Account Information Update

Account Information Update
Your Financial Details
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.
Are you:
Employed
Retired
Source of income:
Title:
First names:
Family name:
Date of birth:
Mr
Mrs
Miss
Other
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D l D lMlM l Y l Y
American Express Card number
3 7
-
Job title:
Years with
employer/
self employed:
Business/
employer’s name:
Nature of
Business:
Business/
employer’s
address:
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Nationality:
Please provide a copy of proof of your identity. Select the type of document and
enter the document number:
City:
Passport
Drivers licence
ID Card
Document
number:
Please give your permanent home address (including country and postal code)
Care of (c/o) business/PO box addresses are not acceptable.
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Address:
City:
Country:
Postal code:
Home tel number:
(inc. country & area code)
Mobile tel number:
(inc. country & area code)
Email address:
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Country:
Postal code:
Tel. number:
(inc. country & area code)
Accountant’s
name: (if self-employed)
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Accountant’s
address:
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City:
Country:
Postal code:
Accountant’s
Tel. number:
(inc. country & area code)
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 the last year, have you or a family member or close associate (including anyone with a
close business relationship, eg joint ownership of company, partnership, or anyone
benefiting from any company/other entity you own) held the position of:
Head of state, minister, deputy or assistant minister? Member of parliament? Member of
Supreme Court, of a constitutional court or other high-level judicial body? Member of court
of auditors or of the Board of the Central Bank? Ambassador, chargés d'affaire or highranking officer in the armed forces? Member of the administrative, management or
supervisory bodies of a state-owned enterprise?
Please tick if ‘Yes’
If you answered yes to any of the above, please state:
Title of role:
Name of
the organisation:
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Country of
the organisation:
If a close associate, give names and relationship to you:
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Homemaker
GBR£
Trust fund/Inheritance
(e.g. private income. Please specify)
US$ Amount
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years
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months
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Please complete if you are self-employed.
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Investments
Savings Other
Gross
annual income:
Student
Other (Please specify)
Salary
Please complete in English using Blue or Black ink and CAPITAL LETTERS.
Your Personal Details
Self-employed
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Please Sign Below
By signing below, I confirm the information I have given on this form is true and
correct.
Cardmember please sign here
D D M M Y Y
X
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
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.
American Express Services Europe Limited, Registered Office: Belgrave House, 76 Buckingham Palace Road, London, SW1W 9AX, United Kingdom, registered in
England and Wales with number: 1833139.
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