Bank of Baroda Credit Card Form
Bank of Baroda Credit Card Form
UNIFORM CHECKLIST
JSTOMER NAME:
IODUCT APPLIED FOR:                            Fevnande
                                                    EASY                 SELECT              PREMIER                     ETERNA                 PRIME
ENAISSANCE       HPCL ENERGIE      IRCTC         SNAPDEAL                 ICAI              CMA ONE                       ICSI                  UNNATI
                INDIAN ARMY                                                              PRAGATI                          OTHERS
VARUNAH                            VIKRAM       RAKSHAMAH         THE SENTINEL                            EMPOWER
                  YODDHA
                                                     INCOME PROOF/SURROGATE
                    BRANCH                                                                                                                      HOME
                                   BOB            NON-BOB                                                             AUTO LOAN
       ITR       RELATIONSHIP                                            STAFF            CARD ON CARD
                                 SALARIED         SALARIED                                                                                      LOAN
                     VALUE
REQUALIFIED                        FIXED       REGISTRATION                            OTHERS
                    RADIANCE                                              CIBIL
                                                 CERTIFICATE
    SALES                         DEPOSIT/
                                                                          SELF                                  OTHERS
MPLOYEMENT STATUS:                                SALARIED                                   AETIRED
                                                                       EMPLOYED C
AME OF ORGNISATION:                                                                                          TENURE(YEARS):
ESIDENCE:           OWNED         RENTED         PARENTAL              HOW LONG(YEARS):
 FFICE:             OWNED         RENTED      RESI. CUM OFFICE         HOWLONG(YEARS):
SUER/BANK NAME:
REDIT LIMIT:
NTAGE OF CARD(YEARS):
                                               Re yOO9                                    four La bhg andy
1CASE CUSTOMER HAVE ANY BOB HL/AL/PL/EL ETC:                     YES             NÞ    IF YES, PLS SPECIFY DETAILS:
RE OVERALL COMMENTS:
ROMOBILE NUMBER:
                                8769689S2                                  RRO SIGNATURE:
                        Bank of Baroda
                        Credit Card                                                     3ETERNA                                           APPLICATION FORM
 ForquickK processing of your application, please complete all sections in BLOCK LETTERS                                           in boxes where appropriate and write N. A. if not applicable.
 Please fill in CLEAR BLOCK Letters, without touching the
                                                          boxes e.g. AB
 IWe wish to apply for Bank of Baroda ETERNACredit Card
                                            For BFSL Use
                                                                                                                                                For Branch Use
               Source Code
                                           Campalgn Code                      Promo Code                        Branch SOL ID               Employee Code (ECNo.)            Branch Head EC No.
 Father's Name
                                   GRAAERaDo
 Date of Birth         DD          MM     YY
                        L61              29 Gender                    MaleFemale                       TG            Nationality        Resident Indian           NRUPIO             Foreign National
 Marital Status         Single          Married       Widow(er)
 CKYC No.KYC ldentifier Number (KIN)
                                                                                                                          ADHAAR NO. Rb SS                                           93S
                                                                                                                              PAN No.CEPG
 Educational Qualification: WGraduate                    Post Graduate            Professional               Other
VialavoreT
Cy 7hoth                                       kudi in                          2 oo
Landmark
                NEARVANAN|4STORE
Tel. (with STD code)
                                                                                                      Landmark
OCCUPATION
Office Address
                                                                                                                                             City
Pin
                                        Tel. (with STD code)|                                                                               Extn.
Bank Name
Bank A/c No.                                                                                   Savings Alc,               CurrentAlc                Other
Mandatory fields. Do not leave blank as it may lead to delaylrejection of the aplication.
                                                                                   ADD-ON CARDS (Photo ldentity Proof Required) (Must be ovor 18 Yoars of Ago)
  IWould like to apply for Add-on Cards for                                                                                                                                                                                           MM
                                                                                                                                                                                                                        DD
                                                                                                                                                     MFTG                                      Date of Birth
                                                                                                                                                                                     PAN No.
