Gi y Ngh C p Th Tn D ng ANZ Kim H p ng ANZ Credit Card Application and Agreement

Chng Trnh Gi i Thi u Thnh Vin M i/ Member Get Member Promotion

Vui lng i n t t c thng tin d i y ngh Please complete all the sections of this application: LO I TH TN D NG QU C T ANZ / TYPE OF ANZ CREDIT CARD: Th Chu n / Classic Card: Thu nh p t i thi u hng thng 8.000.000 VN Minimum Gross Monthly Income required is VND 8,000,000 Ph th ng nin 350.000 VN/Annual Fee VND 350,000. Th Vng / Gold Card: Thu nh p t i thi u hng thng 16.000.000 VN Minimum Gross Monthly Income required is VND16,000,000 Ph th ng nin 450.000 VN/Annual Fee VND 450,000. Trong tr ng h p khng c c p Th Tn D ng ANZ Vng, b n c mu n c c p Th Tn D ng ANZ Chu n khng / If you are not o ered an ANZ Gold Credit Card, please indicate if you wish to accept an ANZ Classic Credit Card? C / Yes Khng / No

Hnh th c s h u nh / Home ownership: S h u / Owned Mua tr gp / Mortgaged Thu / Rented

S ng v i b m / Living with Parents Khc (Xin ghi r) / Others (please specify): Th i gian t i a ch hi n t i: Years and months at current address i v i ng i n c ngoi/For foreigner: S tham chi u c a Th th c c tr / Visa number: Ngy h t h n lu tr t i Vi t Nam: Visa expiry date / / Nm year Thng month

Ngy/thng/nm (dd/mm/yyyy) S ng i b n ang chu c p ti chnh / No. of dependants: Trnh h c v n / Education level: THCS Secondary THPT High shool C/H College/University Th c s/Ti n s Master/PhD

THNG TIN C NHN / PERSONAL DETAILS: H tn (nh trn CMND)/ Full name: H /Surname Tn m/Middle name Tn/Given name

M t m (t i a 06 k t ) Security password (max 06 characters)

*Ghi ch: M s ny khng ph i l s PIN/Note: Security password is not your PIN

Tn in n i trn th (ch in, t i a 19 k t k c kho ng tr ng) Name to appear on the card (Max 19 characters, including space)

THNG TIN NGH NGHI P / EMPLOYMENT DETAILS: i lm / Employed T kinh doanh / Self Employed

Nam/Male

N /Female / /

Khc (xin ghi r) / Others (please specify): Ni cng tc / Company name:

Ngy sinh (ngy/thng/nm): Date of Birth (dd/mm/yyyy) Ni sinh (thnh ph , qu c gia): Place of birth (town, country) S CMND/H chi u: National ID/Passport No. Qu c t ch / Nationality:

a ch c quan / Company address:

i n tho i / Company phone No.: Lo i hnh doanh nghi p / Business type: Nh n c State-owned C ph n Joint-stock N c ngoi/Lin doanh Wholly Foreign Owned/Joint Venture TNHH Private limited H p danh/T nhn Partnership/Sole Proprietary

a ch th ng tr / Permanent residential address:

a ch t m tr (n u khc a ch th ng tr) / Temporary residential address (if di erent from your permanent residential address):

Khc (xin ghi r) / Others (please specify): Ngnh ngh / Industry: Nng nghi p Agricultural Xy d ng Construction S n xu t Manufacturing Truy n thng Media Ti chnh / Ngn hng Finance / Banking B t ng S n Real Estate Bn bun / bn l Wholesale / Retail Trading

i n tho i lin l c: Home phone No. TD / Mobile: Email: Tnh tr ng hn nhn / Marital status: c thn / Single l p gia nh / Married Ly d / Divorced

B o hi m Insurance V nt i Transportation Du l ch/nh hng Tourism/Restaurants

Khc (Xin ghi r): Others (please specify)

ANZ Bank (Vietnam) Limited

Gi y Ngh C p Th Tn D ng ANZ Kim H p ng ANZ Credit Card Application and Agreement

Chng Trnh Gi i Thi u Thnh Vin M i/ Member Get Member Promotion

Ch c v / Current position: Nhn vin Clerk Ph T ng Gim c Deputy General Director Ch Doanh Nghi p / Owner Th i gian cng tc t i c quan hi n t i: Time in current employment Lng c b n tr c thu hng thng Gross Monthly Base Salary Before Tax Ph c p hng thng Monthly allowance Thu nh p khc n u c Other income if any VN VN VN Nm year Thng month Chuyn vin O cer Gim c Manager

