Request for Credit Card

Application No : DCC1111230387 Date : 14/11/2023

Products

Products Applied ¨ Personal Loan þ Credit Card ¨ OverDraft

Credit Card

Please indicate your choice of Credit Card :

¨ World MasterCard ¨ Visa Infinite ¨ Visa Signature

þ Titanium Mastercard ¨ Visa Platinum ¨ Super Saver
¨ CBD Smiles Visa Signature ¨ CBD Smiles Visa Platinum ¨ CBD One
Total Limit Requested (In AED): 10,000
Name to be printed: MUQEET QUADRI

Secured Credit Card Yes ¨ No þ

Preferred Language þ English ¨ Arabic

Personal Details

Title Mr þ Miss ¨ Mrs ¨

Name (as per passport): MUQEET AHMED ABDUL JABBAR QUADRI
Nationality: India
Mobile No. in UAE: 971523558202 Gender Male þ Female ¨
Country of Birth: India Date of birth (as per 21/07/1994 City of Birth: JAMKHANDI
passport): KARNATAKA
Marital status: Single ¨ Married þ Number of dependents: 1
Education: Post Graduate
Personal Email Address: muqeetahmedq015@gmail.com
Duration of residence in UAE: 5 years 0 months
Mother's maiden name: SABEELA
Wife/Husband employed No þ Yes ¨
Emirates ID No: 784199424693606 Passport No: L8997653
Emirates ID Expiry Date: 05/02/2025 Passport Issuance Date: 24/04/2014
Visa No: 20120232144058 Passport Expiry: 23/04/2024
Visa Expiry: 05/02/2025 Passport City of Issuance: BANGALORE
Emirates ID Application No.: N/A Passport Status: Normal þ Diplomatic ¨
Emirates ID Application Date: (for N/A Passport Country of Issuance: India
Renewal/New):
Do you have dual nationality: Yes ¨ No þ
If yes please state other nationality: Not Applicable
Were you born in the US or hold a US Passport or green card or have a US social security number or any tax obligations to the US?
¨ Yes þ No

CRS Self Tax Declaration:

I hereby declare that I:

Reside in the UAE: Yes þ No ¨

Does your profession mentioned under the resident visa, match any of the following types ?
None þ Investor ¨ Partner ¨ Real Estate ¨ House Wife ¨

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 Application Reference Number: DCC1111230387

Employment Details:

Designation: Employed Date of Joining 06/02/2023

Nature of Employment þ Salaried ¨ Pensioner ¨ Salaried + Pensioner

Occupation (Industry): CIVIL ENGINEERS

Name of Employer: ABHIKALPA DESIGN CONSULTANCY

Probation Confirmed: þ Yes ¨ No

Employment Contract: ¨ Fixed þ Renewable
Street: AMMAN STREET Office /Villa No: OFF NO. 603 MONA RESIDENCE

Building Name: OFF NO. 603 MONA RESIDENCE Office Tel. No.: 45299236

Nearest Landmark: EXCELLENCY DRIVING SCHOOL

Office Email: P.O. Box: P.O.Box 87076

Emirate of P.O. Box: DUBAI Emirate of Work: DUBAI

Personal No. as in Labour Card (Optional): N/A

Work Permit No. as in Labour Card (Optional): N/A

Preferred correspondence address: þ Office ¨ Residence

Income Details (In AED):

Total Monthly Income: 8,000.00

Basic Salary (Optional): 0.00

Secondary income (Salaried + Pensioner): 0.00

Other monthly variable Income: ¨ Yes þ No

If yes select the following

¨ Education Allowance 0.00

¨ Commission Allowance 0.00

¨ Other Allowance/ Income 0.00

Source of Other Income (Optional):

Monthly house rent allowance: 0.00

¨ Credit to Bank Account ¨ Rent Paid to Landlord

Annual Bonus (Optional) 0.00

Completed Residential properties on Gifted / Granted Lands : N/A

Settlement

Please select the card payment mode:

¨ CBD Account No

¨ DDA Form No

þ Others

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 Application Reference Number: DCC1111230387

Current Residence Details in the U.A.E.

