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MasterCard-Visa Card
MasterCard & Visa Card Classic
MasterCard & Visa Card
Credit Card Application Form
Please read before filing this application Form:
  • Application must be 18 years of age and above.
  • Enclose your ID/Passport
  • You are required to place a fixed deposit of 1 time of the credit limit should your application be approved
  • For non Cambodia: Please furnish us a copy of your employment letter, work permit and entry (Issued by the Immigration Department)
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Card Type
  
My Personal Details
Title
Fist Name
Last Name
Date Of Birth
   
Gender
Email
Mobile Phone
Location
My Financial Details
Annual Income
Source Of Other Income
Annual Fee
Annual Fee for MasterCard/Visa Credit Classic Card
Principle USD 25 and Supplementary USD 15
My Declaration
By Signing Below:
  • I/We ask that an account be opened for me/us and card(s) issued as I/We request, and that you renew and replace it/them until termination I/We agree to be bound by the Cathay United Bank Bank Cardmembers Terms and Conditions received with the card(s), unless I/We cut the card(s) in half and return both halves to you. I/We agree to be liable jointly and severally for all charges to the Principal and Supplementary cards issued on my/our request.
  • I/We authorize you to obtain and verify and infomation about me/us as you deem fit in your absolute discretion and I/We consent to your branches or to any third party as you deem fit in your absolute discretion any information relating to me/us or to the card account.
  • I/We warrant that all information give by me/us in this application and in any other documents enclosed is true and accurate. I/We acknowledge that in considering my/our application,you will rely on such information and that you may in your absolute discretion reject my/our application without assigning any reason thereof. I/We confirm that at the time of this applicatioin, I/We am/are not undischarged bankrupt(s) and no statutory demand has been served on me/us nor legal proceeding commenced against me/us.
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MasterCard & Visa Classic