Fillable Printable Scotiabank Credit Card Application Form - Canada

Scotiabank Credit Card Application Form - Canada

Scotiabank Credit Card

Application Form

* Trademarks of The Bank of Nova Scotia. Trademarks used under authorization and 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 |||Months If less than 2 years, time at previous Residence: |||Years |||Months

Marital Status: Single Married Divorced Widow(er) Home Phone #: ||||||||||| Cell Phone #: ||||||||||

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

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

Time with Employer: |||Years |||Months Full-time Part-time If less than 2 years, time with previous Employer: |||Years |||Months

Monthly Employment Income: $ |||||||||Other Monthly Income: $ ||||||||

WOULD YOU LIKE A CO-APPLICANT CARD FOR YOUR SPOUSE?

Yes No

If yes, complete this section:

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 |||Months Full-time Part-time Monthly 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? Yes No Amount: $||||||||| Monthly Pymt: $|||||||

Other Lender? Yes No Lender: ||||||||||||| Amount: $||||||||| Monthly Pymt: $|||||||

Other Credit Card? Yes No Lender: ||||||||||||| Balance: $||||||||| Monthly Pymt: $|||||||

Other assets: Car Value: $||||||||Lender (if any): ||||||||||||||Monthly Pymt: $|||||||

Other assets: Savings / Deposit Account Balance: $|||||||||||| Investments /Stocks Value: $ |||||||||||

Are you a Scotiabank customer? Yes No If yes,Account #: ||||||||||||| ScotiaCard #: ||||||||||||

Would you like to insure your Scotiabank Credit Card account balance?

Yes, I would like to insure my Scotiabank Credit Card account balance for: Single Coverage Joint Coverage

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 and any

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 about me (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 Signature Date Co-Applicant’s Signature Date

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

TWO FORMS OF GOVERNMENT ID

(eg. Passport, Drivers Licence)

UTILITY BILL

(for proof of address)

JOB LETTER OR PAY SLIP

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