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CREDIT CARD BROCHURE CUM APPLICATION FORM

VERSION 1.36 E
Source

Promo

Team/BR code

LG/DSE

LC1 Code

We Understand Your World

Ld No

LC2 Code

EReference No:

16013003181

Token No
APS Reference No

I wish to confirm that,I agree to pay the fee as per the Credit Card chosen/ticked by me from the below
RENEWAL 1ST Year Fee
Waiver Condition
FEE

ANNUAL
FEE

CREDIT CARD TYPE*

Renewal Fee(2nd year


onwards)waiver condition
AFFIX YOUR PHOTO

MONEYBACK CARD - LIFE


Online Application

INTERNATIONAL ENABLED

Primary Applicants signature

Online Application

HDFC Bank customers need to sign as per bank records

Title

First Name
YEATESH

Mr.

Middle Name

Name preferred on the card

Last Name
SABHARWAL

YEATESH
(Applicable for Business Credit Card only)

Business Name as desired on the card


JetPrivilege Frequent Flyer Program Membership No.
Marital Status

Gender

JP

(Applicable for existing JP FFP Members only if applying for


JetPrivilege Co-Branded Credit card)

NO

MALE

29/05/1991

Date of Birth

No. of Dependents

Educational Qualification
PAN No.

ANCPY6362L

Voter ID.------------------------

Primary UID.

Passport No.

Place of issue --------------------

Driving Licence No.----------------------

Place of issue---------------------

Nationality

INDIAN

PLEASE TELL US WHERE YOU LIVE


Residential Address:
Flat / Door No. & Building Name

HNO 166 WARD 17

Road Number / Road Name

PARADE MOHALLA KALKA


HARYANA
KALKA

City/State

133302

PIN

Landmark
*Tel No.

91-8901322623

Is it a PP No.?

Personal E-mail ID

YEATESH21@GMAIL.CO

Yes

No

Mobile No.

7027322623

Please provide non-generic E-mail ID for security reasons as confidential / sensitive informaiton may be shared vide E-mail.
Alternate/Permanent Address:
HNO 166 WARD 17
Flat / Door No. & Building Name
PARADE MOHALLA KALKA
Road Number / Road Name
HARYANA
133302
PIN
KALKA
City/State
Landmark
-

*Tel No.

Is it a PP No.?

Yes

No

Mobile No.

7027322623

Please give us the name of a relative/friend in your city who does not stay with you as reference.
Name
Tel No.
Your residence is

FAMILY

Period at current residence

Your vehicle is
Your vehicle is

Vehicle-make (Model Name)-------------------Financed

Owned

Company Provided

Policy Expiry Month

Years

Months

Yr. of Purchase-------------------Covered by (Insurance Co.) ---------------------

PLEASE TELL US YOUR OCCUPATION


Occupation

SALARIED

If salaried, employed with

PUBLIC LIMITED

If salaried, type of industry/business

OTHERS

If self-employed, your firm is


If self-employed you are a
Total years in employment/business

Years (if self-employed, mention total period in business) If self-employed, Capital Investment-----------

Annual Turnover.............. No. of Employees----------

PLEASE TELL US YOUR OFFICE ADDRESS


*Company Name

WEP SOLUTIONS LTD

Company Address :
Flat / Door No. & Building Name
Road Number / Road Name
City/State
Landmark
Company Code

Designation

SALES INCHARGE

PLOT NO 182/66
INDUSTRIAL AREA PHASE-1
PUNJAB
CHANDIGARH

Department SALES

PIN

160002

Emp Code

*Tel No.

Extension No.

HR Contact No.

Fax No.

Supervisor Contact

Time of Contact
Period at the current employment

Office E-mail ID

Years

Months

Please provide non-generic E-mail ID for security reasons as confidential /sensitive informaiton may be shared vide E-mail.
Are you an HDFC Bank / ADFC Employee NO
(If Yes Salary A/C No.
Empl ID
/ Grade/Band:
IMPORTANT FIELDS TO BE FILLED*
Other Banks
Name of your Bank

For HDFC Bank Customers


Account No.
50100109690226
Primary UCIC.
Account Type

63111437
SAVINGS

Branch Name
Demat Account(if any)----------Years

Duration of the account held


Loan Account / Agreement No.
Loan Account
(if any) Car Loan

Months

Account No.
Account Type

Current

No. of years a/c held


Personal Loan Consumer Durable Loan Loan Against Shares

Savings
Years

Months

Housing Loan(HDFC)

Other Bank Credit Card / Loan Details


Issuing Bank

Credit/Charge Card / Loan Accout No.

Expiry Date

Income Details:
20228
1. Gross Monthly Income---------------------------------------------------------2. Additional Monthly Income (attach documents if any)-----------------------------3. Average Monthly Expenses.---------------------------------------------------------*

Member Since / Loan open date Credit Limit / Loan Amount

Spouse's Name---------------------------------------------------------------Spouse's Monthly Income (attach documents)--------------------------------

Spouse's Company Name-----------------------------------------------------Spouse's Office Tel No-------------------- Extension No--------------------Yes-The details provided are correct best of my knowledge *.
No-I don't want to provide any details*.

Online Application

HDFC Bank customers need to sign as per bank records

RELATIONSHIP -IMPORTANT*
Do you have any relationship with any Director or Senior Officer of HDFC Bank :
Name of Director/Senior Officer

NO
Relationship with the Director/Senior

STATEMENT
Where would you like your card statements and other correspondence to be sent?

