Application for credit card facilities on a Telephone Betting Account

D. CONFIDENTIAL IDENTIFICATION QUESTIONS
Answer any six (6) of the following questions. Be sure to answer the questions that are personal to you and not known by other persons.
1. What is your favourite sport? _______________________________ 6. Which school did you last attend? _______________________________
2. What is your place of birth? _______________________________ 7. What is your wife's maiden name? _______________________________
3. What is your mother's maiden name? _______________________________ 8. What is your maiden name? _______________________________
4. What is your favourite number? _______________________________ 9. What is your favourite animal? _______________________________
5. What is your favourite colour? _______________________________ 10. What is your favourite car? _______________________________
E. INDEMNITY
I hereby authorise my respective bank to release any information required by Gold Circle (Pty) Ltd in order to verify the authenticity of the account/s stated above and my credit worthiness.

I hereby agree to be solely responsible and liable for any and all deposits or cash advances made to my telephone betting account on the above noted credit cards when used in conjunction with my telephone betting account pin number and any of two (2) of the six (6) questions answered above. I hereby further acknowledge and agree that Gold Circle (Pty) Ltd shall not be liable to me for any losses or damages incurred by me, or any other party, resulting from the use of these credit cards in conjunction with my telephone betting account. I further agree to indemnify and hold harmless Gold Circle (Pty) Ltd, from any and all claims, liabilities, losses or damages whatsoever incurred from the use of these cards by any third party specifically including the credit card merchant.






Signature: _______________________________ Date: _______________________________
*All references made to Gold Circle (Pty) Ltd specifically include all former and current employees of the said company.
N.B! PLEASE ENSURE THAT A CLEAR COPY OF THE FRONT AND BACK OF THE RELEVANT CREDIT CARDS ARE ATTACHED TO THIS FORM!