Scribd
Upload
291 views1 page

CC Sup PDF

This document is a supplementary credit card application form. It requests information about the primary cardholder such as their name and credit card number. It then requests information about the prospective supplementary cardholder like their name, date of birth, gender, photo, relationship to primary cardholder, mobile number, email, desired credit limit on the supplementary card, and copies of identity and address proofs. It notes that the supplementary card limit will be within the primary cardholder's overall credit limit and that the primary cardholder will be liable for all charges on both cards. It requests signatures agreeing to the credit card terms and authorizing verification of application information.

Uploaded by

Ravi Kumar Chintada
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
291 views1 page

CC Sup PDF

This document is a supplementary credit card application form. It requests information about the primary cardholder such as their name and credit card number. It then requests information about the prospective supplementary cardholder like their name, date of birth, gender, photo, relationship to primary cardholder, mobile number, email, desired credit limit on the supplementary card, and copies of identity and address proofs. It notes that the supplementary card limit will be within the primary cardholder's overall credit limit and that the primary cardholder will be liable for all charges on both cards. It requests signatures agreeing to the credit card terms and authorizing verification of application information.

Uploaded by

Ravi Kumar Chintada
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

SUPPLEMENTARY CREDIT CARD APPLICATION

(Liability of the Supplementary Credit Card will be on the Primary Card Member)

RM Emp Id : Lead Fulfiller Emp Id :


Lead Generator Emp Id :

PRIMARY CARDHOLDERS DETAILS:


Name

Credit Card Number

SUPPLEMENTARY CARDHOLDER DETAILS:

Name*

Photo of Supplementary Date of Birth* Gender Male Female Third Gender


Card Applicant
Relationship Spouse Father Mother Son Daughter Brother Sister
(To be cross-signed
by the supplementary
card applicant) Name as desired on the Card*
(Maximum 19 characters, including spaces)

Mobile*

E-mail ID (Personal)*

Spend limit for Supplementary Card ` (multiples of “000” only)

** Instructions – Please enclose the following documents


A self-attested copy of proof of identity (any one of the following)*
Passport Voters ID Driving License
PAN Card Aadhar Card Government ID Card
A self-attested copy of proof of residential address (any one of the following)*
Passport Voters ID Utility Bill
Aadhar Card Driving License Bank Statement
• Self Attested copy of PAN Card is mandatory. If the applicant does not have a PAN Card then Form 60 and ID Proof with customer acknowledgement of PAN
Application to be collected.
• Utility bill, which is not more than two months old of any service provider - electricity, telephone post-paid mobile phone, piped gas, Water bill
• Bank account or Post Office savings bank account statement
• ID & Address Proof needs to be ticked out of the options provided

1. The spend limit set for the supplementary card would be a subset of the credit limit available on the primary credit card. If not specified, the entire credit limit of the
primary credit card would be shared with the supplementary card
2. As per provisions of Reserve Bank of India Master Circular (RBI/2009-10/73; DBOD. AML. BC. No. 2/14. 01. 001/2009-10) on Know Your Customer (KYC) norms dated
01 July 2009, it is mandatory for all banks to update the customer identification documents (including photographs). Please submit the completed form along with
the documents to the nearest ICICI Bank branch.

We confirm that the information given is true and correct. We understand the Primary Card Member will be liable for all the charges incurred with the Primary
Card and the Supplementary Card. We jointly and severally agree to be bound by the Rules and Regulations of use of the Credit Card, copy of which we
have receivedand understood. In particular, we confirm the usage in strict accordance with the Exchange Control Regulations of the Reserve Bank of India.
We understand that in the event of failure to do so, we are liable for action under the Foreign Exchange Regulation Act, 1973 and may be debarred from
holding the ICICI Bank Credit Card, either at the instance of ICICI Bank or the RBI. We authorise ICICI Bank to verify information in this application and to
receive or exchange information about s with other banks, agencies, companies for marketing and administrative purpose or for prevention of frauds, etc.

Signature of Primary Card Applicant Date

PN_2019_MAR_ICICI CREDIT CARD_CORP_11143122_SIZE_A4_SUPPLEMENTARY CREDIT CARD APPLICATION FORM

You might also like