MasterCard-Visa Card
MasterCard & Visa Card Platinum
MasterCard & Visa Card Platinum
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
Number of Dependant(s)
Marital Status
ID/Passport No.
Home Address
Length Of Stay
Home Phone
Mobile Phone
Ownership Type
Oversea Address
(For Non-Cambodian)
Length Of Stay
Highest Academic Quafications
Bill Statement
My Empoyment Details
Employment Status
Nature Of Business
Current Position/Job Title
Company Name
Length Of Stay
Address Of Current Employer
Entry Visa Information(For Non-Cambodia only)
Visa Type Class
Visa No
Expiry Date
My Financial Details
Annual Income
Other Income
Source Of Other Income
My Other Credit Card
Issuing Bank
Credit Limit
My Relationship With Cathay United Bank Bank
Account Number
My Settlement
I would like to settle my credit card account by
My Family Details
Mother's Maiden Name
(For Security Verification Purpose)
Name of A Relative Or Friend Not Living With You
Home Address
Annual Fee
Annual Fee for MasterCard/Visa Credit Classic Card
Principle USD 288 and Supplementary USD 188
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 Platinum