Thng Tin Ti Kho n / Bank Account Details Tn ngn hng giao d ch chnh Name of your main Bank S ti kho n giao d ch Bank account number

T ng Gim c / Gim c Ton Qu c General Director / Country Manager

Thng Tin Cc Kho n Vay / Loan Details Tn Ngn Hng / Cng Ty Ti Chnh Lo i Vay Kho n tr gp hng thng (VN) Bank / Finance Company Name Type of loan Monthly repayment (VND) 1. 2. Thng Tin Th Tn D ng Khc / Other Credit Card Details Tn Ngn Hng / Cng Ty Ti Chnh Bank / Finance Company Name 1. 2. S th Card number M th t nm Member since

Ni cng tc tr c y / Previous company name:

Th i gian cng tc t i c quan tr c y Time in previous employment T ng th i gian cng tc Total number of years working

Nm year Nm year

Thng month Thng month

N u b n c hn hai kho n vay ho c th tn d ng, vui lng cung c p thng tin chi ti t trn m t trang gi y ring/ If you have more than two loans or credit cards, please provide details on a separate page. THNG TIN THAM CHI U / REFERENCE INFORMATION Ng i tham chi u l ng i c th xc nh n thng tin c a b n l ng (v d nh Gim c hay ng nghi p c a b n) / A Reference is someone that can con rm your identi cation, e.g. your Manager or colleague. H tn / Reference name:

THNG TIN NG I HN PH I / SPOUSE DETAILS H tn (nh trn CMND) / Full name: H /Surname Tn m/Middle name Tn/Given name

H /Surname

Tn m/Middle name

Tn/Given name

i lm / Employed

T kinh doanh / Self Employed

a ch / Reference address:

Khc (Xin ghi r) / Others (please specify): S CMND/H chi u: National ID/Passport No. Qu c t ch / Nationality: i n tho i nh / Home phone No.: i n tho i c quan / Business phone No.: Ni cng tc / Company name: TD / Mobile: Ph n Dnh Cho Ng i N c Ngoi / Foreigner Only a ch c quan / Company address: Vui lng cung c p thng tin lin l c c a m t ng i ni ti ng Anh t i n c b n a / Please provide one permanent home country English speaking contact: H tn / Full name: i n tho i lin l c/ Home phone No. TD/ Mobile THNG TIN TI CHNH / FINANCIAL DETAILS B n l khch hng c a ANZ / Are you an ANZ Customer: C / Yes Khng / No i n tho i lin l c / Phone No.: TD / Mobile: Email: H /Surname a ch / Address: Tn m/Middle name Tn/Given name

ANZ Bank (Vietnam) Limited

Gi y Ngh C p Th Tn D ng ANZ Kim H p ng ANZ Credit Card Application and Agreement

Chng Trnh Gi i Thi u Thnh Vin M i/ Member Get Member Promotion

THNG TIN KHC / PREFERENCE Ngn ng s d ng / Preferred language of communication: Ti ng Vi t English

S ti kho n c a Ti/Chng ti t i ANZ l: My/Our ANZ account number is Ti/Chng ti mu n ch n t l thanh ton: My/Our repayment amount is Thanh ton S Ti n T i Thi u Minimum Amount Thanh ton ton b D N Full Closing Balance

B n mu n nh n b ng sao k giao d ch hng thng v th t khc g i qua bu i n (trong gi hnh chnh) t i / You want to receive your monthly statement and other correspondences sent by post (during business hours) at: a ch th ng tr / Permanent residential address a ch t m tr / Temporary residential address a ch c quan / Company address B n mu n ng k nh n b ng sao k giao d ch hng thng qua D ch v th tn i n t t i a ch email ng k trn/You want to receive your monthly statement with eStatement service via your registered email: C / Yes Khng / No

Ch k v h tn c a Ch Ti Kho n ( i v i ti kho n ng s h u c phng th c i u hnh l ng ch ti kho n cng k, t t c cc ch ti kho n c n ph i k vo y) /Signature and name of account holder (For joint account with all instructions to operate are to be signed jointly, all signatories have to sign here) x

THNG TIN CH TH PH / SUPPLEMENTARY CARD DETAILS H tn (nh trn CMND) / Full name: H /Surname Tn m/Middle name Tn/Given name

B n mu n nh n th tn d ng v m s PIN c a th chnh v th ph (n u c) / You want to receive your primary and supplementary (if any) Credit Card and PIN number.
*Ghi ch: Vui lng ch ch n m t hnh th c nh n th / Note: Please select one card reception only

