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Diners Club Shari'ah Card Online Add-on Application
Principal account holder
Diners Club Card
Name
Surname
ID Number
Email address
Add-on card
Relationship to the applicant
Title
Please Select
ABLE SEAMAN
ADMIRAL
ADV
APOSTLE
BARON
BARONESS
BISHOP
BRIG
BROTHER
CANON
CANTOR
CDR
CHARGE D'AFFAIRES
CHIEF
COL
COMD
COMDT
COMMODORE
CONSTABLE
COUNT
COUNTESS
CPL
CPT
DR
DR
DR & MR
DR & MRS
DR & MS
ELDER
ENSIGN
EVANGELIST
FATHER
FLIGHT-SERGEANT
GEN
GOVERNOR
HER EXCELLENCY THE AMBASSADOR
HER EXCELLENCY THE HIGH COMMISSIONER
HER WORSHIP THE MAYORESS
HER WORSHIP THE MAYORESS MS
HIS EMMINENCE
HIS EXCELLENCY THE AMBASSADOR
HIS EXCELLENCY THE HIGH COMMISSIONER
HIS MAJESTY THE KING
HIS WORSHIP THE MAYOR MR
JUDGE
JUSTICE
KING
LADY
LANCE-CORPORAL
LEADING SEAMAN
LIEUTENANT-COLONEL
LIEUTENANT-COMMANDER
LIEUTENANT-GENERAL
LORD
LT
MADAME
MAJ
MAJOR-GENERAL
MASTER
MESSRS
MISS
MOTHER SUPERIOR
MR
MR & MRS
MR & MS
MRS
MS
MS & MRS
NO TITLE
OVERSEER
PETTY OFFICER
PRIEST
PRINCE
PRINCESS
PROF
PROPHET
QUEEN
RABBI
RABBI & MRS
REAR-ADMIRAL
REV
REV & MRS
SENATOR
SERGEANT-MAJOR
SGT
SHEIKH
SIR
SIRS
SISTER
SQUADRON LEADER
STAFF-SERGEANT
SUB-LIEUTENANT
THE ACCOUNTANT
THE ACCOUNTING OFFICER
THE ADMINISTRATIVE MANAGER
THE ADMINISTRATOR
THE AMBASSADOR/THE HONARY CONSUL
THE ATTORNEY
THE ATTORNEYS
THE BROTHER SUPERIOR
THE CHAIRPERSON
THE CHIEF ACCOUNTANT
THE CITY TREASURER
THE CURATOR
THE DEPUTY SHERIFF
THE DIRECTOR
THE DIRECTOR GENERAL
THE DIRECTORS
THE EDITOR
THE EXECUTOR
THE FATHER IN CHARGE
THE FINANCE EXECUTIVE
THE FINANCIAL MANAGER
THE GENERAL MANAGER
THE GRANTEE
THE GROUP FINANCIAL DIRECTOR
THE HEAD
THE HEADMASTER
THE HEADMISTRESS
THE HONORARY SECRETARY
THE HONOURABLE
THE HONOURABLE JUSTICE
THE HONOURABLE MR JUSTICE
THE HONOURABLE MS JUSTICE
THE HONOURABLE PRIME MINISTER
THE INVESTMENT MANAGER
THE LIQUIDATOR
THE MANAGER
THE MANAGERESS
THE MANAGING DIRECTOR
THE MATRON
THE MEMBERS
THE MOST REVEREND
THE PARTNERS
THE PASTOR
THE PAYMASTER
THE POSTMASTER
THE PRESIDENT
THE PRINCIPAL
THE PROPRIETOR
THE RECEIVER OF REVENUE
THE RECTOR
THE REGISTRAR
THE REPRESENTATIVE
THE RESIDENT REPRESENTATIVE
THE RIGHT REVEREND
THE SECRETARY
THE SHERIFF
THE SOLE MEMBER
THE STATE PRESIDENT
THE SUPERINTENDENT
THE TOWN CLERK
THE TREASURER
THE TRUSTEE
THE TUTOR
THE VENERABLE
THE VERY REVEREND
UNDER DEACON
VICE-ADMIRAL
VISCOUNT
WARRANT- OFFICER
WING CDR
First Name
Initials
Surname
Identity Type
Please Select
RSA ID
Passport
Identity Number
Passport Number
Date of Birth
Gender:
Female
Male
Undefined
Nationality
Please Select
AFGHANISTAN
ALAND ISLAND
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BONAIRE, SINT EUSTATIUS AND SABA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CABO VERDE (CAPE VERDE)
CAMBODIA
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLUMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
COUNTRY UNKNOWN
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ESWATINI
ETHIOPIA
FAEROE ISLANDS
FALKLANDS ISLANDS (MALVINAS)
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MC DONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN (ISLAMIC REPUBLIC OF)
IRAQ
IRELAND, REPUBLIC OF
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKSTAN
KENYA
KIRIBATI
KOREA DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KOSOVO
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA,THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHELEMY
SAINT HELENA
SAINT KITTS & NEVIS
SAINT LUCIA
SAINT MARTIN (FRENCH PART)
SAINT PIERRE & MIQUELON
SAINT VINCENT & THE GRENADINES
SAMOA
SAN MARINO
SAO TOME & PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SINT MAARTEN (DUTCH PART)
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND SOUTH SANDWICH ISLANDS
