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American Express Platinum Credit Card Application

Free American Express Platinum Credit Card Application - PDF Form Download

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American Express Platinum ReserveSM Credit Card Application form is suitable for Indian customers to avail credit card facilities. You have option to pay Lifetime Foundation Membership Fee in the first statement or in five equated monthly installments. Read all 8 sections of the form before proceeding.

You need to file Form A, B, and C in addition to the main application form for enabling ECS enrollment. The form also has provision for providing standing instructions to BillDesk and various service providers. However, you must enclose latest bill by the service provider to enable these bill payment facilities. Read terms and conditions, Income Documents, and Card member Undertaking along with Facility of Opt-Out Option to understand the provisions.

Start by entering preferred name on the card and then mark the box in case you want to make payment of Lifetime Foundation Membership Fee in installments.

American Express Platinum Credit Card Application

Personal Information

Enter title, then first, middle, and last name. Select the gender, enter date of birth, select residential status, provide nationality, passport/driving license number, PAN, and continue by providing residential address, city name and pin code. Then enter your phone and mobile number followed by email address, education, name of last college or university, select marital status, and residential details. Select the right box that applies to your residential status and specify if other selected. Insert tenure at current residence, provide vehicle details, select preferred mode of sending statements, and mark the box for requesting additional card.

Occupation Information

Select your employment status and then provide the organization name on the next line. Enter the nature of business and the current designation. Type the office address, city, and pin code along with office phone numbers and extension number if any. Mention the number of years at present organization/business. You must enter details like turnover, number of employees, years in business, and net profit in case you are self-employed in Occupation Information part of American Express Platinum Credit Card Application.

Financial Particulars

Enter gross annual income, sign on the next line, mention your bank’s name, then select account type, enter account number, number of years of the account operations, and other financial details like investment in shares, mutual funds, insurance, and specify others on the space provided for the same.

Credit Cards/Loans

Enter the details of two most frequently used credit cards you own like issuer/bank’s name, card number, credit limit, and number of years since using the card for each card. Mention the existing relationship and then provide card number if any. Enter the loan account number, lending bank’s name, and select type of loan if any in this part of American Express Platinum Credit Card Application.

Supplementary Credit Card

You can give up to 2 supplementary cards to your family members. Please provide title, name as preferred on the card, first, middle, and last name, date of birth, and relationship with you for each supplementary cardholder.

Tele-Marketing Communication

Select the box and sign on the next line for receiving marketing communication if you prefer so.

Cardmember Undertaking And Signature

Sign on the line provided and enter date in acceptance to the terms & conditions and undertaking.

Form A

Enter your name, bank account particulars, name of account holder, Bank Name, Branch Address, 9-digit bank code, account type, ledger folio number if any, and account number on lines 3a through 3g. Mark the box for enclosing blank check or photocopy and sign on the space provided. Enter date next to the signature.

Form B

Enter bank name and account number. Then mark your choice of payment and write the percentage in figure and words if you choose the option percentage. Sign and insert date in the respective spaces.

Form C

Enter bank name, address, and account number on the respective lines. Sign and insert date to complete form C of American Express Platinum Credit Card Application.

BillDesk Standing Instructions

Enter your name as appears on the card, then provide date of birth, address, mobile number and email address in the respective spaces.

Service Providers Standing Instructions

Select the service provider listed in this part of American Express Platinum Credit Card Application and provide information like utility company name, phone number, customer ID or account number, name of subscriber, and city for each service provider you want to subscribe for standing instructions. Sign and insert date to complete this section of the application form.


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