Application for issuance of a payment card

Valid from: 12.08.2019

Customer information


Information on the payment card and account currency

MasterCard Business
With printing1
Without printing

Based on the assessment of the credit collateral oered by the Client and/or solvency of the Client, the Bank will take decision on granting credit limit and issuance of the Card.

The Bank has the right to refuse to issue credit Card and to grant credit limit to the Client, and maintains its rights not to provide information on reasons for refusal.

1 for additional fee

Information about financial collateral


To befilled in for the selected type of collateral

Funds on the current account
Funds on the term - deposit account

should be regarded as collateral for securing my liabilities and the said funds should be blocked till full coverage of my liabilities, in accordance with the Terms and Conditions for Issuing and Servicing of the Bank Payment Card.


Other information related to issuance of the card


I would like to receive the Card:

At the Bank
Via post
Sent by courier2

Address for receipt of the statement:

At the Bank
Via post
By means of the Internet banking system

I would like to receive Travel Insurance:3

Standart level
Gold level
Silver level
Platinum level

2 for additional payment

3 for additional payment


By signing this I, do hereby acknowledge, that

I confirm that I have read the General Business terms and conditions of AS "Industra Bank", Price-list of services, fully understand them and agree to observe the requirements;

I am aware of the fact that the Bank shall be obligated to provide information to the Credit Register of the Bank of Latvia and shall be entitled to receive information from the Credit Register of the Bank of Latvia, in the events prescribed by its regulations (;

I confirm the completeness and accuracy of the information provided in this application, and undertake to notify the Bank on any changes related to the information indicated in this application.

Please open the payment card account with the Bank and issue the payment Card

I hereby consent to the processing of personal data.

* mandatory fields