Building Name/Flat/Villa No: F 304 RAFEEQ SAILKOT BUILDING

Street Name: MUWAILAH P.O. Box: 87076 Emirate of PO DUBAI

Box:
Emirate: SHARJAH City: SHARJAH Tel. No: 97140000000

Nearest Landmark: KARACHI PALACE BAKERY

Residency Type: Rented Duration in current address: 1 years 0 months

Permanent Address in Home Country (for expatriates only)

Flat / Villa No/ Building Name/ Street: ATHANI ROAD QURESHI COLONY BIJAPUR KARNA

City: Bangalore Postal Code: 586102

Country: India Tel No: +917795307685

Loans, Cards from other Financial Institutions (optional)

Product Type Principle amount / Outstanding Monthly Payment Bank Name Tenor No. Of Remaining
Credit limit (In Balance (In AED) (In AED) Installments
AED)

Term Deposit Account Details

Term Deposit Account Number Term Deposit Limit (In AED) Term Deposit Expiry Date Amount to be hypothecated (%)

N/A N/A N/A N/A

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 Application Reference Number: DCC1111230387

Request for Credit Shield (Takaful for Islamic )

This feature ensures that your CBD Credit Card outstanding is protected in the unforeseen events of death, disability, sickness or involuntary
loss of employment. You can enjoy total peace of mind and insure yourself with Credit Shield facility by paying a nominal monthly premium of
0.89% of your monthly statement outstanding balance.

Tick here if you wish to apply for Credit Shield on the below card(s).
¨ Titanium Mastercard
Terms and Conditions Apply. Visit www.cbd.ae for full terms and conditions.

Request for Balance Transfer (Subject to approval of Credit Card(s))

Not Applicable

Fee & Interest

Card Type Titanium Mastercard

Fee Free For Life

Retail Interest 3.69% per month (Effective 6 Sep 2023 rate will be revised to 3.85%)

Cash Interest 3.69% per month (Effective 6 Sep 2023 rate will be revised to 3.85%)

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 Application Reference Number: DCC1111230387

