copy of valid permit (If non-Kenyan)*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Six months certified bank statements for other bank accounts held*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Employer's guarantee * (if available)

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Recent colour passport size photograph***

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

A copy of ID/Passport***

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Loan statement where applicable

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Applicant Signature Upload*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

* Letter of guarantee from employer in format provided by the Bank ** To be provided by those who do not have an account with the Bank

DECLARATION TERMS AND CONDITIONS*

I confirm that all the above details are correct and that I have read, understood and agree to be bound by I&M Bank General Terms and Conditions, and Credit Card Application General Terms and Conditions as amended from time to time and available here . I also agree to indemnify and hold I&M Bank Limited harmless from and against all claims arising from any information that I have provided herein.

PRIVACY NOTICE*

I hereby acknowledge that I have read and understood how the information that I have provided in this form will be used by the Bank as outlined in the Privacy Notice available at here and I consent to usage of this data as stipulated therein.

ATTACHMENTS FOR SELF EMPLOYED

Copy of registration certificate of business*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Copy of current operating licence*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Six months certified bank statements for other bank accounts held*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Recent colour passport size photograph***

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

A Copy of ID/Passport***

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Loan statement where applicable*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

Applicant Signature Upload*

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB.

* Letter of guarantee from employer in format provided by the Bank

** To be provided by those who do not have an account with the Bank

DECLARATION TERMS AND CONDITIONS*

I confirm that all the above details are correct and that I have read, understood and agree to be bound by I&M Bank General Terms and Conditions, and Credit Card Application General Terms and Conditions as amended from time to time and available here . I also agree to indemnify and hold I&M Bank Limited harmless from and against all claims arising from any information that I have provided herein.

PRIVACY NOTICE*

I hereby acknowledge that I have read and understood how the information that I have provided in this form will be used by the Bank as outlined in the Privacy Notice available at here and I consent to usage of this data as stipulated therein.

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