Additional Cardholder Application Form

PLEASE NOTE THAT THE FOLLOWING IS REQUIRED WITH YOUR APPLICATION:

Valid Photo Identification Front and Back (e.g. Barbados identification card, passport or driver’s license)
Passport Size Photo
Proof of Address (e.g. current utility bill or bank statement no older than 3 months)
$20.00 Additional Cardholder Fee

Primary Cardholder Information

Primary Cardholder Name

Payce Digital Account Number

Card Expiration Date

Current Address

Home Telephone

Mobile Telephone

Work Telephone

Email Address

Political Background (Anti-money laundering legislation requires that we confirm the below)

Are any of the applicant(s) or immediate family members a current or former senior government, political or military official, or do any of them have a relative or close connection who is a current or former senior government, political or military official?

Yes No

Additional Cardholder Information

Title

Last Name

First Name

Middle Name

Marital Status

Barbados Identification Number

Date Of Birth

Relationship to Primary Cardholder

Current Address

Home Telephone

Mobile Telephone

Email Address

Employment Information

Name of Employer

Your Job Position

Work Telephone Number

Employer Address

Upload Any Supporting Documents ( eg. Scans of identification documents or business registration documents as images or pdf files. )

Please note original documents should be provided in order to complete the process.

Summary Of Terms and Conditions

By signing this form, I agree to issue a supplementary Payce Digital Card on my account to the designated Additional Cardholder and agree to the terms and conditions of the Cave Shepherd Card (Barbados) Inc. Cardholder Agreement. I understand that all authorized users are jointly and severally liable for all transactions and charges debited to this account.

Primary Cardholder Signature ^*

Additional Cardholder Signature ^*