SOUTH SUDAN
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD & JAN MAYEN
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN,PROVINCE OF CHINA
TAJIKISTAN
TANZANIA,UNITED REPUBLIC OF
THAILAND
TIMOR LESTE
TOGO
TOKELAU
TONGA
TRINIDAD & TOBAGO
TUNISIA
TURKEY
TURKISH REP
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S)
WALLIS & FUTUNA ISLANDS
WESTERN SAHARA
YEMEN
YUGOSLAVIA
ZAMBIA
ZIMBABWE
Issuing Country
Please Select
LESOTHO
OTHER
AFGHANISTAN
ALAND ISLAND
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BONAIRE, SINT EUSTATIUS AND SABA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CABO VERDE (CAPE VERDE)
CAMBODIA
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLUMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
COUNTRY UNKNOWN
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ESWATINI
ETHIOPIA
FAEROE ISLANDS
FALKLANDS ISLANDS (MALVINAS)
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MC DONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN (ISLAMIC REPUBLIC OF)
IRAQ
IRELAND, REPUBLIC OF
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKSTAN
KENYA
KIRIBATI
KOREA DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KOSOVO
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA,THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHELEMY
SAINT HELENA
SAINT KITTS & NEVIS
SAINT LUCIA
SAINT MARTIN (FRENCH PART)
SAINT PIERRE & MIQUELON
SAINT VINCENT & THE GRENADINES
SAMOA
SAN MARINO
SAO TOME & PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SINT MAARTEN (DUTCH PART)
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND SOUTH SANDWICH ISLANDS
SOUTH SUDAN
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD & JAN MAYEN
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN,PROVINCE OF CHINA
TAJIKISTAN
TANZANIA,UNITED REPUBLIC OF
THAILAND
TIMOR LESTE
TOGO
TOKELAU
TONGA
TRINIDAD & TOBAGO
TUNISIA
TURKEY
TURKISH REP
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S)
WALLIS & FUTUNA ISLANDS
WESTERN SAHARA
YEMEN
YUGOSLAVIA
ZAMBIA
ZIMBABWE
Contact Country
Please Select
AFGHANISTAN
ALAND ISLAND
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BONAIRE, SINT EUSTATIUS AND SABA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CABO VERDE (CAPE VERDE)
CAMBODIA
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLUMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
COUNTRY UNKNOWN
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ESWATINI
ETHIOPIA
FAEROE ISLANDS
FALKLANDS ISLANDS (MALVINAS)
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MC DONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN (ISLAMIC REPUBLIC OF)
IRAQ
IRELAND, REPUBLIC OF
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKSTAN
KENYA
KIRIBATI
KOREA DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KOSOVO
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA,THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHELEMY
SAINT HELENA
SAINT KITTS & NEVIS
SAINT LUCIA
SAINT MARTIN (FRENCH PART)
SAINT PIERRE & MIQUELON
SAINT VINCENT & THE GRENADINES
SAMOA
SAN MARINO
SAO TOME & PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SINT MAARTEN (DUTCH PART)
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND SOUTH SANDWICH ISLANDS
SOUTH SUDAN
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD & JAN MAYEN
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN,PROVINCE OF CHINA
TAJIKISTAN
TANZANIA,UNITED REPUBLIC OF
THAILAND
TIMOR LESTE
TOGO
TOKELAU
TONGA
TRINIDAD & TOBAGO
TUNISIA
TURKEY
TURKISH REP
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S)
WALLIS & FUTUNA ISLANDS
WESTERN SAHARA
YEMEN
YUGOSLAVIA
ZAMBIA
ZIMBABWE
Contact Number Type
Please Select
CELLULAR PHONE
Contact Number
Preferred Communication
Please Select
