Additional Cardholder Application Form

PLEASE NOTE THAT THE FOLLOWING IS REQUIRED WITH YOUR APPLICATION:

Valid Photo Identification Front and Back (e.g. Barbados identification card, passport or driver’s license)
Passport Size Photo
Proof of Address (e.g. current utility bill or bank statement no older than 3 months)
$20.00 Additional Cardholder Fee
$20.00 Credit Assessment Report Fee

Primary Cardholder Information

Primary Cardholder Name *

Payce Digital Account Number *

Card Expiration Date *

Year

Current Address *

Home No.0 / 10

Mobile No. *0 / 10

Work No.0 / 10

Email Address *

Political Background( Anti-money laundering legislation requires that we confirm the below )

Are any of the applicant(s) or immediate family members a current or former senior government, political or military official, or do any of them have a relative or close connection who is a current or former senior government, political or military official? *YesNo

Additional Cardholder Information

Prefix

First Name *

Middle Name

Last Name *

Barbados Identification Number *

Date of Birth *

Year

Month

Day

Relationship to Primary Cardholder

Current Address *

Home No.0 / 10

Mobile No. *0 / 10

Work No.0 / 10

Email Address *

Employment Information

Name of Employer *

Job Position *

Work Telephone Number *0 / 10

Employer Address *

Upload Any Supporting Documents( e.g. Scans of identification documents or business registration documents as images or pdf files )

Upload files *Please note original documents should be provided in order to complete the process.

Summary of Terms and Conditions

PRIMARY CARDHOLDER SIGNATURE NAME *

ADDITIONAL CARDHOLDER SIGNATURE NAME *