Add - on Card (s) Application Form Cum MID

Version 1.10

If you are an existing Cardmember, please tick whichever is applicable

Gold Card Business Gold Card Credit Card Number Name of the Primary Cardmember:
First name Middle name
Please leave one box space between names and surname

Appl. No.: World MasterCard

Business Platinum Card Titanium Card

Platinum Card Visa Signature Card

Last name

Name to be embossed on the Card

Title Mr Ms Mrs Dr
Please tick as applicable

Please restrict to 30 characters including Spaces

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

Add-on Applicant Add-on applicant's Mobile no.

Add-on applicant's Email ID

AFFIX YOUR PHOTO

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. Add-on Card Regular - (Life Time Free)

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.

Name to be embossed on the Card

Title Mr Ms Mrs Dr
Please tick as applicable

Please restrict to 30 characters including Spaces

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

Add-on Applicant Add-on applicant's Mobile no.

Add-on applicant's Email ID

AFFIX YOUR PHOTO

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. Add-on Card Regular - (Life Time Free)

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 & Address proof. If Add-on applicant does not hold HDFC Bank a/c and is sibling of primary applicant valid photo ID & 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.

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
1. 2. 3. 4. 5. 6. 7. 8. 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

9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Name of TSE : ________________________________________________________ TSE Code : __________________________________________________________ Name of Doc-Ex : _____________________________________________________ Doc-Ex Code : ________________________________________________________ Channel : ____________________________________________________________ Source Code / Activity : _________________________________________________

Team Supervisors Code : _______________________________________________ Signature of Team Supervisor : ___________________________________________ PB/RM (Mandatory Field) : BRANCH CODE : BDR Code / LC Code :__________________________________________________
Aug 10

City : _______________________________________________________________

20.5cm x 29cm