Professional Documents
Culture Documents
VERSION 1.36 E
Source
Promo
Team/BR code
LG/DSE
LC1 Code
Ld No
LC2 Code
EReference No:
16013003181
Token No
APS Reference No
I wish to confirm that,I agree to pay the fee as per the Credit Card chosen/ticked by me from the below
RENEWAL 1ST Year Fee
Waiver Condition
FEE
ANNUAL
FEE
INTERNATIONAL ENABLED
Online Application
Title
First Name
YEATESH
Mr.
Middle Name
Last Name
SABHARWAL
YEATESH
(Applicable for Business Credit Card only)
Gender
JP
NO
MALE
29/05/1991
Date of Birth
No. of Dependents
Educational Qualification
PAN No.
ANCPY6362L
Voter ID.------------------------
Primary UID.
Passport No.
Place of issue---------------------
Nationality
INDIAN
City/State
133302
PIN
Landmark
*Tel No.
91-8901322623
Is it a PP No.?
Personal E-mail ID
YEATESH21@GMAIL.CO
Yes
No
Mobile No.
7027322623
Please provide non-generic E-mail ID for security reasons as confidential / sensitive informaiton may be shared vide E-mail.
Alternate/Permanent Address:
HNO 166 WARD 17
Flat / Door No. & Building Name
PARADE MOHALLA KALKA
Road Number / Road Name
HARYANA
133302
PIN
KALKA
City/State
Landmark
-
*Tel No.
Is it a PP No.?
Yes
No
Mobile No.
7027322623
Please give us the name of a relative/friend in your city who does not stay with you as reference.
Name
Tel No.
Your residence is
FAMILY
Your vehicle is
Your vehicle is
Owned
Company Provided
Years
Months
SALARIED
PUBLIC LIMITED
OTHERS
Years (if self-employed, mention total period in business) If self-employed, Capital Investment-----------
Company Address :
Flat / Door No. & Building Name
Road Number / Road Name
City/State
Landmark
Company Code
Designation
SALES INCHARGE
PLOT NO 182/66
INDUSTRIAL AREA PHASE-1
PUNJAB
CHANDIGARH
Department SALES
PIN
160002
Emp Code
*Tel No.
Extension No.
HR Contact No.
Fax No.
Supervisor Contact
Time of Contact
Period at the current employment
Office E-mail ID
Years
Months
Please provide non-generic E-mail ID for security reasons as confidential /sensitive informaiton may be shared vide E-mail.
Are you an HDFC Bank / ADFC Employee NO
(If Yes Salary A/C No.
Empl ID
/ Grade/Band:
IMPORTANT FIELDS TO BE FILLED*
Other Banks
Name of your Bank
63111437
SAVINGS
Branch Name
Demat Account(if any)----------Years
Months
Account No.
Account Type
Current
Savings
Years
Months
Housing Loan(HDFC)
Expiry Date
Income Details:
20228
1. Gross Monthly Income---------------------------------------------------------2. Additional Monthly Income (attach documents if any)-----------------------------3. Average Monthly Expenses.---------------------------------------------------------*
Spouse's Company Name-----------------------------------------------------Spouse's Office Tel No-------------------- Extension No--------------------Yes-The details provided are correct best of my knowledge *.
No-I don't want to provide any details*.
Online Application
RELATIONSHIP -IMPORTANT*
Do you have any relationship with any Director or Senior Officer of HDFC Bank :
Name of Director/Senior Officer
NO
Relationship with the Director/Senior
STATEMENT
Where would you like your card statements and other correspondence to be sent?
Residence
NOT APPLIED
Primary Applicants signature
*
Online Application
Date--------
HDFC Bank account number aforementioned above in the Bank Details section will be used for direct debit facility. If neither option
clearly chosen /the MAD option will be set by default..
Mr
Ms
Mrs
Dr
Sex
DD
MM
YYYY
I confirm that the add-on applicant is my---------------------- (relationship with Add-on) and is [
]Staying/ [
at the same residential address as provided in this application form. 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.
Online Application
If add on applicant does not hold HDFC Bank a/c then valid Photo ID proof and Address Proof needs to be submitted.
Add-on applicant's HDFC Bank a/c No.