Qua bu i n t i a ch nh n th ch n trn / By post at mailing address provided above T i chi nhnh ANZ (dnh cho Khch Hng ANZ Signature Priority Banking) At ANZ branch (for ANZ Signature Priority Banking Customers only):
*Ghi ch: Vui lng ch ch n 1 chi nhnh/ Note: Please select one branch only

Tn in n i trn th (ch in, t i a 19 k t k c kho ng tr ng) Name to appear on the card (Max 19 characters, including space)

Nam/Male

N /Female / /

14 L Thi T , Q.Hon Ki m, H N i Phng 102 Nh D5, Tr n Thi Tng, Q.C u Gi y, H N i T ng 1, Ta nh VIMECO, Ph m Hng, Q.C u Gi y, H N i 39 L Du n, Q.1, TP HCM 02 Ng c K , Q.1, TP HCM 65 Ph m Ng c Th ch, Q.3, TP HCM 86 T n , Q.5, TP HCM 47 Ph M Hng, i l Nguy n Vn Linh, Q.7, TP HCM B n c ng nh n thng tin t ANZ (bao g m nh ng thng tin khng ph i l b ng sao k hng thng) thng qua email, tin nh n SMS v cc thi t b i n t khc khng? /Do you agree to receive ANZ correspondence (including information other than monthly statement) via email, SMS and other electronic devices? C / Yes Khng / No

Ngy sinh (ngy/thng/nm): Date of Birth (dd/mm/yyyy) Ni sinh (thnh ph , qu c gia): Place of birth (town, country) S CMND/H chi u: National ID/Passport No. Qu c t ch / Nationality: M i quan h v i ch th chnh: Relationship to primary card holder

* Ch th ph t 16 n 18 tu i ph i c cha/m l ch th chnh / If supplementary cardholder is from 16-18 years old, primary cardholder is required to be his/her parents

M t m (t i a 06 k t ): Security password (max 06 characters)

*Ghi ch: M s ny khng ph i l s PIN/Security password is not your PIN

GHI N T NG / AUTO DEBIT AUTHORISATION Ti/Chng ti ng l ANZ c quy n, v c Ti/Chng ti y quy n, th c hi n ghi n t ng cc kho n n ph i thanh ton (hay b t k ph n thi u h t c a b t k kho n n ph i thanh ton th a thu n tr c no) vo ti kho n c a Ti/Chng ti t i ANZ vo ngy n h n m i thng ho c ngy lm vi c ti p theo c a ngy lin quan n th tn d ng c a Ti/Chng ti. I/we agree that ANZ may, and is authorised for this purpose, debit my/our accounts opened with ANZ any amount payable (or any shortfall to any agreed amount payable) to ANZ on the monthly due date or the next working day to settle my/our ANZ credit card account(s).
ANZ Bank (Vietnam) Limited

N u b n yu c u nhi u hn 1 th ph vui lng cung c p thng tin chi ti t trn m t trang gi y ring/ If you apply for more than 1 supplementary card, please provide details on separate supplementary application form.

Gi y Ngh C p Th Tn D ng ANZ Kim H p ng ANZ Credit Card Application and Agreement

Chng Trnh Gi i Thi u Thnh Vin M i/ Member Get Member Promotion

CH P THU N C A CH TH / AGREEMENT BY CARDHOLDER(S) B ng cch k vo ph n d i y, Ti/Chng ti hi u v ng r ng: (i) (ii) Vi c i n y cc thng tin theo m u gi y ngh ny khng m b o s ch p thu n gi y ngh ny c a ANZ. Ti/Chng ti c c b n Cc i u Ki n v i u Kho n Th Tn D ng ANZ v b t k i u ki n v i u kho n ho c/v h p ng cng nh ch p thu n no khc c lin quan n th tn d ng ANZ v Ti/Chng ti hi u v ch p thu n nh ng i u kho n i u ki n v vn b n (danh sch c a nh ng vn b n c lin quan c li t k d i). Ti/Chng ti s , k t khi nh n th tn d ng ANZ, b rng bu c b i Nh ng i u Kho n v i u Ki n th tn d ng ANZ v b t k i u ki n v i u kho n ho c/v h p ng cng nh ch p thu n no khc c lin quan n th tn d ng ANZ (c th thay i ty t ng th i i m) i u ch nh vi c pht hnh v s d ng th tn d ng ANZ v cc ti li u , cng v i m u n ny, t o nn m t h p ng rng bu c v m t php l v c hi u l c gi a chnh Ti/Chng ti v ANZ cho vi c i u hnh ti kho n th tn d ng ANZ v s d ng th tn d ng ANZ (H p ng Th Tn D ng). Ti/Chng ti ch u trch nhi m i v i nh ng ngha v v trch nhi m pht sinh lin quan n th tn d ng ANZ thng qua vi c s d ng Th Tn D ng ANZ m Ti/Chng ti c c p. N u l Ch Th chnh, Ti b o m r ng Ti trn 18 tu i v hi u r ng ANZ c quy n ngng cung c p d ch v Th Tn D ng ANZ trong tr ng h p d ch v th tn d ng ANZ ny c c p nh m cho ng i d i 18 tu i. thm an ton, Ti/Chng ti ch n (cc) M t M bao g m su (06) k t s c yu c u khi lin h ANZ v th tn d ng ANZ thng qua D ch V Th ANZ 24/7. Ti/Chng ti ng r ng n i dung c a gi y ngh ny hon ton ng v chnh xc v ch k c a Ti/Chng ti d i l b ng ch ng cho vi c Ti/ Chng ti hi u v ng cho nh ng n i dung c nu ra trong gi y ngh ny v H p ng Th Tn D ng. Ti/ Chng ti ng r ng, theo yu c u c a Ti/ Chng ti v lun ph thu c vo ton quy n quy t nh c a ANZ, Th Tn D ng v m s PIN c th c chuy n cho Ti/ Chng ti qua ng bu i n n a ch nh n th ng k ho c b ng b t k hnh th c no khc m ANZ cho l thch h p. Ti/ Chng ti ng s ch u m i r i ro lin quan n vi c giao nh n th tn d ng v m s PIN nh nu trn, bao g m nhng khng gi i h n cc r i ro v m t mt, th t l c ho c l m d ng th tn d ng.

