Title: Mr Mrs Miss Other
First names:
Family name:
Date of birth:
American Express Card number
Nationality:
Please provide a copy of proof of your identity. Select the type of document and
enter the document number:
Passport Driverslicence IDCard
Document
number:
Please give your permanent home address (including country and postal code)
Care of (c/o) business/PO box addresses are not acceptable.
Address:
City:
Country:
Postal code:
Hometelnumber:
(inc. country&area code)
Mobiletelnumber:
(inc. country &areacode)
Email address:
Providing American Express with your email address will allow us to send you email
offers which we believe are suited to your needs, including information on new benefits,
products and services. You may request not to receive these offers at any time by
updating your email preferences via the privacy statement link on the American Express
website. Please note we can accept a maximum of 30 characters for your email address.
In thelastyear, haveyou or a familymember or closeassociate (includinganyone with a
closebusiness relationship, eg jointownership of company, partnership, or anyone
benefitingfrom anycompany/other entityyou own) heldthe positionof:
Head of state,minister, deputy or assistant minister? Memberofparliament? Memberof
Supreme Court, of a constitutional courtorother high-level judicialbody?Member of court
of auditorsorof the Boardofthe C
entral Bank? Ambassador, chargésd'affaireorhigh-
ranking officer in thearmed forces? Memberofthe administrative, managementor
supervisorybodies of a state-owned enterprise?
Please tickif‘Yes’
If
you answered yes to any of the above, please state:
Title of role:
Name of
the organisation:
Country of
the organisation:
If a close associate, give names and relationship to you:
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Your Personal Details
Account Information Update
A review of your American Express
®
Cardmember account has indicated
that we require some additional/updated information. Please complete this
form and return to American Express to ensure the ongoing availability of
your Card.
Please complete in English using Blue or Black ink and CAPITAL LETTERS.
s
American Express Services Europe Limited has its registered office at Belgrave House, 76 Buckingham Palace Road, London, SW1W 9AX, United
Kingdom. It is registered in England and Wales with Company Number 1833139 and authorised and regulated by the Financial Conduct Authority.
IMPORTANT. Please ensure you provide:
• Proof of your address
(e.g. Utility bill or bank statement dated within the last three months.)
• Copy of your passport, drivers licence or identity card.
Are you: Employed Self-employed Student Homemaker
Retired Other
(Pleasespecify)
Sourceofincome: Salary Investments Trust fund/Inheritance
Savings Other
(e.g. private income. Pleasespecify)
Gross
annual income: GBR£ US$ Amount
Job title:
Years with
employer/
self employed: years months
Business/
employer’s name:
Nature of
Business:
Business/
employer’s
address:
City:
Country:
Postal code:
Tel. number:
(inc. country &areacode)
Please complete if you are self-employed.
Accountant’s
name: (if self-employed)
Accountant’s
address:
City:
Country:
Postal code:
Accountant’s
Tel. number:
(inc. country & area code)
By signing below, I confirm the information I have given on this form is true and
correct.
Please send the completed form to:
UK Executive Customer Relations
Department 333
1 John Street
Brighton
BN88 1NH
Alternatively, fax the documentation to: +44 (0) 1273 624026
Cardmember please sign here
X
D D M M Y Y
Please Sign Below
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Your Financial Details
