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Application Form

CARD APPLICANT DETAILS

First Name*
Middle/Second Name
Last Name*
CPR*
Mobile*
Telephone
Email

Address

Type:
Flat/Building*
Road*
Block*
Area/City*

REQUEST TYPE

*Valid CPR – front and backside
Please, write or specify the existing card number*
Upload CPR(only JPG,JPEG,PNG and PDF format of file allowed,2MB)*

FEATURES REQUIRED

1. Restrict Card to one vehicle?*
If yes, vehicle no*

2. Restrict usage of card to fuel type?*
Remarks *Restriction feature ensures all fuel transaction is limited to the listed vehicle

Delivery

I confirm that I have read and understand the Terms and Conditions and I agree to be bound by them. I also confirm that all the information supplied to the Bahrain Petroleum Company in this form is, to the best of my knowledge, true and correct.