(ii)

(iii)

(iii)

(iv)

(v)

(iv)

(vi)

(v)

(vii)

(vi)

(viii)

(vii)

I/We have read the ANZ Credit Card Terms and Conditions and any other terms and conditions and/or contract and agreement applicable to ANZ credit card and have understood and accepted the same (the list of these documents provided below); I/We will be bound, upon receipt of ANZ Credit Card, by the ANZ Credit Card Terms and Conditions and any other terms and conditions and/or contract and agreement applicable to ANZ credit card (as may be changed from time to time), governing the issuance and use of the ANZ credit card which, together with this application, constitutes a binding and enforceable contract between myself/ourselves and ANZ for operation of the ANZ credit card account and use of the ANZ credit card (the Credit Card Contract); I/We hold myself/ourselves liable for all obligations and liabilities incurred under the ANZ credit card through use of the ANZ credit card issued to me/us; In case of a Primary Cardholder, I warrant that I am above 18 years of age and acknowledge that ANZ reserves the right to immediately terminate my ANZ Credit Card service in the event that such access was mistakenly provided to a person under 18 years of age; For additional security, I/We nominate a Security Code(s) of six (06) characters long required when contacting ANZ regarding ANZ Credit Cards through ANZ Cards 24/7; I/We agree that the contents of this application are true and correct and that my signature below evidence my understanding of and consent to all matters set out in this application and the Credit Card Contract; I/We agree that the Credit Card and PIN code may be, at my/our request, and subject always to ANZs sole discretion, delivered via post to my/our mailing address registered with ANZ or by any other method that ANZ may consider appropriate. I/We agree to bear all the risks associated with the delivery of Credit Card and PIN code as provided above including but not limited to the Credit Card being lost, stolen or abused.

(viii)

This application has been made as a single original for the records of ANZ. The ANZ Credit Card Terms and Conditions and relevant documents can be accessed at anz.com/vietnam or at any ANZ branch or by calling ANZ Cards 24/7 at 1800 1559. A copy of the ANZ Credit Card Terms and Conditions will also be provided to you when your ANZ credit card is issued. ANZ Bank (Vietnam) Limited (ANZ) is a separate entity to Australia and New Zealand Banking Group Limited (ANZBGL). ANZ is not an authorised deposit taking institution within the meaning of the laws of Australia. Deposits or liabilities with ANZ are not deposits or other liabilities of ANZBGL does not guarantee the obligations of ANZ. Ch k c a Ch th chnh Signature of Primary applicant x

Gi y ngh ny c l p thnh m t b n chnh v c gi b i ANZ. Cc i u Kho n v i u Ki n Th Tn D ng ANZ v cc vn b n lin quan khc c th c xem t i anz.com/vietnam hay t i b t k chi nhnh ANZ no ho c b ng cch g i cho D ch V Th ANZ 24/7 theo s 1800 1559. M t b n sao c a Cc i u Kh an v i u Ki n Th Tn D ng ANZ cng s c cung c p khi th tn d ng ANZ c a khch hng c pht hnh Ngn hng TNHH ANZ (Vi t Nam) (ANZ) l m t php nhn tch bi t i v i T p on Ngn hng TNHH Australia v New Zealand (ANZBGL). ANZ khng ph i l m t nh ch c php nh n ti n g i theo qui nh c a lu t php Australia. Ti n g i ho c cc ti s n n khc t i ANZ khng ph i l cc kho n ti n g i ho c ti s n n khc c a ANZBGL v ANZBGL khng b o m cc ngha v c a ANZ. By signing below, I/We acknowledge and agree that: (i) The completion of this application does not ensure approval of my/our application by ANZ;