Add-on applicant's Customer ID
Primary Applicants signature
*
Online Application
Date--------------ADD ON SUB-LIMIT OPTION : Please indicate the Sub-Limit to be set on the Add-on Card per Statement Cycle
Rs.5000
Rs.10000
D E C L A R AT I O N
I hereby apply for HDFC Bank International Credit Card(s) and declare that the information included in this form is true and correct and that I am a Resident Indian/foreign
national working in India and that I am eligible to apply for an internationally valid card. I accept that HDFC Bank is entitled in its absolute discretion to accept or reject this
application. It is my responsibility to obtain the Terms and Conditions applicable to the HDFC Bank International Credit Card(s) separately and read the same. I will be bound
by the Terms and Conditions as may be in force from time to time and receipt/use of the Credit Card shall be deemed to be acceptance of those Terms and Conditions. I
authorise HDFC Bank and/or its associates to verify any information or otherwise at my office/residence or to contact me/my employer/banker/credit bureau/RBI or any other
source to obtain or provide any information that may be required for confirming membership requirements or maintaining my account in good credit standing. I agree to be
charged my card fee in my first statement. In case I have applied for Add-on Card(s) (available for Resident Indian parent / spouse /brother / sister /child over 18 years of age
at special rate) I will be billed for such an Add-on Card in the normal monthly statement. I, the Primary applicant 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. The
facility of Add-on Card(s) being a special facility at a concessional fee/rate, continuation of the Add-on Cardmember will be dependent on the continuation of my
membership. I understand and undertake that the usage of the HDFC Bank International Credit Card(s) shall be strictly in accordance with the exchange control regulations
of the Regulatory Authorities as applicable from time to time which I undertake as my responsibility to keep myself updated of, and in the event of any failure to do so, I will be
liable for action under the Foreign Exchange Management Act, 1999 or its statutory modification or re-enactment thereof. I confirm that I have no insolvency proceedings
pending against me nor have I ever been adjudicated insolvent. I agree that my signature on the chargeslip will amount to an unconditional undertaking by me to pay HDFC
Bank the amount stated 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. My
liability under the chargeslip signed by me shall not withstand any dispute I may have with respect to the quality/quantity of goods purchased or quality of services obtained. I
will not hold the Bank responsible if any outlet/franchisee refuses to accept the card. I authorise HDFC Bank to disclose, from time to time, any information relating to my
Credit Card(s), (including any default in payments) to any other card issuer, credit bureau, financial institution, any parent/subsidiary, affiliate, Co-brand partner and
associate of HDFC Bank, and to third parties engaged by HDFC Bank, for purpose such as marketing of services, proper operation of Credit Card accounts and other
administrative services. The Bank will be entitled to cancel my card(s) at any time without assigning any reasons. I understand Service Tax as applicable from time to time will
be levied on fees, interest and other charges, as per government guidelines.I understand that Service Tax is not applicable on my regular purchases. I am aware that the
Bank reserves the right not to return the supporting financial documents given by me along with the application.I have received and read the detailed Terms and Conditions
and agree to abide by them, once I am allotted the Credit Card. I hereby confirm that I have also read and understood the contents of the Schedule of Charges and disclosure
details, and agree to be levied variouscharges mentioned therein as and when applicable to me. I confirm that basis my eligibility HDFC Bank shall at its sole discretion
reserve the right to issue any existing card product in their portfolio. Credit Limit on any card account may be reviewed as per the Bank policies specified from time to time and
the Bank reserves the right to revise (increase or decrease) and/or unconditionally cancel the limit assigned on a card without any prior notice to the Cardmember. I also
understand and agree to the fact that the Bank is authorised to change any or all of the Terms and Conditions of the Schedule of Charges at its own discretion. I authorise the
Bank to record specific conversations between me/my representative and the Bank's representative, in case of grievance-related conversations or payment-recovery
related conversations or any other conversation that the Bank may deem fit, at its own discretion. I agree to abide by any Terms and Conditions as may be added/amended
by the Bank from time to time without giving notice to me, regarding this Credit Card and any other facility/loan product that I avail through this Credit Card or any other Credit
Card that I may be issued by the Bank in the future. I agree to receive my card statements through email on the email IDs mentioned in the Application Form. I am aware that
my new Credit Card would be automatically registered for NetBanking in case I am already an HDFC Bank NetBanking customer. I understand that HDFC Bank will issue the Credit
Card according to the Bank's internal guidelines. I hereby give my consent to the Bank to provide me a different card in case I am not eligible for the product applied
for. I authorise HDFC Bank to transfer my accrued reward points periodically to my JetPrivilege Frequent Flyer Program membership number as provided by me in the
Credit Card application form.
I/We hereby authorize and give consent to the Bank to disclose, without notice to me/us, information furnished by me/us in application form(s)/related documents executed /
to be executed in relation to the facilities to be availed from the Bank, to the Bank's other branches/subsidiaries/affiliates/ Credit Bureaus/Rating Agencies, Service
Providers, banks/financial institutions, governmental/regulatory authorities or third parties for information verification, credit risk analysis, or for other related purposes that
the Bank may deem fit. I/We waive the privilege of privacy and privity of contract"
Date----------
Online Application
I agree to participate in any or all of the Card upgrade programs and limit enhancement programs that
the Bank may conduct on my card account from time to time as part of periodic portfolio reviews basis
relationship / income details available with the bank as per prevalent policy conditions of the bank.
I do not
to receive information/service for marketing purposes
through Telephone/Mobile/SMS/e-mail/any other mode from the Bank/or its agents
* I Confirm that I have read and understood the MITC (Most Important Terms and Conditions), Product
Features & Pricing and fully accept it.
* I hereby give my consent and specifically confirm that the Online Application form submitted to HDFC
Bank shall be valid, effective and legally enforceable against me though it is not electronically signed by
me. For the purpose hereof, a document shall be deemed to be ELECTRONICALLY SIGNED if it has
been encrypted / Authenticated by using an electronic method or procedure in accordance with the
provisions of the Information Technology Act, 2000 or in any other manner / method / procedure /
technique as is recognised / envisaged as a valid method of encryption / authentication under the
provisions of the Information Technology Act, 2000.
