APPLICATION FOR DEBIT CARD
Branch Name _____________________________Branch Code Customer ID_________________
*Applicant’s Name Mr./Ms.
Address/Telephone *Residence Office
Door No/ Street
*City/District/State
*Pin Code
*Mobile No:
Email ID:
*Account Details: SB CD *A/C No.
*Date of Birth: *PAN/GIR No.
*PASSPORT No:__________ *Annual Income: Rs._________ Nationality: _________________ NRI YES NO
*Card Requested for: New Replacement Upgrade Personalised Card Insta Card
If Replacement: Reasons Lost Damaged
**Important Notice: As per RBI guidelines, cards will be issued for Domestic ATM/POS usage only. At
the time of Card activation, ECOM, Contactless and International Operation can be enabled, based
on the specific request.
DOMESTIC INTERNATIONAL CONTACTLESS TRANSACTIONS YES NO
ATM ATM
OFFLINE WALLET FACILITY YES NO
POS POS
ECOM ECOM
*TYPES OF THE CARD
RUPAY VISA MASTER
Classic Classic Platinum
Platinum Gold Signature Gold
Select SME
PMJDY/Mudra/Kisan
Declaration:
I/We declare that the above information is true and correct. I/We clearly understand that all operations effected
through this Debit Card at any of the ATMs/PoS/Ecom are binding on me/us. I/We have read the terms and conditions
governing the use of Debit Card Facility and agree to the terms/conditions and also agree to abide by any
amendments stipulated by the Bank from time to time.
*Signatures (in case of joint accounts operated by anyone or survivor, all account holders to sign the application)
No. Name Signature No. Name Signature
FOR BRANCH USE:
Charges, where applicable, recovered: Rs.__________Application Ref No.__________________
*Roll no. of the applicant, in case of staff: _____________Application Processed & Bonafides Verified.
Debit Card may be issued.
Card No:________________________________________
Date: ________ Entered By: ___________________Approved By:________________
