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Credit Card Application
Home
Credit Card Application
Credit Card Application
Personal Details
*Title
Mr.
Ms.
Mrs.
*First Name
Middle Name
*Last Name
*Date of Birth
*Marital Status
Single
Married
Common Law
Divorced
Name of Spouse
*Preferred Branch
Main Branch
Rose Hall Branch
Corriverton Branch
Anna Regina Branch
Diamond Branch
Beterverwagting Branch
Corporate Branch
Mahaica Branch
Leonora Branch
*Required Limit (GY$)
Identification Documents
*Primary Identification Document
—Please choose an option—
Identification Card
E-Identification Card
Driver's Licence
Passport
Document Number
*Issue Date
*Country of Issue
*Document Expiry Date
Contact Details
Home Phone
*Mobile Phone
Work Phone
*Email
*Residency
Local
Foreign
*Nationality
*Country of Birth
*Country of Residence
*Lot/Apt & Street
*Village/City/Town
*County/State
Zip/Postal Code
*Country
Type of Residence
—Please choose an option—
Owner
Family
Spouse
Tenants
Other
Years at Residence
Income/Employment Records
*Employment/Income Details
Employed
Self-Employed
Unemployed or Dependent or Students
Employment Details
*TIN
*Employer
*Occupation
*Years Employed
Self Employed
*Business Name
*Nature of Business
*Date of Registration
*Position
Provider’s Name
Provider’s Employer Name
Provider’s Occupation
Provider’s Net Income (GY$)
*Provider’s Years Employed
Monthly Income
*Monthly Income After Tax (GY$)
Other Income (GY$)
Detail of Other Income
Monthly Expenses
Loan Repayments (GY$)
Rent (GY$)
Utilities (GY$)
Living Expenses (Groceries, etc.) (GY$)
Transportation/Vehicle/Fuel (GY$)
Personal Care (GY$)
Other (GY$)
Assets
Land (GY$)
Home (GY$)
Savings (GY$)
Motor Vehicles (GY$)
Term Deposits (GY$)
Stocks & Shares (GY$)
Loans Due to You (GY$)
Other (GY$)
Borrowings
*Do you have any borrowings?
Yes
No
Vehicles
Bank/Institution
Amt Borrowed (GY$)
Current Balance (GY$)
Monthly Repayment (GY$)
Housing
Bank/Institution
Amt Borrowed (GY$)
Current Balance (GY$)
Monthly Repayment (GY$)
Credit Card
Bank/Institution
Amt Borrowed (GY$)
Current Balance (GY$)
Monthly Repayment (GY$)
Hire Purchase
Bank/Institution
Amt Borrowed (GY$)
Current Balance (GY$)
Monthly Repayment (GY$)
Other
Bank/Institution
Amt Borrowed (GY$)
Current Balance (GY$)
Monthly Repayment (GY$)
Upload Required Documents (jpeg/jpg/pdf files)
*Upload Primary Identification (as selected above)
Note:
Front and back scans
are required for your primary identification.
Note: The
biographic information page
of your passport is required.
Front:
Back:
______________
Upload TIN Certificate
*Upload a filled and signed Self-Attestation of address (
CLICK TO DOWNLOAD TEMPLATE
) OR Upload a recent Proof of Address (dated within the last 8 months)
*Upload Statement of Income/Projections/Payslip/Job Letter
Upload Recent Loan Statement (if applicable)
Upload Recent Hire Purchase Receipts/Statements (if applicable)
Upload Bank Statement for Last 2 Months (if you have accounts outside of Demerara Bank)
Other services I may be interested in:
Statement Savings Account
Personal Chequing Account
Registered Business Account
Incorporated Company Account
Payroll Service
Night Deposit Facility
Point of Sale
Home Loan
Vehicle Loan
Commercial Loan
E-Banking (Retail + Corporate)
Have you ever had or currently have an account with Demerara Bank?
Yes
No
I/We hereby warrant and confirm all the foregoing statements as contained in my/our submission are true and correct and have been made by me/us knowing you will rely thereon in considering the abovementioned application. I/We by means of my / our signature affixed below do hereby authorize and give specific consent as required by Law to allow Demerara Bank Limited, its agents and / or servants permission to access a Credit Report in my / our name from Everydata Guyana Incorporated for the purpose of due diligence and risk management processes in respect of an assessment of the eligibility of my / our application for credit facilities. I/We undertake to notify the Bank immediately of any situation, which materially changes the representations on this application.
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