State Bank of India Application for ATM Gold International Debit Card Branch:

Visa MasterCard (Please tick one of the options)

I hold A/c No.

with the following customer number (IN CASE OF CORE BANKING BRANCH ONLY)

at your branch in my sole name/jointly with and to be operated on Self/E or S/F or S /Anyone or survivor basis. I have been issued a domestic Debit Card No

I have not been issued any Debit Card (delete as applicable). I hereby apply for an ATM Gold International Debit Card for my use I am aware that ATM Gold International Debit Card can be used in India and abroad. I am aware that the ATM Gold International Debit Card can be used for all domestic transactions and transaction involving foreign exchange permitted under the Foreign Exchange Management Act and the Rules framed there under by Reserve Bank of India from time to time. I undertake to use the card in strict compliance with the applicable Exchange Control/Foreign exchange Management regulations and any violation thereof will result in cancellation of the card and make me liable under relevant provision of the act/regulations. I also undertake to furnish all the details in respect of any transaction entered into by me to facilitate any investigation. I hereby authorise you to recover from my account the cost of the card and all other fees which may be payable by SBI to master card (other than transaction fee) for extraordinary services rendered by them (example lost/stolen Card). B. My name on the card should appear as under [This can be full name (not exceeding maximum 24 characters) or an abbreviated form of the name of the applicant for example. Bharat Kumar can appear as Bharat Kumar, B.Kumar or K.Bharat].

C. I furnish the following particulars to be used for identification when I contact the Help Line through telephone for reporting loss of SBI ATM Gold International Debit Card Fathers First Name * Mothers Maiden Name ** Date of Birth D D D D D D M M M M M M Y Y Y Y Y Y Y Y Y Y Y Y Passing SSC Y Y Y Y Y Y Y Y Y Y Y Y Marriage *** Y Y Y Y Y Y Y Y Y Y Y Y

* Do not furnish surname for example, if the name is S R Tendulkar, the name should be Sachin. ** In respect of Mother's maiden name, you may furnish Mother's name before marriage. *** If not relevant it may be filled as XXXX. I have read the terms & conditions detailed overleaf and agree to abide by them. Name Address City Telephone E-mail PIN Mobile

