Platinum Loyalty Mastercard Application Form

View our Convenient FAQs and Terms and Conditions for more details on the Platinum Loyalty Mastercard.

Sanctioned Countries Declaration

As part of our Platinum Loyalty Mastercard application process, and on behalf of our partner, the St. Kitts-Nevis-Anguilla National Bank Limited, we are obligated to collect the below information about your status as it relates to sanctions.

Required fields are marked with *

Mastercard Sanctioned countries are Russia, Burma (Myanmar), Iran, Sudan, Syria, and North Korea.
Please state the issuing country and the reason you have been placed on this list
Please state the issuing country and the entity you are affiliated with

Required fields are marked with *

Primary Cardholder Details

Additional Cardholder Details

Miss / Mrs. / Mr.

No ' or – or special letter

No ' or – or special letter

No ' or – or special character

No dash

ID #1

No dash

ID #2

No dash

Location

Contact