CELLULAR PHONE
Residency information
Country of Residence
Please Select
AFGHANISTAN
ALAND ISLAND
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BONAIRE, SINT EUSTATIUS AND SABA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CABO VERDE (CAPE VERDE)
CAMBODIA
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLUMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
COUNTRY UNKNOWN
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ESWATINI
ETHIOPIA
FAEROE ISLANDS
FALKLANDS ISLANDS (MALVINAS)
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MC DONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN (ISLAMIC REPUBLIC OF)
IRAQ
IRELAND, REPUBLIC OF
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKSTAN
KENYA
KIRIBATI
KOREA DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KOSOVO
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA,THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHELEMY
SAINT HELENA
SAINT KITTS & NEVIS
SAINT LUCIA
SAINT MARTIN (FRENCH PART)
SAINT PIERRE & MIQUELON
SAINT VINCENT & THE GRENADINES
SAMOA
SAN MARINO
SAO TOME & PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SINT MAARTEN (DUTCH PART)
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND SOUTH SANDWICH ISLANDS
SOUTH SUDAN
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD & JAN MAYEN
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN,PROVINCE OF CHINA
TAJIKISTAN
TANZANIA,UNITED REPUBLIC OF
THAILAND
TIMOR LESTE
TOGO
TOKELAU
TONGA
TRINIDAD & TOBAGO
TUNISIA
TURKEY
TURKISH REP
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S)
WALLIS & FUTUNA ISLANDS
WESTERN SAHARA
YEMEN
YUGOSLAVIA
ZAMBIA
ZIMBABWE
Visa/Permit Type
Please Select
Asylum Permit
Business VISA
Crew VISA
Critical Skills Work VISA
Diplomat Permit/Visa
Exchange VISA
General Work VISA
Intra-Company Transfer Work VISA
Medical Treatment VISA
Permanent Residence Permit
Quota Work VISA
Refugee Permit
Relative Visa
Retired Person VISA
Study Visa
Treaty VISA
Visitor VISA
Country of Citizenship
Please Select
LESOTHO
OTHER
AFGHANISTAN
ALAND ISLAND
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BONAIRE, SINT EUSTATIUS AND SABA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CABO VERDE (CAPE VERDE)
CAMBODIA
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLUMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
COUNTRY UNKNOWN
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ESWATINI
ETHIOPIA
FAEROE ISLANDS
FALKLANDS ISLANDS (MALVINAS)
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MC DONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN (ISLAMIC REPUBLIC OF)
IRAQ
IRELAND, REPUBLIC OF
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKSTAN
KENYA
KIRIBATI
KOREA DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KOSOVO
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA,THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHELEMY
SAINT HELENA
SAINT KITTS & NEVIS
SAINT LUCIA
SAINT MARTIN (FRENCH PART)
SAINT PIERRE & MIQUELON
SAINT VINCENT & THE GRENADINES
SAMOA
SAN MARINO
SAO TOME & PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SINT MAARTEN (DUTCH PART)
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND SOUTH SANDWICH ISLANDS
SOUTH SUDAN
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD & JAN MAYEN
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN,PROVINCE OF CHINA
TAJIKISTAN
TANZANIA,UNITED REPUBLIC OF
THAILAND
TIMOR LESTE
TOGO
TOKELAU
TONGA
TRINIDAD & TOBAGO
TUNISIA
TURKEY
TURKISH REP
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S)
WALLIS & FUTUNA ISLANDS
WESTERN SAHARA
YEMEN
YUGOSLAVIA
ZAMBIA
ZIMBABWE
Visa/Permit Number
Country of Birth
Please Select
AFGHANISTAN
ALAND ISLAND