           SpouseParentSibling                                       Child           Mobile Number
                                                                                                                                                                                                                          DO          MM         YY
                                                                                                                                                                                               Date of Birth
                                                                                                          DECLARATION
                                                                     ing facility to use the credit card, Ido hereby declarg and confirm that Ihave personally read, understood and Interpreted the MITC (Most Important Terms &
In cor                                                               cdal.com. Iconfim that I have received the MITC along with the application form and have read all details In it The MITC provided is in English language and I am
Condr                                                                guest BOB Financial Solutions Limited to provide anv information with regard to Bank of Baroda Credit Card In English language.I will be bound by the terms and
fully o                                                             he card shall be deemed to be acceptance of those tems and conditlons. I agree to be charged for Ihe first year fee in my first stalement. In case of application of
Condit                                                                in the monthly statement. I declare and understand that the Credit Card issued to me, lIf used overseas, shall be utilized stricly in accordance with the relevant
add-o                                                                                                                                 dmy entlements as per the exchange control guldelirnes of RBI, Iundertake to bring the same
                                                                     bnue Rank of Indla (RBI) from time lo ime. In he even
excha                                                                ure to comply with the prevalng exchange control guldelinesexveeu" dby RBI by me, Ishal be liable for any acion under the Foreign Exchange Management Ac.,
immed                                                             ylther at BFSL instance or RBI. I agree thal credit limit on my card account may be reviewed as per the Company policles specifed from time to ime and the
 1999. will be entilled to cancel my application/cards or to alter the credi/cash withdrawal limits or updale the product at any time without assigning any reason. I understand that BFSL will provide the credit card as per its
Company
internal auidelines and I give Consent for issuance of any diferent credit card in case I am not eligible for the credit card applied for, I am also aware and agree that in the event off my
                                                                                                                                                                                                    a00ngetting approved, E-stalements
would be sent every month to the email id as updated in BFSL records. Also, all SMS related to the card account will be sent to the registered mobile number provided in the application. Iwould like partner with BFSL on The Go
Green' initiative. Please mail my credit card billing statement on the email ID provided in his form. [Please note that no hard copy of monthly statement shall be provided. In case you require hard copy of monthiy billing statement,
please login to your online card account and raise request for a hard copy bill]. Ihereby give my consent lo BFSL for oblaining my KYC details from CERSAI CKYC portal and to receive information from Central KYC Registry
through SMS/Email on the above regislered numberlemail address
 Ihereby authorize BFSL to provide aand collect infomation about the applicant and/or the card account to the financial credit bureaus/regulalory authorities. Iconfim that the attached photograph presents true ldentity of me and that
dim
appliesaduional
        in additioncad
                    to z0picais.
                       the terms ofwhich authotzes
                                    the Card MemberheAgreement
                                                      Company which
                                                               lo applgovems
                                                                      y i to mythecedituSe cards
                                                                                           of my and
                                                                                                 card.forIwhich l acceplthatul responsilly
                                                                                                           also confim                      and agreof anyto notCredit
                                                                                                                               Iam not a defaulter                makeInstitule/Bank
                                                                                                                                                                        any dam against
                                                                                                                                                                                     and mytherepayments
                                                                                                                                                                                               Company arenrespect
                                                                                                                                                                                                            regular.thereto,And that
                                                                                                                                                                                                                      By signing       his candlionI
                                                                                                                                                                                                                                 this application,
understand that all he transactions are effected through my card account. I, including my sUCcessors, lega! heirs, assignees shall be lawtulty responsible for making payments for the same, as per the schedule in force from time to
ima  Ionther undersand thal mere dsputng the transacliensshall nel absolve my pime liabiny todeferldelay the pajment ol my credt card dues and Ialong with my successors, legal bers, assignees wil ba tuly responsbie lar
making payments of the same, as per the payment schedule in force from time to time.
 Ifurther authorize BFSL and/or its associates/subsidiaries/affliates to verify from, and disclose to, any information pertaining to me Imy officelresidence and/or contact my family members and/or my Employer/Banker/Credit
Bureau/ClBILRBI and/or any (hird party including but nol limited to Financial credit bureaus/regulatory authoritles etc. as they deem necessary and/or to do any such verification as they deemmnnecessary. I confim that Ihave no
insolvency proceedings pending against me nor have lever been adjudicaled insolvent. I agree that my slgnature on the charge sllp wll amount to an unconditional undertaking by me to pay BFSL the amount slated therein and
agree that a copy of my periodic statement of accounts will be a conclusive evidence of my liability for the charges stated therein. Iunderstand appllcable taxes from time to time will be levied on fees, interest and other charges, as
per government guidelines.
 Ialso undersland that the BFSL reserves the right to vary any or all of the Terms &Conditions of the Schedule of Charges from time to time. Changed Terms &Conditions shall be communicated through the BFSL'S website and/or by
against monthlyl any dues in Credit Card issued lo me on the basis of this applcaion fom. Yes No Slgnature of Johtaccount Holder ißapplcl
          Tolal Amount Due                Minimum Amount Due                         Customer specific          | % ( fnot spacifed total amount due wil be debited)
 Ihave an active Bank of Baroda Credit Card                                          Ihave an existing Merchant relationship (POS) with BFSL:                      VesNo                (fyes, provide MID number
 Iundertake thal all the documents submitled by me with this application are self-attested true coples of the original documents and are deemed to be submitted by me lo BFSL. I further undersland that in case applicaion is not
 considered   favourably,
  lagree to abide by termstheand
                              Company    reserves
                                 conditions as maytheberight lo relainby Uhe
                                                         amended          the documents submited
                                                                               Company from time towilh
                                                                                                    tlme,thiswithout
                                                                                                              applicalon.
