Add - on Card (s) Application Form Cum MID
Version 1.11
Appl. No.:
If you are an existing Cardmember, please tick whichever is applicable
Gold
Titanium
Platinum Plus Card
Visa Signature Chip Card
Business Platinum Credit Card
World MasterCard
JetPrivilege Titanium
Titanium Edge
Solitaire
JetPrivilege Platinum
Regalia
Superia
JetPrivilege World
Credit Card Number
Name of the Primary Cardmember:
First name
Middle name
Last name
Please leave one box space between names and surname
Name to be embossed on the Card
Title Mr
Ms Mrs
Dr
Please restrict to 30 characters including Spaces
Please tick as applicable
Date of Birth
D D MM 1 9 Y Y
Sex
Add-on applicants HDFC Bank A/c No.
* Mandatory for Add on customer who have an account.
Add-on applicant's Cust ID
AFFIX
YOUR
PHOTO
Add-on applicant's Mobile no.
Add-on
Applicant
Add-on applicant's Email ID
I confirm that the add-on applicant is my __________________________________________________ (relationship with Add-on)
and is
staying/
not staying with me at the same residential address as provided to the Bank by me. I as primary card holder
take the full responsibility of the add-on card, including all transactions/usage and payments related to the add-on card. I will produce
the ID proof of the add-on card member, as and when requested by the Bank.
Regular - (Life Time Free)
Add-on Card
ADD-ON SUB-LIMIT OPTION: Please indicate the limit to be set on the Add-on Card per statement cycle:
25% of Credit Limit
50% of Credit Limit
Rs.1000
Rs.5000
Rs.10000
If neither option is chosen clearly, 100% will be set as default Add-on limit.
Add-on applicant without HDFC Bank A/c & not staying with Primary cardholder will be required to submit valid photo ID, Pan Card or Form 60 & Address proof. If Add-on applicant
does not hold HDFC Bank a/c and is sibling of primary applicant valid photo ID, Pan Card or Form 60 & Address proof will be required. Please refer to the List of Acceptable valid photo ID
& address proof for Add on in the next Page.
I hereby acknowledge the request made for Add-on Card and warrant that the above information is correct and hereby request and authorise that an Account be opened and Card(s) be issued as indicated
herein and renewed and replaced until I give notice to cease, and in connection herewith authorise the exchange and transfer of credit information from / with my Bank or any other source. I understand that
HDFC Bank Ltd., reserves the right decline the application without giving any reason whatsoever. The additional applicant (s) and I agree to be bound by the terms and conditions of The Cardmember
Agreement earlier executed by me. I declare and undertake that the Cards issued to me, if used overseas shall be utilised strictly in accordance with the relevant exchange control regulations issued and as
amended by the Reserve Bank of India (RBI) from time to time. In the event I exceed my entitlemants as per the exchange control guidelines of RBI, I undertake to bring the same immediately to the notice of
HDFC Bank Ltd., in writing. And in the event of any failure to comply with the prevailing exchange control guidelines issued by RBI, I shall be liable for action under the Foreign Exchange Management Act,
1999 as amended, and be debarred from the Card facility. The undersigned will be liable for all charges incurred with the Add-on Card(s) issued on the Account and each Add-on Applicant will be liable for all
charges incurred with the Add-on Card jointly and severally with the holder of the Primary Card.
Conditions Apply: Sub-limit on Add-on Card is per statement cycle. Sub-limit will hold good only for ATM and POS transactions but the same will not apply for online transactions.
For detailed terms & conditions visit www.hdfcbank.com.
FORM NO. 60 (SEE THIRD PROVISION TO RULE 114 B)
Form of declaration to be mandatorily filled by a person who does not have a Permanent Account Number.
4. Address Proof Attached
1. Full Name and Address
Passport
Driving Licence
Voter ID
Bank account statement/Passbook
Utility bill (incl. mobile postpaid bill)
Registration documents/Ownership proof copy
Ration card
Lease deed/Rent agreement copy
Others (please specify)
VERIFICATION
2. Are you a Tax Assessee
Yes
No
3. If Yes,
knowledge and belief.
A. Details of ward/circle/range the last ITR was filed
Verified today the
B. Reason for not having PAN
Place
Track your Credit Card application status at the HDFC Bank website through 16-digit unique application
reference number which you will receive on your mobile number.
www.hdfcbank,com->Cards->Credit Cards->Track your Credit Card.
do hereby declare that what is stated above is true to the best of my
day of
Signature of the Add-on Applicant
Date
HDFC Bank customers need to sign as per Bank records.
Primary Cardmembers Signature ........................................................................................................................
By Signing here, I certify that I have read and agree to all applicable Terms & Conditions.
Date : ............................................................
List of acceptable Photo ID for Add on Card holder. (Expired ID proof will not be consider as valid proof)
ANY ONE OF THE BELOW
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
PAN Card
Passport
DL / LL (DL from Uttar Pradesh alone can be accepted without Signature)
Voters ID
Ration Card (In Customer Name)
Company/Institution photo ID card
Student ID card
Club membership card (which carries customer photo)
OBC Photo Card
Insurance / Mediclaim Photo Card
Passbook with Photo
Railway station pass ID - Government recognised
Senior citizen ID - wherever applicable
Government organisation ID card with signature and photo.
List of acceptable Address Proof for Add on Card holder.
ANY ONE OF THE BELOW
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Passport
Driving licence(Customer having Driving License Issued from Uttar Pradesh can be accepted with out the Signature on the
same.)
Telephone bill - MTNL / BSNL & all WLL lines' bills can be accepted
Electricity bill - Ebil and Physical Bill
Bank account statement - Bank statement or Pass book can be accepted - In both the address should be mentioned
Ration card
Voters ID (if it has address)
Letter from the society (only Registered societies) - on the letterhead which carries the society's Registration No. The letter
should carry the applicant's name & full address as well as the signatories full name, designation (Secretary, President) and
address.
Monthly outgoings bill from Registered Housing society - on the letterhead which carries the society's Registration No.
(Maintenance charges receipt issued by the society NOT acceptable)
Registration documents/Ownership proof copy
Senior citizens card from Indian Railways/Indian Airlines (if it has address)
Mobile post paid bill
Letter from any recognized public authority (In original)
Company ID card (For CAT AB companies only)
LIC Premium receipt
Address confirmation by the corporate on company letter head as valid address proof (For CAT AB companies only)
Gas Bill
Water Bill
Society Maintenance Bill
Property Tax Receipt
Name of TSE : ________________________________________________________
Team Supervisors Code : _______________________________________________
TSE Code : __________________________________________________________
Signature of Team Supervisor : ___________________________________________
Name of Doc-Ex : _____________________________________________________
PB/RM (Mandatory Field) :
Doc-Ex Code : ________________________________________________________
BRANCH CODE :
Channel : ____________________________________________________________
BDR Code / LC Code :__________________________________________________
Source Code / Activity : _________________________________________________
City : _______________________________________________________________
Aug 10
1.
2.
20.5cm x 29cm
