ACCOUNT NAME:

LAST NAME

FIRST NAME

MIDDLE NAME

NICK NAME:

COMPANY NAME:

PRESENT HOME ADDRESS :

HOME PHONE NO. :

OFFICCE PHONE NO. :

MOBILE NO. :

E-MAIL :

BIRTHDATE (dd/mm/yyyy) :

SEX :

PLACE OF BIRTH :

NATIONALITY :

MOTHER'S MAIDEN NAME :

OCCUPATION :

FOR BANK USE ONLY (IDs presented)

CID NO. :

ID Details

Issuance/Expiry Date

Place Of Issue

Referred/ID Guaranteed by:

1)

2)

RELATED PERSONAL ACCOUNTS WITH CHINATRUST OR CHINATRUST CARDS

Account Card No.

Type

Joint Depositor, if any

1)

2)

3)

I declare the above information to be correct. I hereby acknowledge to have received, read, understood and agreed to bound by the

general terms and condition applicable and governing my card account application. I agree to notify you in writing of any change in the

information supplied in this form.

Print Name and Sign

Account Application Approved by:

OCA Performed by:

Card Number:

Date:

Date:

Account Number: