Credit Cards

Credit Cards

Request For Add-on Card

Details of Add-on Cardmember
APPLICANT TITLE* Mr. Mrs. Ms MIDDLE NAME FIRST NAME* Dr Date of Birth* D D SURNAME* Sex* Name as desired on the Credit Card: (max. 19 characters)*
(Please leave one box between name and surname)

Request For Add-on Card

If Add-on Cardmember not an existing Axis Bank customer, please provide the following documents:
1) Identity Proof: (tick one)
Valid Passport (unexpired) Voters Identity Card Valid Permanent / Learning Driving License (unexpired) PAN card

M M

Photo of Add-on Cardholder

2) Address Proof: (tick one)

Senior citizen card

Bank Pass Book of Scheduled Commercial Bank containing photo Utility Bill not more than 3 months old electricity/telephone/mobile/gas/water /house maintenance) Valid Permanent / Learning Driving License (unexpired)

Ration Card

Valid Passport (unexpired)

F
Voters Identity Card

Copy of Insurance Policy / Premium receipt of general / life insurance company not more than 12 months old

Relationship with Primary Holder* Contact Number*

Spouse

Son/Daughter (Over 15 yrs.)

Brother/Sister (Over 15 yrs.)

Parents

In-laws
Other bank credit card statement not more than 3 months old Copy of rent / lease / leave and license agreement (registered / unregistered) in the individual name, which are not expired Copy of RC book

Mothers maiden name*

(for caller identification only)

E-mail ID

Occuption* Existing Axis Bank Customer* Yes No

PAN intimation letter

Axis Bank Saving/Current/FD/Loan Account/Credit Card/Debit Card No.

(Add-on Applicant)

Name of the Primary Cardmember:

AXIS Bank Card Number: Address* 1) 2) 3) Landmark City Pin Code STD Code State Tel No (Residence) You can fax/ e-mail/ courier the form to: Credit Card Customer Service Axis Bank Ltd, Solaris Tower 'C', 6th Floor, Opp. L&T Gate No 6, Saki Vihar Road, Powai, Mumbai - 400072 Fax: 022-40754632 Email Id: Customer.services@axisbank.com Contact No: 1800 233 5577 or 1800 209 5577 or 1800 103 5577 Please Note: Separate Address Proof for Add-on Applicant is to be provided except where: 1. Primary Applicant has signed the above declaration or 2. Add-on Applicant is an existing Axis Bank Customer and Residential address mentioned above is same as the existing address with Axis Bank. Card Expiry Date: MM YY

Declaration by Primary Applicant (if applicable): I hereby declare that Addon Applicant is staying with me at the residential address mentioned above. Primary Applicant Signature Place: D D M M Y Y Y Y

Cardmember Declaration I understand I can get Additional Card (s) for my Resident Indian parent, parent-in-law, spouse, brother, sister or child over 15 years of age at a special rate. The Additional Card fee will be billed in my statement. It will be my responsibility to honour all charges incurred on the additional card & to ensure that the Additional Cardmember returns the acknowledgment slip containing his/her specimen signature within ten days of receipt of the additional card. I accept that use of the Additional Card by the additional cardmember constitutes acceptance of the terms & conditions of the Cardmember agreement as amended from the Additional Cardmember that the usage of the card shall be in accordance with the Exchange Control Regulation of the Reserve Bank of India & Foreign Exchange Management Act 1999 & that failure to under the Foreign Exchange Management Act 1999. I accept that the facility of an additional card will stand automatically terminated in case of termination of membership of the Primary Cardmember. Further I agree that all communication pertaining to the addon cardholder shall be addressed to me.

Signature of the Primary Cardmember