MASTERCARD CORPORATE CARD - Danish Technological Institute

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MASTERCARD CORPORATE CARD - Danish Technological Institute

MASTERCARDCORPORATE CARDHave you already submitted your application by faxYesNoApplication for a corporatecard with personal liabilityTeknologisk InstitutAftalenr.: 0104205445, T05MasterCard Corporate ClassicWith lounge and with insuranceXCard limit DKr45,000Account LimitIncrease of Account Limit (see above)Other Account Limit Dkk.For MasterCard’s useAccountThe monthly payment will be made through Betalingsservice (direct debit service) on reg. No.accountwith (financial institution), BranchPayment will be made by way of inpayment form Please send the invoice to my home addressPersonal dataCPR No.OccupationFirst name(s) Surname InitialsXAddressPostal codeCityTelephone No. (home)Unlisted telephone No.No telephoneMarriedSingleCohabitantWidow(er)Divorced/separatedDanish citizenYesNoWork permit No.Aliens registration No.Expiry (month/year)Number of children living at home No children Number of cars (excluding company cars) No carOwn detached or terraced houseOwner-occupied flatWeek-end houseFlat under a multi-ownership scheme Tenancy Other type of dwellingPresent address since (Month/Year)Other addresses and names within the past five years, including starting and ending datesIncome and taxAnnual income before tax, DKrOccupationEmployeeMonthly income after tax, DKrSelf-employed Employer or company Telephone No.Employee or self-employed since (Month/Year)Previous occupation within the past five years, including starting and ending datesI am a member of an unemployment insurance fundYesNoDanske Bank · Postboks 1134 · Holmens Kanal 2-12 · DK-1009 Copenhagen KTelephone +45 70 25 10 15 · Fax +45 70 25 10 13 · www.danskebank.com2006.11Danske Bank A/SCVR-nr. 6112 62 28 - København


Other payment cardsI have a DankortNoYes, card numberI have a Visa/DankortNoYes, card numberI have an American Express cardNoYesI have a MasterCard/Eurocard No Yes I have a Diners card No YesI have a petrol cardNo Yes I have a department store credit card or other retailers’ association credit card No YesPlease enclose a copy of your latest annual tax assessment and advance tax assessment from ToldSkat (tax authorities) and yourthree latest pay slips, if you apply for a MasterCard Corporate Gold.I confirm that the information given in this application is true and complete, and I certify by my signature that I have received,read and accepted the MasterCard Corporate Card conditions and list of charges.I recognise that I owe Danske Bank for any withdrawals made from the card account, including interest, overdraft interest, feesand charges, always subject, however, to the rules laid down in section 11 of the Danish Act on Certain Payment Instruments.I accept that– Danske Bank makes a credit assessment of my financial standing, which may include obtaining information from or passingon information to credit institutions, credit-rating agencies and banks as well as an assessment of my present (and previous)facilities with any company of the Danske Bank Group– Danske Bank will make continuous assessment of my financial standing, including any facilities I may have with othercompanies of the Danske Bank Group. Consequently, information on my customer relationships, including my CPR number,may be passed on to and received from other companies of the Danske Bank Group– additional benefits may be linked to the card– Danske Bank exchanges information with business partners for the establishment and administration of additional benefits tomy card – and for the processing of any claims– this application, together with the card conditions and the list of charges, forms the contractual basis of the MasterCardCorporate Card agreement.I am aware that Danske Bank receives a commission on my use of the card in shops and other outlets.X I consent to my card data, now or at a later date, being used in the company Travel Expense Management system or inMasterCard Smart Data Online for statistics that provide an overview and optimise the company’s card administration andpurchases. I can always revoke this consent by writing to or calling Danske Bank.DateIdentificationAs proof of identity, I enclose a copy of myApplicant’s signatureID carddriver’s licencepassport Serial No. ExpiryCompany confirmationCertificationWe confirm that the card application is in accordance with the concluded company card agreement.Company stampTeknologisk InstitutGregersensvej 12630 TaastrupDate and signature(s)

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