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BONAIRE, SINT EUSTATIUS AND SABA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CABO VERDE (CAPE VERDE)
CAMBODIA
CAMEROON
CANADA
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLUMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
COUNTRY UNKNOWN
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ESWATINI
ETHIOPIA
FAEROE ISLANDS
FALKLANDS ISLANDS (MALVINAS)
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MC DONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN (ISLAMIC REPUBLIC OF)
IRAQ
IRELAND, REPUBLIC OF
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKSTAN
KENYA
KIRIBATI
KOREA DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KOSOVO
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA,THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHELEMY
SAINT HELENA
SAINT KITTS & NEVIS
SAINT LUCIA
SAINT MARTIN (FRENCH PART)
SAINT PIERRE & MIQUELON
SAINT VINCENT & THE GRENADINES
SAMOA
SAN MARINO
SAO TOME & PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SINT MAARTEN (DUTCH PART)
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND SOUTH SANDWICH ISLANDS
SOUTH SUDAN
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD & JAN MAYEN
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN,PROVINCE OF CHINA
TAJIKISTAN
TANZANIA,UNITED REPUBLIC OF
THAILAND
TIMOR LESTE
TOGO
TOKELAU
TONGA
TRINIDAD & TOBAGO
TUNISIA
TURKEY
TURKISH REP
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S)
WALLIS & FUTUNA ISLANDS
WESTERN SAHARA
YEMEN
YUGOSLAVIA
ZAMBIA
ZIMBABWE
Visa/Permit Issue Date
Were you ever a citizen of South Africa?
Yes
No
Visa/Permit Expiry Date
Residential Address
Suburb
Residential Addres Line 2
City/Town
Residential Addres Line 3
Postal Code
Frequent Flyer Programme
I would like to be linked to frequent flyer programme
ClubMiles
Other
None
South African Airways Voyager
British Airways Executive Club
Membership number if already a member of a frequent flyer programme
Prominent Influential Persons Information
Are you a public official in a position of authority?
Yes
No
Are you related to a public official in a position of authority?
Yes
No
What is the nature of the relationship or association?
Please Select
BUSINESS PARTNER
CLOSE ASSOCIATE
PARENT
SIBLING
SON/DAUGHTER
SPOUSE/PARTNER
Details of Person:
Consent and Acceptance
As part of our service Diners Club (S.A.) Proprietary Limited would like to provide you with information on products and services offered by the group and other companies, which we believe may benefit you.
Because we regard your personal information as confidential, we need your consent to share it with the group. The group means our affiliates, associates, subsidiaries and divisions together with our holding company, Standard Bank Group Limited, and its affiliates, associates, subsidiaries and divisions.
I consent to
You communicating other companies‘ products, services and special offers to me. If I respond positively to such communication, I may be contacted by that company
Yes
No
You contacting me for research purposes.
(The research companies we use follow strict codes of conduct and treat customer information confidentially)
Yes
No
You marketing your products, services and special offers to me
Yes
No
You sharing my personal information within the group for marketing purposes and the group then marketing its products, services and special offers to me
Yes
No
I declare to the best of my knowledge and belief that the particulars as set out in this application form are true and correct,
and that no additional information that may influence Diners Club SA (Pty) Ltd has been withheld by me
I hereby apply for Diners Club Card subject to the
Terms and Conditions
, which I have read and agree to be binding on me