Terms and Conditions

I hereby apply for a CBD (Commercial Bank of Dubai) Credit Card and /or bank account and declare the information provided in this
application is true and correct and I shall advise you of any changes thereto. I hereby authorize CBD to verify and or obtain any information
from whatever source it may consider appropriate. I acknowledge and agree that this application and or use of the credit card and /or CBD's
account facilities or availing any of the facilities and benefits offered by CBD will be construed and deemed as an integral part of the terms and
conditions of accounts, banking services for CBD and the product general terms and conditions in English or Arabic, available at cbd.ae, which
may be amended from time to time and shall apply to all customer relationships which I may hold with CBD, which, I declare that I have read
and agreed upon. I agree and accept to be bound by CBD's schedule of services and tariffs as amended from time to time, as available at
CBD's website, www.cbd.ae. Terms and conditions are applicable to the Primary as well as Supplementary Cards. Signing this application
form is an acceptance of paying the outstanding in the manner prescribed herein, prevailing annual fees, commission, charges announced as
per CBD's service and price guide and applicable monthly interest rate, late payment fee, over limit fee, foreign currency conversion fee and
any other applicable fee (interest rates varies based on customer segment) that can be changed from time to time at CBD's sole discretion.
Where requested, I authorize CBD to issue Supplementary Card(s) to other person(s) and agree that CBD may provide information to him/ her
about the account/card. I hereby agree to indemnify CBD against any loss, damage, liability or costs incurred by CBD on account of any
breach by me or the Supplementary Cardholder(s) of the aforesaid condition or any other Terms and Conditions contained in CBD's Credit
Card Agreement or by any reason of any legal disability or incapacity of the Supplementary Cardholder(s). I take full responsibility on the
identity, legal status and occupation of the Supplementary Cardholder(s) and I will be responsible solely in case of breach of any statutory/legal
regulations. I also understand that it shall be my primary responsibility to honor all outstanding amounts, interests, fees and charges incurred
on the Supplementary Card(s) as an integral part of my obligations towards CBD for my Credit Card. The continuation of the membership of the
Supplementary Cardholder(s) shall depend on the continuation of my membership. I hereby agree and acknowledge that CBD can open a bank
account on the approval of this application. Such bank account shall be governed by the terms and conditions prescribed by CBD in relation to
opening and operations of bank accounts. I further undertake to provide CBD an undated security cheque drawn on my above referred bank
account for an amount equivalent to the limit assigned on my Credit Card(s). In the event of a default or failure by me to effect payments of the
outstanding amount under my Card Account (including any Supplementary Card). I hereby authorize CBD to insert the date in the said cheque,
and present it for payment. I hereby give unconditional and irrevocable consent to CBD, its subsidiaries, agents and authorized staff including
any credit bureau and any third party service providers for disclosures, sharing, usage, processing and searching my credit information/report,
credit record as required. I hereby agree that CBD shall keep all the information relating to the customer confidential and authorize CBD to
request a credit Information Report from the Credit Bureau or any successor organization at any time and disclose any information to: (a) any
member of CBD's group of Companies (b) any of its professional advisor, who is under a duty of confidentiality to CBD. (c) any authorized
credit reference agency or credit bureau (d) any actual or potential transferee or assignee of our rights under this agreement (e) as required by
Law, government or regulatory authority or by Court order (f) in accordance with applicable law or regulation or requests from any applicable
statutory or regulatory body, including but not limited to Etihad Credit Bureau. I shall not hold CBD or its group companies or any of its
directors, officers, employees and agents liable for the use of furnishing of these details and/ or information. Approval in principle or conditional
approval is subject to CBRB (Central Bank Risk Bureau) check and appropriate Fraud checks. This application will remain the property of CBD,
whether the facilities are approved or not. I authorise CBD to accept any subsequent changes to the information provided in the application
form signed by me, electronically and or via a signed form. This will be deemed as my confirmation of the change request. I agree that any
duplication, copy, photocopy, electronic data, or facsimile which have been made as a copy from the original, by means of photocopying,
image scanning, or recording in whatever forms shall be deemed as evidence of consent with the same effect as its original. I shall hold CBD
safe from any claims howsoever arising from as a result of such sharing, searching, usage, processing or disclosure of account information and
data.

Super Saver Credit Card Terms & Conditions

I hereby agree and acknowledge that I have read and understood the Super Saver Credit Card Terms & Conditions published in www.cbd.ae
which may be amended from time to time), in addition to the Credit Card General Terms & Conditions and that I shall be bound by them.

CBD Smiles Credit Card Terms & Conditions

I hereby agree and acknowledge that I have read and understood the CBD Smiles Credit Card Terms & Conditions published in www.cbd.ae
(which may be amended from time to time), in addition to the Credit Card General Terms & Conditions and that I shall be bound by them.

CBD One Credit Card Terms & Conditions

I hereby agree and acknowledge that I have read and understood the CBD One Credit Card Terms & Conditions published in www.cbd.ae or
www.cbdone.ae (which may be amended from time to time), in addition to the Credit Card General Terms & Conditions and that I shall be
bound by them.

þ I’d like to receive information on CBD offers. We may send you emails, SMS or call you.
Signature of Customer:

Name of customer: MUQEET AHMED ABDUL JABBAR QUADRI

Date: 14/11/2023

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 Application Reference Number: DCC1111230387

Specimen Signature

Signature of Customer:

Name of customer: MUQEET AHMED ABDUL JABBAR QUADRI

Date: 14/11/2023

RIM No.(for bank use only):

Account No. (if applicable):

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

For Bank Use Only

Preferred Branch Name: Main Branch

Date: 14/11/2023 Application No: DCC1111230387

Staff Referred by (Optional): N/A

RIM No.: 1968776

Account No. with CBD (if applicable):

Campaign Code (TML Code): General Promotion Code (Optional): N/A

Product Class (for Account): N/A SIC Code: 99106

Segment: CBD Personal

Recommended/Approved:

Security Cheque Number:

Central Archiving Unit:

(original documents along with application form received)

------------------------ ------------------------

(Staff Name and ID) (Signature)

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