                                                                                                                     giving notice to me. The MITC (Most Important Terms &Conditions) as available on the Company's website has been read by
 me and I agree
 Tunderlake  nol toto use
                      abide
                          thebyCredil
                                them.Card on Internet or otherwise for purchase of prohibited items lke lottery tickels, banned or proscribed magazines, participalion In sweepslakes, payment for callback services, remittance in any fom
 lOwards overseas forex trading, margin calls to overseas exchanges/overseas counter party, trading in forelgn exchange in domesticloverseas markets etc.
  Tundersland that the Company reserves the right to withdraw any of the existing features/conditions including Personal Accldental Death Cover, in which case he nomination details oblained would stand null and void. Ifurther
 undersland hat in the event of settlerment of claim by the Insurance Company against Personal Accidenlal Death Cover, BFSL dues, if any shall be approprlated first and balance shll be paid to the nomlnee. In case of delault in
 payment of the card outslanding, Company may refer he malter to the sole arbltralor to be appolnted by the Company. The arbitraton shall take place in Mumbal and/or Delhi and Iundertake to abide by terms and conditions whalsoev
 er of the award, if any passed by such arbilralor. Iconfirm and authonize BFSL to (a) Use my Aadhaar details to authenticale me from Unique ldentification Aulhority of India (UIDAI) (b) UIDAI lo release my demographic details lo
 BFSL through   biometnc
         authorize  BFSL authenicaion  which informalion/transactlon
                         to share cardholder BFSL may use lor KYC details
                                                                       verificaion
                                                                              with (idenily/address  proo)aliates,
                                                                                   parent, subsidiaries,    lor thebusiness
                                                                                                                    purpose partners
                                                                                                                            of Credit and/or
                                                                                                                                      Card. associates of BFSLfor the purposes of markeing and ofering various products and services
 of BFSL or its group companles, subsidiaries, afiliates, business partners and/or assoclales.
 am nterested okhowmore aboul tlevanous other productyseice)ol BFSL andor aflialessubsidlaryholdingcompany of BFSL or agenis authartzad by BFSL. nd hareby provide my cansenl lo andor aflialosisubsidaryhlid
  ng company ofBFSLor agents aulhonued by BFSL (0 comlacd me lor the sameand Ihis consent shal havean overtding aféct on any Naional Do Nol Cal (NDNC)Tglaty madelopled by me.
 laonm   nat the atadred a0ressprools are presendy alid and tuevenlficalon documents ol mysell wl nouiy BFSLImmediataly when thero is achange in my current ieaidenilal addres, by ghing arequest along with requred
 KYC documenis.
 Thereby agree andIn undersland
                     case any of that
                                  the inabove inlomaion
                                          the absence    (s found
                                                      of me       to be lalse
                                                             submitting OVD ,oflam
                                                                                my aware
                                                                                   CurrentUhat imay wilhin
                                                                                           Address  be heldaliable
                                                                                                             periodforoft3 months trom he dale of his appllcation, BFSL shall be free to proceed wilh appropriale remedies, which may
 include bul shall not be limited to cancellation of the Card issued to me.
 /we hereby Dsubmit my Aadhaar numberlAadhaar Card/Asdhaar Detalls ("Aadhaar Deails") as lssued byby UIDAl B3 proof of identily and Address (or KYC purpose. Futher, Uve valunarily provide mylour independent consent for
 submitting mylour Aadhaar Delails to BOB Financial Solutions Limiled (BFSL), as per regulaions ol Aadhaar ar Act. 2016 (or procassing my credilt card application. I conhim and agree that BFSL $hall nol be liable in any manner
 whalsoever due to my submiting Aadhaar Detalls with BFSL. I further stale and declare that while sourcing the appllcation of Bank of Baroda Credit Card: No Cash has        ncallecled trom me, No credit limits l addiional gifts etc.
 have been promised lo me. Ishall contact the BoB Credit Card Cuetomer Helplina in se I have any doubls/clariflcations.