Below mentioned box has to come next to above Information Technology ACT confirmation:
101.57.7.219
at IP address----------------------------------------
Kindly note that approximate Credit Card processing time is about 2 -3 weeks from the date of submission of completed form
FormNo.60(seeThirdProvisontoRule114B)
Form of declaration to be mandatorily filled by a person who does not have a Permanent Account Number
4. Address proof attached:
[ ] Passport [ ] Driving Licence [ ] Utillity bill(incl.Mobile postpaid bill) [ ] Ration Card [ ] Voter ID
1. Full Name & Address:---------------------------------------------[ ]Bank account statement/passbook [ ] Leasedeed/Rent agreement copy [ ] registration documents/Ownership proof
--------------------------------------------------[ ]Others(Please specify)
--------------------------------------------------VERIFICATION
--------------------------------------------------I---------------------------do hereby declare that what is stated above is true to the best of my knowledge
and belief.Verified today the-------------------------------2. Are you a tax assessee
[ ] Yes [ ] No
Primary Applicants signature
3. If YES
Date--------------*
A.Details of ward/circle/range where the last ITR was filed---------------------------- day of--------------------------Online Application
Place----------------------------B. Reason for not having PAN Number----------------------------------------------HDFC Bank customers need to sign as per bank records
Acknowledgement of Credit Card application
We acknowledge the receipt of your application for a credit card from HDFC Bank. In case of any queries you may contact our Customer
Service call centers or mail us at customerservices.cards@hdfcbank.com.
Signature of DSA/HBL Rep :
Date-------------------------*
HBL/DSA Name : -----------------------------------Online Application
Mobile no of HBL/DSA -----------------------------Please indicate your choice of HDFC Bank international Credit Card
City
Details 1
Details 2
Details 3
Telephone
Electricity
Mobile Co 1
Mobile Co 2
Insurance Co 1
Insurance Co 2
Insurance Co 3
* To set a maximum limit of payment that can be made towards the billing company; *Mandatory Field.
1) You can apply from only the list of the billers provided in the table under smartpay on Regular Card Offerings
2) Please sign on the reverse side for smartpay after reading the terms and conditions
3) Please provide a copy of the latest bill (any of the last three bills received from your utility company); for each utility company opted above to enable us to verify the
customer account details.
4) Only duly completed forms will be accepted.
5) Continue making bill payments towards the above mentioned utility company bill outstandings until you receive a SmartPay activation confirmation through email /SMS / Letter.
I agree to be levied processing fee of Rs. 10/- plus service tax for each bill paid on my behalf on my HDFC Bank Credit Card. I agree and accept that HDFC Bank reserves the right to withdraw this
offer without any prior information to me. I hereby declare that the above information is correct and complete and request that SmartPay facility be provided to me. I acknowledge that I have read,
understood and agree to be bound by the SmartPay Terms & Conditions that are currently in effect and as may be amended from time to time. I declare that I have not registered for any other
alternate mode of payment for any of the bills mentioned above and I agree that my registration would be rejected if already registered with any other service provider.
Primary Applicants signature
Date---------------
*
Online Application
HDFC Bank customers need to sign as per bank records
Card No------------------------
Expiry Date-----------------------
Date-------------
Online Application
C A S H O N C A L L A P P L I C AT I O N F O R M
Amount in Fig. (Rs.) UPTO CASH LIMIT MAX 50,000
only
Tenure (in months) 24 Rate of Interest (p.m.) 1.35%
Processing fee ( Rs.) 2% Min 250, Max 1250 (+ Service Tax as prevailing rate)
Please note that Monthly Payment = Principal Amount+Interest Amount+Service Tax on the interest amount.
Please refer to the Amortization Schedule (will be sent after your loan is set up) for details of Principal Amount & Interest Amount.
Service Tax at the prevailing rate (Currently 10.3%) will be levied on the Interest Amount of the EMI.
Credit to my Savings (in my name) held with HDFC Bank.
HDFC Bank A/c No.:
I agree and abide by the following Terms & Conditions :
Primary Applicants signature
Date-----------------
Online Application
I hereby agree to accept the COC of an amount / tenure /ROI/ Processing fee as mentioned above.* The COC amount
approved for would be blocked against my HDFC Bank Credit Card limit.* The above offer is subject to approval of the
COC amount applied for * Approval of COC at the sole discretion of the Bank * Normal Terms and Conditions are applicable .
* HDFC Bank will charge preclosure fees (3% of principal outstanding) and the Interest on the principal outstanding from last
statement date till date of loan preclosure.
I N S U R A N C E D E C L A R AT I O N
Customer Name : -------------------------------------------------------------------------------I/We hereby declare that HDFC Bank has disclosed to me/us the Referral Fee payable to them for the policy recommended to me/us.
Primary Applicants signature
Date----------------
*
Online Application
HDFC Bank customers need to sign as per bank records
App. No.
16013003181