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Published by Robbi Satishkumar

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Published by: Robbi Satishkumar on Jun 05, 2011
Copyright:Attribution Non-commercial


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Advance Gift: -
Page No: 1
I want the Kotak Urbane Gold CardI want the Kotak Velocity Platinum CardI want the Kotak Trump Gold Card
Goodie type-Goodie name-
About MeForm No.:IOOC873835
1.First NameSATISH2.Middle NameKUMAR3.Last NameROBBI4.Name as desired on the Card(Maximum 19 characters)5.Date of Birth20-04-19866.Marital StatusMarriedSingle6.Mother's Maiden Name7.GenderMaleFemale8.No. of Dependents10.Educational QualificationSecondary SchoolHigh SchoolGraduatePost GraduateOthers (pls. specify)11.Net Monthly SalaryLess than 25,00012.PAN No.(Mandatory)AMNPR7957A13.Type of VehicleFour WheelerTwo WheelerBothnone14.OccupationSalariedSelf Employed BusinessSelf Employed Professional15.Email IDsatishkumar.robbi@gmail.com16.Mobile No.+91-9059024398
(To receive information on Email & SMS,Please give us your Email ID & Mobile No.)
17.If Salaried18.If Self Employed17A.Total Work Experience17B.Desgination
My Contact Details 
Page No: 2
Present Residence Address
Residence StatusOwned bySelf Owned byParentsRented with FriendsRented withFamilyAddressMODI BUILDERS, B-202,S.R.NAIK NAGAR,IDA JEEDIMETLALandmark CityHyderabadPincode500055Tel NO. STD CodeTel No.20.
Permanent Residence Address
Same as above (if different please fill below)
AddressMODI BUILDERS, B-202,S.R.NAIK NAGAR,IDA JEEDIMETLALandmark CityHyderabadPincode500055Tel NO. STD CodeTel No.21.
Office Address
Name of CompanyTHERMALSYSTEMSHYDERABAD PVT LTDDepartmentManufacturingAddressLandmark CityPincodeTel No.(Office) STD CodeTel No.22.
Preferred Mailing Address
My Bank Detail
Sign up & Declaration
Loyalty Program
Program NameMember Id.
Main Bank Details
Name of Bank Account NumberBranchAccount TypeSavingsCurrentOther (Please Specify)Customer Relationship Number(In case you have a kotak account)
Main Credit Card Details
Name Of Bank Card No.Member SinceCredit Limit"I hereby declare that the particulars contained herein above are complete, true and correct to the best of my knowledge andKotak Mahindra Bank Ltd. ("Bank") is entitled to verify the same directly or through any third-party agency. I authorise theBank and its affiliates to use information from this application for marketing and administrative purposes. I confirm that I am aresident of India. I further understand that the Bank may at its sole discretion accept or reject this application. I further agree tobe fully liable and authorise the Bank to debit the Kotak Credit Card account for all spends, fees and other charges, interest etcon the Card. Service tax and surcharge at applicable rates will be charged on all fees, charges, interest etc. and I agree to pay thesame. In case I have applied for an Add-On card, I will be billed separately for the Add-On Card in the monthly statement. I willbe liable for all charges incurred on the Add-On Card. I undertake to notify the Bank immediately of any change in the abovedetails and information given by me. I hereby declare that I have read the Cardholder Agreement and I understand that upon myrequest, print copy of the same would be couriered to me by the Bank. I further agree and understand that all documents given tothe Bank in connection with this application including, but not limited to photocopies of original documents, signatureverification, address verification and bank details shall become property of the Bank and shall not be returned to me. I herebyconfirm that I have read and understood the terms and conditions governing the entire business relationship with the Bank andrelating to the various services including but not limited to Cardholder Agreement, ATMs, Phone Banking, Home Banking, NetBanking and Bill Payment. I understand that the Bank may at its sole discretion , discontinue or modify any of these servicescompletely or partially without any prior notice to me. I authorise the Bank, its group companies and their agencies to exchangeor share all information relating to me and my repayment history with Banks, financial institutions, credit bureaus, agencies,statutory bodies etc. as may be required or as they deem fit. I expressly consent to Bank, its group companies, agents / representatives to provide me information on various products, offers and services provided by the Bank / its group companiesthrough any mode ("including without limitation through telephone calls / SMS/ emails")."Applicant SignatureDate

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