Signature
                                   VERIFIED WITHORIGINAL
                                Ban of Baroda.Tuticorin Branch
                                        CHRISTINAV
                                        Asst. Manager
                                        EC No: 163906
          Government of lncia                                             Unlgue ldentiicaion ADINOty ohdia
                     VERIFIEDWITHORIGINAL
                                                   Branch
                                       Tuticorin
                       Bagoda
                  Ba of
                                         Manager
                              Manager/ Sr
                     Officer /ChiefManager
                                                                  Aspin
                     CHRISTINAV
                     Asst.Manager
                       EÇNo:163906
                                          Annexure - 1
                                                                     Place :Atcoin
                                                                      Date
The Chief/Sr. Br./Br. Manager,
Bank of Baroda
Tuticomin branch
Dear Sir/Madam,
Subject: In relation to Credit Card issuedto be issucd/ Credit Card Application Ref No. [.] made
to BoB Financial Solutions Limited (BFSL") for issuance of Credit Card.
With reference to the application      issuance pf a Çredit Card to be issued by BoB Financial
Solutions Limited to fo nono eqCardffoider,UWe hereby authorize Bank of Baroda
(the "Bank") to mark a lien to the extent of Rs.         o000       (amount in figures) , Rupces
    five lakhs                   (amount in word5 on the Fixcd Deposit Account Number
    o2o3206L330, including renewals              thereof (FD"),   as security for the Credit Card
being issued to melus by BFSL.
                                                                             FDR3)082200
UWe, hereby intends to deposit the original Fixed Deposit Receipt No.                 dated [.]z|·&.2os
issued in connection with the FD ("FDR"), with Bank of Baroda for creation of security interest
by way of marking lien in favor of Bank of Baroda for securing the due repayment of any and/or
all outstanding amount, including without limitation, any or all outstanding dues/ interest/pcnal
charges/ late payment charges or fees/any other charges or fees/cost ("Outstanding Amount") in
relation to the Credit Card.
I/We, also confirm that the above FD is currently free from lien and/or any kind of
encumbrance and the said FDR shall be treated as continuing security even if the Credit
Card account runs intocredit or is reduced or extinguished at any time or from time to
time.
UWe,agree that the Bank at its sole discretion is hereby fully authorizod to liquidate the
FD without any cause or notice to melus and appropriate the proceeds towards any
Outstanding Dues on the Credit Card and remit such amount to BFSI. In such event,
UWe expressly agree that the Bank shall not be responsible for any loss arising duc to
pre-mature encashment of the FD.            I/We shall, not apply for premature withdrawal
of the FD and authorize the Bank to automatically rollover the FD for such further similar
periods on each maturity date as long as the Credit Card is active and/or is in use and/or
any Outstanding Amount is due towards the Credit Card and is not fully paid to BFSI.
VWe,furthcr acknowledge, confirm and agree that in an event the BFSL decides in its sole and
independent discretion to recalls the Credit Card limit granted to mehus, the Bank in such
  an event shall be entitled to adjust the
                                           BFSL's Credit Card account or any Outstanding
  Amount  due to BFSL by liquidating the FD and IWe shall not
                                                              raise any
  action taken by Bank of liquidation and adjustment of the FD          dispute any such
                                                                        amount towards
  Outstanding Amount of the Credit Card being paid to BFSL.
  UWe. further agree to arrange for further FDs from time to
  may be required by the Bank/BFSL, with lien in favor of thetime of requisite amounts as
  Bank shall be entitled to proceed against the Card Holder forBank. I/We agree that the
  after adjusting the FD towards the dues.
                                                                 the balance outstanding
 Note: 1.Signature to be same as that used for banking transactions 2. To be signed by all the Joint
Account Holders
                                                  Annexure 2
Ref No.:
Dear Sir/Madam,
 All capitalized Terms used herein but not defined, shall have the
Customer Declaration (Annexure - 1).                               meaning ascribed to them in
We refer tothe Fixed Deposit Receipt bearing no. [.] dated [] for an amount of
name of the Card
                                                                               Rs., ("FDR") 0ssued in the
                   Holder and We write to confirm that:
   1. We have noted lien for       bO00 on his/her fixed deposit bearing no.0708030ol330
         and     A/c No. Ofo Polbo00 G217 (copy enclosed) for R               00000                         for
         securing the due repayment of Outstanding Amount against the Credit Card.
   2. We have obtained the duly executed Customer Declaration and letter of
                                                                            Authority as per
      prescribed format and the same are enclosed.
   3. The aforesaid FDis duly discharged on the reverse with our
                                                                 endorsement.
   4. There is no lock in period for encashment of the said FDR.
  5. The amount under the said FDR Would be paid to you on demand, at any time, upon maturity of the
     said FDR or before maturity of the sald FDR without reference to Card Holder.
