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Application Form
CARD APPLICANT DETAILS
First Name
*
First Name Required
Middle/Second Name
Last Name
*
Last Name Required
CPR
*
CPR Required
Invalid CPR Number
Mobile
*
Mobile Required
Invalid Mobile Number
Telephone
Invalid Telephone Number
Email
Invalid Email Format
Address
Type
:
Flat and Building
House/Villa
Select type
Flat/Building
*
House/Flat Required
Road
*
Road Required
Block
*
Block Required
Area/City
*
Area Required
REQUEST TYPE
Select Request Type
New Card
Renew or Lost Existing Card
*
Valid CPR – front and backside
Please, write or specify the existing card number
*
Required
Enter Valid Card Number
Upload CPR(only JPG,JPEG,PNG and PDF format of file allowed,2MB)
*
Select File
Only PDF,JPG,PNG and JPEG file is allowed!
Select File
Only PDF,JPG,PNG and JPEG file is allowed!
FEATURES REQUIRED
Select Any One Option
1. Restrict Card to one vehicle?
*
No
Yes
Record vehicle no
If yes, vehicle no
*
Required
Invalid Vehicle Number
Select at least one
2. Restrict usage of card to fuel type?
*
Open to all
Jayyid
Diesel
Mumtaz
Super
Remarks
*
Restriction feature ensures all fuel transaction is limited to the listed vehicle
Delivery
Mailing Address ( It takes about 10 working days to be delivered)
Select Delivery Type
Select Nearest Location
Muharraq Club Fuel Station (Arad)
Hidd Consumer (Al Hidd)
Qalali Fuel Station (Qalali)
Al Hoora Fuel Station (Al Hoora)
Central Market (Nearby Marina Mall)
Estiqlal (Sanad -Al Hekma School)
Isa Town Consumer (Isa Town)
Tubli Fuel Station (Nearby Al-Anwar Center)
Al Nuzha Fuel Station (Dar kulaib)
Al Rawadha Fuel Station ( Hamad Town Roundabout 7)
Saar Fuel Station (Neerby Alosra Supermarket)
Wadi Al Sail Fuel Station (Nearby BDF Hospital)
Al Shurooq Fuel Station (Nuwaidrat)
Required
Other person on my behalf
Authorized person's CPR
*
Required
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.