(Mark your selection) (NSB DEBIT /ATM CARD APPLICATION TO: Natonal Savings Bank Branch Uwe hereby authorize and request the National Savings Bank ofssue me/us @ NSB debit ATM card. |/ We confi hat tho information given below is tue and accurate. (We have read and understood and agree to abide by the rules and conditions applicable to NSS DebivATM Card as dotated overeat and subsequent amendments, variations or changes thereto which may at any time be made by the National Savings Bank "Names nfl (Mr/Mrs/Miss/Dr Rev.) connie ri 3 Namo to appear on Card Address Primary Savings Alc No. Dates of Birth Nic Telephone bance e-mail Mobile Home ‘Other Savings accounts maintained inthis Branch required to be linked to the NSB DebiVATM Card ‘Savings Account Nols 1 2 ‘Customer's / Customers! ‘Signaturels 4 2 3 Declaration as per the requirement of Control of Exchange Central Bank of Sri Lanka. (Tobe files by the apecants to obtain foreign exchange against Debt Card), wwe (Sole applicant Joint applicant) cert thatthe information given by melus on this form is tue and correct. le hereby confirm that We anvare aware of the condtons imposed under the Exchange Control Actin te Notice published in the Extraodinary Gazeta No.14115 of 19th September 2008 subject to which the care may be used for transactions In foreign exchange and le hereby undertake to abide by the said conditions. We futher agree fo provide any information on transactions carried out by melus in foreign exchange on the card issued to metus 28 te ‘may requie for the purpose of Exchange Control Act We ais afm that We undertake to surrender the Cards to—__an__, if We migrato or leave Si Lanka for ‘employment abroad We emiare aware that the Authorised Dealer is raqures to suspend availablity of foreign exchange on EFTC if roa sonable ground exist fo suspect that unauthorised forelgn exchange transactions are being cried out on the EFTC Issued to mols, pp uM vy Signature ofthe Sole applicant oo uavy serctomeo ‘Signature of the Joint applicant 1 confi sate receipt of Card Please Not ‘Sionawre & Date 1 Jeining fo for DeDWATM Card le RS.250 All partes to sign in he case ofa Joint Account 3 Joint Account Holdecs;Patners may each possess a DebWVATM Card by which a separateNATIONAL SAVINGS BANK ‘TERMS AND CONDITIONS APPLICABLE TO THE ISSUE OF NSB DEBITIATM CARD 11 To regard the card as the property of the Bank and to surender it Lunconclionaly and without reservation upon demand by the Bank, 2 Ato time to use or attempt to use the card unless there are sufi lent funds in mylour account to cover the withdrawals 3. Torestict he use ofthe Card exclusively to melus as itis not rans- ferrabie. 4 Not to use or attempt to use the Card after any noication of its cancellation has been given to melus by the Bank or by any person ‘acting on behaif ofthe Bank 5. Under no circumstances to disdose to any person the Personal ‘denfcation Number allocated to metus to facta the use of the Cardin the Bank's ATM 6 To not the Bank immeciatoly of he loss or theft ofthe Card 7 Toaccep ful responsibilty of al transactions processed by the use of the Card, 8 Subject to (7) above, to accept the Bank's record of withdrawals ‘and/or transfers as conclusive and binding forall purposes and to authorize the Bank to debit myfour account with all amounts wath- ‘rawn or transfered with or without myfour knowledge or authnty ‘9 To acknowledge that the amount stated on the ATM screen or 2 Printed inquiry sip or receipt advice shal not fr any purpose what- soever be taken as conclusive evidence of the state of myfour account withthe Bank, 10 Not to hold the Bank lable, responsible or accountable in anyway whatsoever for any loss or damage howsoever arising caused by any malfunction or falure of the Card o¢ the ATM or insufficient funds in te ATM, 11 Notwithstanding and without prejudice to the provisions of (10) above, the use of the Card shall be at my/our sole risk and Uwe ‘assume any and al sks indent to or arising out ofthe use ofthe (cara For office Use only 12 The Bank will not be responsible forthe Card not being honoured for any reason whatsoever. 19 To retum the card for cancellation should it be no longer required or should myfour account with the Bank for any reason be closed 14 The Bank shall be at iberty to terminate the facity at any time with- ‘out notice to meus by canceling or refusing to renew the Card. 15 Cash and/or cheques deposit by use ofa Cara wil only be cred- ted to myiour account aftr verification by the Bank. The statement Issued by the Automated Teller Machine at the time of depost wil only represent what liwe anvare supposed to have deposited and shall not be binding on the Bank. Tho Bank's count of the amount contained in the envelopes shall be conclusive. Cheques will be ‘accepted for collection only, and the proceeds wil not be avaible for drawing unt the cheques are Geared and realized. 16 Joint account holders are inter ala, Jointly & severally bound by these terms nd conditions and are Hable for all vansactons processed by the use ofthe Card, ‘17 Al Card Transactions effected in currencies other than Se Lanka ‘Rupees wil be debit to the Card Account afer conversion into Sri Lankan Rupees at a rate of exchange determinded by the exchange rate adopted by VisalMaster Card Intemational on the date of conversion, pus an additional percentage levied by the ‘Bank and any transaction foo(6) charged by VisaMaster Card Intemational tothe Bank, if applicable, which fees may be shared ‘with the Bank 1BAll rules and regulations goveming the operation of Savings ‘Accounts or any other accounts shall be applicable to Card transations relating to such accounts. 19 UW undertake not to use ths card to make payment for purchases (of Real Estate o Financial Assets overseas, 20 The Bank reserves the High to vary these terms and conditions, (Operating instructions of Joint ‘Accounts veri by Customers Signatures verted by Declaration ofthe Bank Officer with relevant docursents submited by ‘Authorised Signatory ofthe NSB Branch {Name of the offcer) have carefully examined the information together -{Name of te Cardholser and satisied myseif ‘hat the said information and document ae in conformity with Exchange Control requirements andthe intemal pallces ofthe Bank ‘The Bank undertakes o exercise due cligence on the transactions cared cut by the Cardholder on hisher EFTC in foreign exchange and to suspend the avaliabty of foreign exchange on the EFTC itreasonable ground exists to suspect that unauthorised foreign exchange transactions are bein cried ‘out onthe EFTC in violation ofthe undertaking given by the Cardholder and to bring the matter othe notice of the Contoler of Exchange. ‘Authorised signatory ofthe NSB Branch Date