    6. Encashment whether premature or otherwise would not reguire any reference/clearance from Card
          Holder/any other authority / person.
7. We agree that on encashment of FDR, the interest accrued will also be released to you.
    8. We agree that the FDR will be renewed for such periods as per you instructions from time to time until
          all Outstanding Amount is paid in full or the Card Holder is discharged by You in writing.
    9. We confirm having retained the original FDR copy in our safe custody and shall not release the
          same without obtaining No Objection Certificate (NOC) from BOB Financial Solutions Limited.
Yours faithfully,
Name:
                       B CHRISTINA V
Designation:                 Asst. Manager
                             EC No: 163906
EC No.:
t o l Scheme                         BARODA TIRANGA PLUS DEPOSI         HY¢A YRG / Joint Holder (s)
ArAIGH INomination                   Y
                                     3108202302
Nominee Registration No.
Deposit Amount            Date of Issue           Rate of Interest      Tenure of Deposit               Maturity Date                    Maturity Value*
500000                    31-08-2023              7.25                    OMonths 399 Days              03-10-2024                        540759
"utvaI Ay rstun              HhT (atAlA HTUH fruad * HqrR)/ Maturity Value is subject to TDS (as per current Incume Tax rulcs)
AuA        rrTerms &Conditions:
                                                                                Rate of Interest is in percerlage per annum.
                                                                            I For Deposils issued for a parod of 1yar and above Deposits wil ba renewed for 1
                                                                           ,ear at thÇ prevai ingrate of intergst on the due cata if not instructed otherise
                                                                            i)For DepTsits issued for a pariod of lass than 1 year. Deposits vil be reved for the
                                                                           same period at the prevailing rate of interest on the due date not instructed atnenvise
                                                                           3.   Form 15G and 15H is applicable to Resident accounts anly.
                                                                           4.   Afresh 15G/ 15H 15AA (d applicabla) has to be submitted by Resident individuals
                                                                           for each Financial Year pribr to crossing the threshold limit, failing vhich TDS wi! ba
                                                                           deducted
                                                                           5    Form 15H can be accepted onhv fronn senior clzens (age of 60 ;ears or nore)
                                                                           i Premalure withdrawal of deposit lor Rs 1crore and above vall atract 153% penat.
                                                                            ie. 15% less than card rale as on (ha dale of deposit for the perlod for which dopozt
                                                                            has remainad wth Bank For prenvature withdraval of depasit Rs 1crere end aour a
                                                                           withdrawal nolica of minimunn 31 s prior to wihdravval ef deposts to be given :0
                                                                            Dank:
    Please note, this is a syslom generated advico and doos not require ary signature
|
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                                                                     CARD
                                                                   DEPOSIT
                                                                   FOR
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              LR167843
                                                           Department
                                                        Request
              User
              |
              2023                ID
                                  Module
              September,
                                                          Requested
                                                          By
                                                                                AB
                                                                                 O ANFK   RODA
                           FERNANDO.                                                             ADURA
                                                                                                         https:/
                                                                                                         ctrl.jsp
              07
                                                        Denomin
                                                        ation
                           J
                           ROBERT
                                                    CD Reason
                                                       No.
                           0708
                                  Lien
                           INRDefined                   EffectiveExpiry
                                                        Lien OTH
              Infosys 07080300014330
                                  User                    Date     2099
                          -
              from InquiryULIEN
                                                    FromDate04-09
                                                              2023
              Solution
                                                        Old
                                                        Lien
                                                          Amt. 5,00,000.00
       IFinacle
           Alc.
           Lien
           Maintenance
              Banking
                                  Module
                                  Type                    Amt.
                                                        Lien
                                                        New      5,00,000.00
              Universal
                    Function
                                            Add
                           ID
                           Alc.
                                                                               OK
                                                                                                       Page 1of 1
                                                                          07-09-2023
                                                                                       ROBERT JFERNANDO
    Account Details
    Address         8EAST STREET                           Addres8
    Line 1                                                                CHIDAMBARANAGAR ST
                                                           Line 2
    Address
    Line 3                                                 City           TUTICORIN
    State           TAMIL NADU
    PIN No.
                                                           Country        MAURITIUS
                    628008
                                                           Phone No.      +02(304)547751 / +09(442)323630
                                                           1/ Phone
                                                           No. 2
    Mobile No.   +919150512843                             Emall ID
    Cust. Status NRI                                                      RFERNAND@INTNET.MU
                                                          Alc. Status     ACTIVE
    Go    Clear
                                     ARA     OF BARO
                                           SADURA)