Scotiabank Credit Card

Application Form

* Trademarks of The Bank of Nova Scotia. Trademarks used under authorizationand control of The Bank of Nova Scotia.

First Name:Mr.Mrs.Miss||||||||||||||||||Last Name:||||||||||||||||||

Address:#:|||||||||Street:|||||||||||||||City:|||||||||||||||||||

State:|||||||||||Country:||||||||||||||||||||Postal Code (if applicable):||||||

Date of Birth:|D|D|M|M |Y|Y|Time at current Residence:|||Years|||MonthsIf less than 2 years,time at previous Residence:|||Years|||Months

Marital Status:SingleMarriedDivorcedWidow(er)Home Phone #:|||||||||||Cell Phone #:||||||||||

First Name:|||||||||||||||||||||Last Name:||||||||||||||||||||||

Date of Birth:|D|D|M|M|Y|Y|Home Phone #:|||||||||||Cell Phone #:||||||||||

Passport/National ID #:|||||||||||||Mother’s Maiden Name:|||||||||||||||||||||||

Employer:|||||||||||||||||Occupation:||||||||||||Work Phone #:||||||||||

Time with Employer:|||Years|||MonthsFull-timePart-timeMonthly Income:$ ||||||||

YOUR FINANCIAL INFORMATION:

Are you a:Homeowner Renter Other If you are a Homeowner,what is the property value? $|||||||||

Existing Mortgage on Home:$||||||||||Lender:|||||||||||||||||Monthly Pymt:$|||||||

Do you have any loans with Scotiabank?YesNoAmount:$|||||||||Monthly Pymt:$|||||||

Other Lender?Yes NoLender:|||||||||||||Amount:$|||||||||Monthly Pymt:$|||||||

You understand that to be eligible for coverage,you must be 18 years of age and under 70 to enroll;and that your coverage will be bound by the Terms and Conditions stated in

your Certificate of Insurance.Furthermore you authorise the Bank to provide the insurer with your Scotiabank Credit Card account number,monthly statement balance andany

other necessary information;and you authorise the insurer to charge monthly premiums to your Scotiabank Credit Card account.

I (We) hereby certify the above information to be true and complete.If this application is accepted by The Bank of Nova Scotia (the “Bank”) I (We) request the Scotiabank Credit

Cards and Convenience Cheques be issued to me (us) as designated above.I (We) hereby authorise and consent to the Bank obtaining further information aboutme (us) and checking

the information I (We) have given here and exchanging information about me (us) with other parties. I (We) agree to read and be bound by the Scotiabank Credit Card Cardholder

Agreement.I (We) authorise the Bank to debit my (our) credit card account with the amount of the annual fees in effect from time to time for the card.

Applicant’s SignatureDateCo-Applicant’s SignatureDate

PLEASE BRING THE FOLLOWING ITEMS WITH YOU WHEN YOU SUBMIT YOUR APPLICATION: