Fill and Sign the Privacy Consent Form

Company Name: ________________________________________________________ Please quote your Company’s Corporate Account Number: (existing accounts only) Applicant Details Please Tick: Title Mr. Mrs. Miss Dr. Other ___________________ Full Name as it appears in your Passport: ________________________________________________________________________ Please insert your name as you would like it to appear on the Card (Max. of 20 letters and spaces) Date of Birth: Day Month Year I, the Corporate Card applicant, hereby apply to Amex (Saudi Arabia) Ltd. for an American Express® Corporate Card. I agree to comply with the terms and conditions that will accompany the Corporate Card when issued. I certify that the information given in support of my application is true and correct. I understand and agree that I will be jointly and severally liable for all charges incurred on the Corporate Card, issued to me. I hereby agree to provide Amex (Saudi Arabia) Ltd. with any information that is requires for establishing and/or administering my accounts and facilities with Amex (Saudi Arabia) Ltd. and I authorise Amex (Saudi Arabia) Ltd. to obtain and collect information as deemed necessary or in regard of me, my accounts and facilities with Amex (Saudi Arabia) Ltd. from the Saudi Credit Bureau (SIMAH) and to disclose that information to SIMAH or to any other agency approved by Saudi Arabia Monetary agency (SAMA). I have read and understood the initial disclosure statement given in this application. To help in the prompt processing of the Corporate Card application, please ensure you have enclosed a copy of your ID / iqama and a copy of your passport. Employee's Signature: _________________________________ Date:_____________ ID number / Iqama: Home Address: P.O. Box: ________________ Postal Code: _________________ City:____________________________________________________________________ Home Tel: ________________________ Mobile: ______________________________ Email: __________________________________________________________________ Position held in Company: ___________________ Employee Number __________ Company Address: P.O. Box: ________________ Postal Code: _________________ City: ______________________________ Country: _____________________________ Company Tel: _______________________________ Fax: _______________________ Have you ever held an American Express Card? Present Member Card Number 3 Former Member No 7 *Please tick to enroll in the Membership Rewards® Programme *Please tick to enroll in the Express Cash Service *These options only valid if the company has approved them. Manager's Approval: ___________________________________ Date:_____________ Declaration by Company Signatory On behalf of the company, named in this application (the Company), we hereby request issuance of an American Express Corporate Card to the individual named above and certify that the named individual is an employee of the Company. We confirm that the information given in this application form is to the best of the company’s knowledge true and correct. We understand and agree that the Company will be jointly and severally liable for all charges incurred on the Card issued to the Applicant. We also understand that American Express reserves the right to decline any application without giving a reason and that no correspondence will be entered into these circumstances. The Company hereby agrees to be bound by the American Express Corporate Cardmember agreement which will accompany the Card when issued upon its approval by Amex (Saudi Arabia) Ltd. The company also declares that the ID documents provided are genuine and represent a true copy of the original. It is essential that the form is counter-signed by an authorised signatory. Signature of Authorised Signatory: ______________________ Date: _____________ Name of Authorised Signatory: ____________________________________________ Position held in Company: ________________________________________________ Monthly Card Limit: ______________________________________________________ Company Stamp: ________________________________________________________ Amex (Saudi Arabia) Ltd, P.O. Box 6624, Riyadh 11452, Saudi Arabia, Toll Free: 800 440 0004, Fax: (+966) 1 201 9449, www.americanexpress.com.sa EMPLOYEE APPLICATION FORM Nationality: __________________________ Passport No: _______________________ Declaration by Applicant Joint & Several Liability The American Express® Corporate Card Employee Application Form – Joint & Several Liability Please read the following important information carefully. If you have any questions, please call our customer service toll-free number on 800 440 0004 or (+966 1) 474 9034. f) Applicable fees Types of Fees a) This account will be billed in the currency that you have chosen, either in US Dollars or Saudi Riyals. As applicable, the annual subscription fee will be included on your first statement of account. c) Your monthly statements can be viewed upon activating your Corporate Interactive application on the website. e) All transactions including Cash Withdrawals, incurred in currencies other than the billing currency of the Card account («Non-Billing Currency»), will be converted into the Card account’s billing currency («Billing Currency»). Unless a specific conversion rate is required by the applicable laws, the American Express Global Network will use conversion rates based on interbank rates which they select from customary industry sources on the business day prior to the date of processing the transaction. A nominal conversion fee of 2.5% on the converted amount will be added by Amex (Saudi Arabia) Ltd. («Amex»), the issuer of your Card. An illustrative example is given below. Transaction value (Non-billing currency) Euro 100 American Express Global Network exchange rate 1 Euro = 1.3572 US$ US$ equivalent US$ 135.72 Currency conversion fee (@ 2.5%) US$ 3.39 Total transaction value in US$ (If US$ is the Billing Currency) US$ 139.11 US$ to SAR conversion rate 3.75 Total transaction value in US$ (If SAR is the Billing Currency) SAR 521.67 Cash withdrawal fee 5% or SAR 55 / US$ 15 which ever is higher 2.5% Cheque returned fee SAR 150 or US$ 40 Statement request fee (more than three months) SAR 40 or US$ 10 Refund of credit balance SAR 100 or US$ 27 Direct debit rejection fee SAR 150 or US$ 40 g) Detailed conditions governing the use of the Corporate Card are included in the Terms & Conditions, which will accompany the Card(s) when issued. The signature of, or the use of the Card(s) shall be deemed as formal approval of the said Terms & Conditions with any subsequent amendments. The Terms & Conditions shall be unilaterally and periodically reviewed, updated and amended by Amex (Saudi Arabia) Ltd, at any time. The up-to-date version displayed over this web page shall contain any such amendment(s), and shall therefore be deemed valid, entering into full effect, automatically replacing and superseding the previous provision(s) whether contained in the Terms & Conditions in written form accompanying the card(s) when delivered to you or previously displayed over this web page, merely and immediately upon the occurrence of such update. You are invited to logon to this website regularly to be informed of such amendments, therefore we hereby draw to your kind attention that your use or possession of the Card(s) after the occurrence of such amendment(s) reflected by our update as provided for hereunder, shall be deemed as your formal and absolute approval to such Terms & Conditions and their subsequent amendment(s). h) We provide credit information relating to our Card members to The Saudi Credit Bureau (SIMAH) on a monthly basis. The information provided reflects the status as at the previous month-end and includes information regarding whether the card account is regular or delinquent. To avoid any adverse credit history with SIMAH, cardholders should ensure that they make timely payment of the amount due on the card account. i) Upon its approval by Amex (Saudi Arabia) Ltd, this application and all supporting documents shall constitute integral parts of the Terms & Conditions. I agree that American Express have the right to keep all the documents supplied with this application. EMPLOYEE APPLICATION FORM d) A grace period of 25 days will be granted to settle the amount, and the payment due date will be indicated on your statement. 2.5% or SAR 150 / US$ 40 which ever is higher Currency conversion fee b) All charges are due for payment in full immediately on receipt of your monthly statement and before the payment due date shown on your statement. If the outstanding balance is not settled the Late Payment Charges on overdue balances monthly in arrears is at the rate of 2.5% or US$ 40 (SAR 150), whichever is higher, of all outstanding sums. Late payment fee Joint & Several Liability Initial Disclosure Statement