Ngy/thng/nm (dd/mm/yyyy) Ch k c a Ch th ph Signature of Supplementary applicant x

Ngy/thng/nm (dd/mm/yyyy)

ANZ Bank (Vietnam) Limited

Gi y Ngh C p Th Tn D ng ANZ Kim H p ng ANZ Credit Card Application and Agreement

Chng Trnh Gi i Thi u Thnh Vin M i/ Member Get Member Promotion

Ch k thay m t i di n cho ANZ/ Signature for and on behalf of ANZ

Ch ng minh thu nh p c a Ch Th Chnh / Income proof of primary card applicant Cng nhn vin / Employed applicant: / / 1. H p ng lao ng xc nh n ch c v , th i gian cng tc, m c lng v th i h n h p ng / Labour contract showing applicants position, time of service, salary and contract tenor. 2. B n g c gi y thanh ton lng c a thng g n nh t / Latest original monthly pay slip. 3. Sao k ti kho n ngn hng th hi n m c lng 3 thng g n nh t / Bank statements showing the last 3 months salary. T kinh doanh / Self-employed applicant: 1. Gi y php kinh doanh / Business registration certi cate. 2. Ha n ng thu thu nh p 6 thng g n nh t (doanh nghi p ng thu khon) ho c Quy t ton Thu 2 nm g n nh t (doanh nghi p ng thu thu nh p doanh nghi p bnh th ng) / Latest 6 months Income Tax Invoice (applicable for business paying xed income tax) or Tax Returns for the last 2 years (applicable for business paying normal business income tax) 3. Sao k ti kho n ngn hng d i tn c a doanh nghi p 6 thng g n nh t / Latest 6 months bank statement in the name of the business. PH N DNH CHO NG I GI I THI U / FOR REFERRER ONLY Vui lng i n thng tin Ng i gi i thi u / Please ll in Referrers detail: H tn / Full name: H /Surname Tn m/Middle name Tn/Given name

Ngy/thng/nm (dd/mm/yyyy)

CC I U KHO N, I U KI N V TH A THU N LIN QUAN / RELEVANT TERMS, CONDITIONS AND AGREEMENTS i u kho n v i u Ki n Chung ANZ, i u kho n v i u Ki n Th Tn D ng ANZ / ANZ General Terms and Conditions, ANZ Credit Card Terms and Conditions i u kho n v i u Ki n D ch V Th Tn i n T / Terms and Conditions for eStatement service H S NH KM / ATTACHED DOCUMENTS
*Ghi ch: H s n p s khng c hon tr /Note: Documents submitted will not be returned.

Ti/Chng ti nh km nh ng h s d i y/ I/We attach copies of the following documents: Ch ng mnh gi y t ty thn v a ch c tr/ Identi cation and Residential address proof Ng i Vi t Nam/ Vietnamese: 1. CMND ho c h chi u/ National ID or Passport Bao g m ch th chnh v ch th ph (n u c)/ Both primary and supplementary cardholder (if any). 2. S h kh u ho c KT3/ Residential Book or KT3 Ng i n c ngoi/ Foreigner: 1. H chi u/ Passport Bao g m ch th chnh v ch th ph n u c/ Both primary and supplementary cardholder (if any). 2. Th th c c tr h p php ho c gi y php lao ng/ Permanent / Temporary resident or working permit.

S CMND/H chi u: National ID/Passport No. TD / Mobile: Email:

PH N DNH CHO NGN HNG / FOR BANK ONLY D a trn t t c nh ng thng tin mnh c, Ti hi u r ng t t c nh ng thng tin do khch hng cung c p trong nh ng h s nh km theo y l hon ch nh, chnh xc, c p nh t v ng s th t. To the best of my knowledge, the above information provided by the Client and contained in the above documents are complete, accurate, up to date and true. M s tham chi u / Source code: Tn nhn vin th c hi n / Sales name:

M s nhn vin th c hi n / Sales number:

(6 ch s Sales code / 6 Sales code digits) Ch k nhn vin th c hi n / Sales signature x x

Ngy nh n h s / Date application received: / /

ANZ Bank (Vietnam) Limited