Taking care of our own and other people's health, we urge our clients to use the bank’s services remotely.

APPLICATION FOR OPENING PAYMENT CARD ACCOUNT AND RECEIVING OF THE PAYMENT CARD

Valid from: 01.07.2017

Customer information

1
Resident
Non-resident

Information on the payment card and account currency

2

MasterCard Standard
MasterCard Gold
Maestro

With printing1
Without printing

2only for the Cardholders of MasterCard Standard, MasterCard Gold, VISA Classic and VISA Platinum

Based on the assessment of the credit collateral oered by the Client and/or solvency of the Client, the Bank will take a 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.

Information about financial collateral

3
Funds on the current account
Funds on the term - deposit account

In case of granting a credit, the funds, deposited on the current/term - deposit account in the

shouldbe 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.

Guarantee
Pledge

I assign

Information about the employment and financial situation

4

Business person
Student
Employee
Pensioner
Housekeeper
Unemployed person
Self-employed person

Information about the work place

Information about finances

Your property

Yes
No

Other information related to issuance of the card

5
At the Bank
Via post
Sent by courier3
At the Bank
Via post
By means of the Internet banking system
Standart level
Gold level
Silver level
Platinum level

3the courier expenses shall be covered by the recipient

4for additional payment

Confirmation

6
By signing this I, do hereby acknowledge, 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 (www.bank.lv);

I assume full nancial responsibility for the Users of additional card;

I conrm 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;

I agree to the processing of my personal data, including data transfer to the third parties according to the procedures specifed in the General Business Terms and Conditions;

I agree to receive all kind of commercial information by e-mail and phone:

Yes
No

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

* mandatory fields