MOST IMPORTANT DOCUMENT

Dear Customer, Thank you for applying for a TATA Credit Card. We request you to fill in this declaration form to confirm your application for the TATA Credit Card. This declaration is in addition to the main TATA Credit Card application and forms an integral part of the same.

DECLARATION
Subject : Confirmation of application for TATA Credit Card and Card fees information. This is to confirm that I am submitting my TATA Credit Card application form along with the required document(s) for processing. I, Mr. / Ms. _______________________, hereby acknowledge that I have applied for TATA Credit Card given below and agree to pay the joining and annual fee mentioned in the corresponding column:
Please Sign Card Type Year 1 Joining Fee* Year 2 Onwards Annual Fee* Rs. 350/(Reversible, subject to spends of Rs. 50,000/- or more in the previous year) Rs. 500/(Reversible, subject to spends of Rs. 50,000/- or more in the previous year)

Rs. 350/(Reversible, subject to cumulative spends of Tata Privilege Card Rs. 3000/- before generation of the 3rd Statement) Rs. 500/(Reversible, subject to cumulative spends of Tata Premiere Card Rs. 3000/- before generation of the 3rd Statement)
*Govt. Service Tax as applicable on above.

I am also aware that this declaration does not necessarily guarantee a credit card approval. All such credit card approvals shall be at the sole option and discretion of TATA Credit Card.
x
(Signature of Primary Card Applicant)

Name of Primary Card Applicant Date Place FOR OFFICE USE ONLY Back Checker Code Back Check Date