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  • HDFC Add On Card Application

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    landb1
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    This document is an application form for a My City Benefit Card. It requests contact information for the primary cardholder and add-on cardholders. It offers various card types including Value Plus, Health Plus, Titanium, Platinum Plus, Silver, Gold, and Woman's Gold. For Health Plus cardmembers, it requests additional health details for insurance purposes for the primary applicant and up to two add-on cardmembers, including name, date of birth, sex, occupation, relationship to primary applicant, and any existing or prior medical conditions. It notes that add-on cards are free for life and a Rs. 400 surcharge will be charged if the primary cardmember is over 55 years old.

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    hdfc add on card appl

    Original Title

    Hdfc Add on Card Application

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    This document is an application form for a My City Benefit Card. It requests contact information for the primary cardholder and add-on cardholders. It offers various card types including Value Plus, Health Plus, Titanium, Platinum Plus, Silver, Gold, and Woman's Gold. For Health Plus cardmembers, it requests additional health details for insurance purposes for the primary applicant and up to two add-on cardmembers, including name, date of birth, sex, occupation, relationship to primary applicant, and any existing or prior medical conditions. It notes that add-on cards are free for life and a Rs. 400 surcharge will be charged if the primary cardmember is over 55 years old.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    8 views2 pages

    HDFC Add On Card Application

    Uploaded by

    landb1
    This document is an application form for a My City Benefit Card. It requests contact information for the primary cardholder and add-on cardholders. It offers various card types including Value Plus, Health Plus, Titanium, Platinum Plus, Silver, Gold, and Woman's Gold. For Health Plus cardmembers, it requests additional health details for insurance purposes for the primary applicant and up to two add-on cardmembers, including name, date of birth, sex, occupation, relationship to primary applicant, and any existing or prior medical conditions. It notes that add-on cards are free for life and a Rs. 400 surcharge will be charged if the primary cardmember is over 55 years old.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    *Please fill the Add-on Health Plus details on the reverse side

    My City Benefit Card - Applicable only to Primary Card Holder


    Add-On Card Regular - (Life Time Free)
    Add-On Card Regular - (Life Time Free)
    Add-On Card Regular - (Life Time Free)
    My City Benefit Card
    Office Tele no.: _____________________________________ extn no.: ________________ Residence Tele no.: ________________________________________________________________
    Mobile no.: _________________________________________________________________ Email - ID _______________________________________________________________________
    Petrol Rs. 99 (One Time Fee)
    Value Plus Health Plus* Titanium Platinum Plus Silver Gold Womans Gold
    Credit Card Number
    By Signing here, I certify that I have read and agree to all applicable Terms & Conditions.
    (For Health Plus Cardmembers)
    Details of Members for insurance
    Name
    Primary Applicant
    Add-on Cardmember 1
    Add-on Cardmember 2
    #
    DOB
    N.A
    Sex
    N.A
    Occupation
    N.A Self
    Relationship to
    primary applicant
    Suffering / Suffered from : 1. Diabetes 2. Hypertension
    3. Chest Pain 4. Coronary Insufficiency 5. Renal failure
    6. Others
    # Available only to applicants lesser than or equal to 60 years of age. Please note that a surcharge of Rs.400 will be charged to the
    card if the primary cardmember's age is greater than 55 years.

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