Place

Date

Applicant Signature

The Terms and Conditions under which the SBI ATM Gold International Debit Card has been issued are mentioned below for your guidance.
Bank issues International SBI ATM Gold International Debit Card which are affiliated to Master Card International/VISA International Programmes. These cards can also be used outside the country. Objectives : To provide the valuable customers with higher daily cash withdrawal limits at ATMs in India To offer the customers with the VMT & VbV facilities available on VISA card programmes To enable customers travelling overseas to meet expenses without carrying foreign currency or travellers cheques To use Internationally/ domestically with higher withdrawal limits, Transactions as per FEMA There is no monetary ceiling on spends through ATM Gold International Debit Card while on a visit outside India except that it should not exceed exchange entitlements of the person under extant FEMA guidelines. The other condition is that the total amount of transactions on the card will be limited to the extent of the balance available in the account maintained by the cardholder. The daily cash withdrawal limit at ATMs has been set at Rs. 50000/- or US$ 1000/- when used domestically or Internationally respectively. The daily transaction limit at Point of Sales (PoS) has been set at Rs. 200000/ US$4000 for domestic or Internationally respectively. Accounting Procedure and Settlement On a daily basis, ASC obtains the TT selling rate for US $ from Foreign Department, Kolkata and this is loaded to the ATM Switch. While the cardholder can transact in any currency, the amount is converted into equivalent US$ by MasteCard International (MCI)/ VISA International and authorisaction is sought for amount in US$. ASC converts US$ into Indian Rupees at the TT selling rate and debits the account of the cardholder before authorizing the transaction. Issue of separate series of SBI ATM Debit Card. Gold International ATMs in order to activate the card for usage at Pos / MEs. The Card holder is advised in his own interest to change this PIN to any other four digit number of his/her choice. Change option is available at SBI-ATMs. While selecting a PIN, the card holder is advised to avoid a PIN which can be easily associated with his/her personal details viz, Telephone no. Date of Birth etc.. Besides, the selected PIN value should not comprise. A sequence from the associated account numbers string of the same number Historically significant dates The Cardholder should change the PIN immediately if it is accidentally divulged. Please remember that an unauthorised person can access the ATM services on cardholder's account if he gains the card and the PIN. The Card, therefore, should remain in Card Holder's possession and should not be handed over to anyone else. The Card is issued on the condition that the Bank bears no liability for the unauthorised use of the Card. This responsibility lies with the Card Holder. Further the Bank will not be responsible for any loss either direct of indirect on account of ATM failure/malfunctioning. (d) Loss of card The Card holder should immediately notify the Branch from where he/she has obtained the card in writing, if the card is lost/stolen. Any financial loss due to misuse of Card will be to the Card Holder's account. Loss of card can also be reported at Bank's all India Helpline No.1800112211 from MTNL / BSNL connection or 080-25608470 from other service providers.. Fresh card will be issued in replacement of lost/damaged card at a charge of Rs.200/- plus taxes, if any, at present. e) Loss of PIN: The cardholder can request for regeneration of PIN in case he has lost / forgotten the same. The Bank provides the customer with a new PIN at a charge of Rs.50/- which will be debited to the customers account (f) Debit to customers account The Bank has the express authority to debit the designated account of the cardholder for all withdrawals/transfer effected using the Card as evidenced by Bank's records, which will be conclusive and binding on the Card Holder. The Card Holder expressly authorises the Bank to debit the designated account with service charges from time to time. (g) Transactions The transaction record generated by the ATM will be conclusive and binding unless found to be otherwise on verification and corrected by the Bank. The verified and corrected amount will be binding on the Card Holder. (h) Closing of Account The Card holder wishing to close the designated account or surrender the card facility will give the Bank 10 working days notice in writing and surrender the Card along with the notice. (i) Validity of Card - SBI ATM Gold International Debit Card is valid for 5 years and the expiry date is pre-printed on the card. Note: The Bank reserves the right to introduce new facilities or remove existing facilities as and when warranted without assigning any reason for the same. However cardholder will be duly advised. OTHER BENEFITS: a) The card carries a complimentary accidental death insurance of upto Rs. 2 lacs b) The card also carries complimentary purchase protection of Goods at Merchant Establishments upto Rs.5000/- for theft and damage of goods upto 90 days from the date of purchase c) The ATM Gold International Debit Cards issued in association with VISA International carry the following additional facilities: i)Visa Money transfer (VMT) whereby the card holder can transfer funds from his VISA Gold Debit Card to another VISA Gold Debit / Credit card issued either by SBI or any other Bank subject to certain terms and conditions and charges ii) Verified by Visa (VbV) By registering for the facility Card holders can carry out transactions more securely over the Internet

The SBI ATM Gold International Debit Cards are issued with a different design and distinct card series to the select customers of the Bank. Although Bank has offered to issue ATM Gold International Debit Card free of cost to the identified customers, Bank may at any time levy a charge on providing ATM Gold International Debit Card and this will be binding on the applicant. (a) Terms Used here : Bank means State Bank of India Cards means SBI ATM Gold International Debit Card issued to customer either in association with MasterCard International or VISA International Cardholder means customer who has been issued SBI ATM Gold International Debit Card (b) The Card The card is the property of the Bank and shall be returned unconditionally and immediately to the Bank upon request by the Bank. The Bank reserves the right to cancel the card and stop its operations unilaterally without assigning any reason. The Card is non-transferable. (c) The PIN The Card Holder is initially allotted a computer generated 4 digit PIN (Personal Identification Number) which will be in a secured and sealed PIN Mailer. It is mandatory for the card holder to carryout a successful transaction using the PIN at SBI

Office Use Account particulars and Signature of Applicant and Mode of operation Verified. Request for issue of ATM Gold International Debit Card approved/declined for the reasons (delete as applicable)

Date Authorised official Forwarded for processing for issue of SBI ATM Gold International Debit Card Date Authorised official