Cash Passport Application Form
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1Cash Passport Application Form
Thank You for purchasing a Cash Passport. Please complete sections 1 and 3 of this
form and take it to the Shop where you selected to collect your Cash Passport. Make
sure you have a valid Passport or UK Photo Driving Licence or EEA ID card with you. For
transactions of £5000 and above, you will also need to provide a proof of address: Bank
Statement, Utility Bill or UK Driving Licence (if your Passport was used as the primary ID).
Section 1 – About You
Your Travelex.co.uk order number:
Title (Mr/Mrs/Miss/Ms]
_________________
- Circle -
First Name(s):
Last Name:
____________________________________
_____________________________________
Address: __________________________________________________________________________________
Post Code
__________________________________________________
: _____________________________________
Home:
Mobile:
________________________________________
_____________________________________
Email:
_______________________________________________________________________________________________
US $
AUSTRALIA $
CANADIAN $
NZ $
Currency of Card
EURO
GLOBE £
:
SOUTH AFRICAN RAND
Amount required on Card:
_________________________
Tick if additional card is required (Free)
Signature: ___________________________________
Date of Application: __________________________
Section 2 – For Office Use Only
Note to Staff Member: Please double check that the card number/s of card/s issued is written correctly on this form.
Card No.
Additional Card No.
Starting Balance:
Commission:
_________________________________
___________________________________
Payment Method:
Cash
Credit/Debit Card
Cheque
ID Seen:
Valid Passport
UK Photographic Driving Licence
National ID Card (Issued by EEA)
ID Number: __________________________________
ID Place of Issue: ____________________________
ID Date of Issue: ______________________________
ID Date of Expiry: ____________________________
Staff Member Processing Transaction: Name: _____________________________ Payroll: ________________
Has Photocopy been taken of the ID?
Has Photocopy been taken of the RTS Receipt?
Section 3 – This section will be destroyed once your application has been processed
Date of Birth: ________________________________
Mother’s Maiden Name: _____________________
Your Security Question. Please choose just 1 of the Questions below to secure your account. Do not disclose
the answer to anyone.
1. Favourite Musician/Band: ____________________
2. Favourite Sport: ___________________________
3. Mother’s Middle Name: ______________________
4. Pet’s Name: ______________________________
5. Town of Birth: ______________________________
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