Untitled Document
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
Fist Name
Last Name
Date Of Birth
Mobile Phone
My Financial Details
Monthly 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