Fill and Sign the Appointment Letter of Dc Industry Form

I agree that, subject to the Privacy Act, you and your agents may do the following (and if my application is successful, this agreement continues until such time as any credit provided to me is repaid): • Exchange personal information about me with the Company (including any related entity of the company) and The Benefit People Pty Limited, in connection with the Corporate Card. • Obtain credit reports about me from credit reporting agencies to assess my application or to collect overdue payments from me, and obtain personal information from a motor vehicle or drivers licence registry or from a business that provides commercial credit worthiness information. • Disclose personal information to credit reporting agencies before, during or after providing credit to me. This includes, but is not limited to: the fact that I have applied for a Card and the credit limit, and that you are a credit provider to me; advice about Card payments at least 60 days overdue and which are in collection (and advice that payments are no longer overdue); advice that cheque(s) drawn by me, or direct debit requests to my bank account which I have authorised you to make, which are more than $100 have been dishonoured more than once; your opinion that I do not intend to meet my credit obligations (or that I have committed some other serious credit infringement; and that credit provided to me has been paid or otherwise discharged. • Exchange personal information with credit providers named in this application or in a credit report issued by a credit reporting agency. This is for purposes including but not limited to: assessing my credit worthiness, this application and any subsequent application by me for credit; notifying other credit providers of a default by me; exchanging information about my Card Account where I am in default with other credit providers; your approval process as to any transactions I wish to make with the Card; and your administration of my Account. • Exchange personal information with any person whose name I give you from time to time. This includes, for example, for the purpose of confirming my employment and income details with any employer, landlord/mortgagee, accountant, financial adviser or tax agent named in this application. • If I am in default under my Card Account, notify and exchange personal information with your collection agent. • Provide personal information to any organisation whose name, logo or trademark appears on my application or on the Card issued to me for marketing, planning, product development and research purposes. This includes The Benefit People Pty Limited who will act as administrators of the Program and will obtain periodic information from American Express about my use of the Card for this purpose. • Use personal information for marketing purposes. This includes putting my name and contact details on marketing lists for the purposes of customer research and offering me goods or services of an American Express company or of any third party, by mail, email or telephone or having your related companies do so directly. After approval of this application, I understand that I can call 1300 36 2639 to remove my name from your marketing lists. • Transfer personal information confidentially to your related companies and other organisations which issue or service American Express Cards or provide services to you, subject to appropriate conditions of confidentiality. This includes transferring personal information to the United States or other countries for data processing and servicing. • Monitor and record my telephone conversations with you from time to time for training, quality control or verification purposes. I also agree that where I have provided you with information about another individual in this application form, I will make sure that the individual is aware of: • my supplying their information to you and the purposes why you have collected the information; and • their ability to access that information in accordance with the Privacy Act (and to advise you if they think the information is inaccurate, incomplete or out-of-date); and the contact details of your Privacy Officer. American Express® Employee Application Australia Limited Liability Customer Service The Corporate Card Hotline is open during business hours for any inquiries about your Card account, for advice on Card services, or to request contact details regarding any American Express Travel Office. Please call on 1300 36 2639 (cost of a local call) between 8.30am – 7.00pm Monday to Friday (Sydney time) or visit our website at: americanexpress.com.au/cs American Express International, Inc. ABN 15 000 618 208 Incorporated with Limited Liability in Delaware, USA. ® Registered Trademark of American Express Company. 20284 THE BENEFIT PEOPLE PTY LIMITED LL 08/03 American Express® Corporate Card Membership Form The Benefit People – Limited Liability Please ensure that all details are completed before you return your enrolment form. Mail To: The Benefit People Pty Limited, PO Box 1992, North Sydney, NSW 2059 2. Employee Details (cont) 1. Corporation Details PD10700201 Corporation Name Telephone ( (company) Position in Company 5. Agreement and Signatures Declaration by Applicant I, the Corporate Card applicant, hereby apply to you (American Express International, Inc.) for an American Express Corporate Card. If issued to me, I agree to comply with the conditions that accompany the Corporate Card. I certify that the information given above in support of my application is true and correct. I acknowledge that you will verify the above information with my employer and other sources. I also authorise you to confirm and exchange credit information concerning my financial affairs as described more fully below. I understand and agree that I will be liable for all charges I make with the Corporate Card and agree to comply with such spending limits as you shall determine from time to time. Years with Company ) Program Administrator’s Name By signing below I acknowledge that I have read and agree to the declaration stated above, and I have read and clearly understood the terms and conditions below and on the reverse of this form. 3. Personal Details The Benefit People Pty Limited to complete Home Address Signature of Applicant Corporate ID Date / / Declaration by Company Signatory (The Benefit People to complete) Cost Centre Name Postcode The Benefit People Employee ID Home Telephone ( ) Own Rent 2. Employee Details Please Tick Mr Buying Years There On behalf of the company named in this application (the ‘Company’), I hereby request issuance of a Corporate Card to the individual named above and certify that the named individual is an employee of the Company. I confirm that the information given in this application form is to the best of the Company’s knowledge true and correct, and that the Company hereby agrees to be bound by the American Express Corporate Card Conditions, with respect to such Corporate Card. Please specify Mrs Ms Dr Male Other Date of Birth / / (mandatory) Please Print Name of Authorised Officer (mandatory) Female Driver’s Licence No. State of Issue Your name as you would like it embossed on the Corporate Card. Surname Signature of Authorised Officer Have you ever held an American Express Card? Present Member Former Member Account No: If you do not provide the information requested or give your agreement below, American Express International Inc. may decline your application. 3 7 6 0 4. Office Use only PROD Postcode 6 0 2 CAN/ DEC Business Telephone ( PROC 3 TEAM FEE DELIV ) REV 7 BILL IND SEX CB REPORT Mailing Address / • collect personal information about you in this application form and from other sources, and • obtain your agreement in relation to handling this personal information. No Email Address Business Address (street) / Authority to American Express International Inc. under the Privacy Act: To assess your application, and if it is approved, to establish and manage your Card Account, American Express International Inc. needs to: Given Names If you wish to receive product offers and service updates from us via email provide your email address below. Date N PRES/ PREV XREF RSN PLAS. IND. 6 The American Express Privacy Policy Statement sets out policies on management of personal information. In accordance with the Privacy Act, you can access personal information about you held by American Express International Inc., and advise if you think it is inaccurate, incomplete or out-of-date. To arrange access to personal information about you, request a copy of the American Express Privacy Policy Statement or enquire generally about privacy matters, write to - The Privacy Officer, American Express International Inc., 175 Liverpool Street, GPO Box 1582 Sydney NSW 2001. C SIGN Y In this section ‘personal information’ means information about me, including about my financial circumstances, my credit worthiness, credit history, credit standing, credit capacity, my use of the Card and conduct of my Account with you. Postcode THE BENEFIT PEOPLE PTY LIMITED LIMITED LIABILITY 08/03