Residence

DIRECT DEBIT OPTION


I accept the direct debit facility and authorise HDFC Bank to debit my Bank account, aforementioned in the Bank Details section, towards credit card payments as indicated below

NOT APPLIED
Primary Applicants signature
*
Online Application

Date--------

HDFC Bank account number aforementioned above in the Bank Details section will be used for direct debit facility. If neither option
clearly chosen /the MAD option will be set by default..

ADDITIONAL CARD DETAILS


Title

Mr

Ms

Mrs

Dr

Name to be embossed on the Add-on Card :


Date of Birth

Sex
DD

MM

AFFIX YOUR PHOTO

YYYY

I confirm that the add-on applicant is my---------------------- (relationship with Add-on) and is [

]Staying/ [

] not staying with me

at the same residential address as provided in this application form. I as primary card holder take the full responsibility of
the add-on card, including all transactions/ usage and payments related to the add-on card. I will produce the
ID proof of the add-on card member, as and when requested by the Bank.

Online Application

If add on applicant does not hold HDFC Bank a/c then valid Photo ID proof and Address Proof needs to be submitted.
Add-on applicant's HDFC Bank a/c No.
Add-on applicant's Customer ID
Primary Applicants signature
*
Online Application

Date--------------ADD ON SUB-LIMIT OPTION : Please indicate the Sub-Limit to be set on the Add-on Card per Statement Cycle

HDFC Bank customers need to sign as per bank records

25% of Credit Limit


50% of Credit Limit
100% of Credit Limit
Rs.1000
If neither option is chosen clearly, 100% will be set as default add-on Limit.

Rs.5000

Rs.10000

D E C L A R AT I O N
I hereby apply for HDFC Bank International Credit Card(s) and declare that the information included in this form is true and correct and that I am a Resident Indian/foreign
national working in India and that I am eligible to apply for an internationally valid card. I accept that HDFC Bank is entitled in its absolute discretion to accept or reject this
application. It is my responsibility to obtain the Terms and Conditions applicable to the HDFC Bank International Credit Card(s) separately and read the same. I will be bound
by the Terms and Conditions as may be in force from time to time and receipt/use of the Credit Card shall be deemed to be acceptance of those Terms and Conditions. I
authorise HDFC Bank and/or its associates to verify any information or otherwise at my office/residence or to contact me/my employer/banker/credit bureau/RBI or any other
source to obtain or provide any information that may be required for confirming membership requirements or maintaining my account in good credit standing. I agree to be
charged my card fee in my first statement. In case I have applied for Add-on Card(s) (available for Resident Indian parent / spouse /brother / sister /child over 18 years of age
at special rate) I will be billed for such an Add-on Card in the normal monthly statement. I, the Primary applicant will be liable for all charges incurred with the Add-on Card(s)
issued on the account and each Add-on applicant will be liable for all charges incurred with the Add-on Card jointly and severally with the holder of the Primary Card. The
facility of Add-on Card(s) being a special facility at a concessional fee/rate, continuation of the Add-on Cardmember will be dependent on the continuation of my
membership. I understand and undertake that the usage of the HDFC Bank International Credit Card(s) shall be strictly in accordance with the exchange control regulations
of the Regulatory Authorities as applicable from time to time which I undertake as my responsibility to keep myself updated of, and in the event of any failure to do so, I will be
liable for action under the Foreign Exchange Management Act, 1999 or its statutory modification or re-enactment thereof. I confirm that I have no insolvency proceedings
pending against me nor have I ever been adjudicated insolvent. I agree that my signature on the chargeslip will amount to an unconditional undertaking by me to pay HDFC
Bank the amount stated therein and agree that a copy of my periodic statement of accounts will be a conclusive evidence of my liability for the charges stated therein. My
liability under the chargeslip signed by me shall not withstand any dispute I may have with respect to the quality/quantity of goods purchased or quality of services obtained. I
will not hold the Bank responsible if any outlet/franchisee refuses to accept the card. I authorise HDFC Bank to disclose, from time to time, any information relating to my
Credit Card(s), (including any default in payments) to any other card issuer, credit bureau, financial institution, any parent/subsidiary, affiliate, Co-brand partner and
associate of HDFC Bank, and to third parties engaged by HDFC Bank, for purpose such as marketing of services, proper operation of Credit Card accounts and other
administrative services. The Bank will be entitled to cancel my card(s) at any time without assigning any reasons. I understand Service Tax as applicable from time to time will
be levied on fees, interest and other charges, as per government guidelines.I understand that Service Tax is not applicable on my regular purchases. I am aware that the
Bank reserves the right not to return the supporting financial documents given by me along with the application.I have received and read the detailed Terms and Conditions
and agree to abide by them, once I am allotted the Credit Card. I hereby confirm that I have also read and understood the contents of the Schedule of Charges and disclosure
details, and agree to be levied variouscharges mentioned therein as and when applicable to me. I confirm that basis my eligibility HDFC Bank shall at its sole discretion
reserve the right to issue any existing card product in their portfolio. Credit Limit on any card account may be reviewed as per the Bank policies specified from time to time and
the Bank reserves the right to revise (increase or decrease) and/or unconditionally cancel the limit assigned on a card without any prior notice to the Cardmember. I also
understand and agree to the fact that the Bank is authorised to change any or all of the Terms and Conditions of the Schedule of Charges at its own discretion. I authorise the
Bank to record specific conversations between me/my representative and the Bank's representative, in case of grievance-related conversations or payment-recovery
related conversations or any other conversation that the Bank may deem fit, at its own discretion. I agree to abide by any Terms and Conditions as may be added/amended
by the Bank from time to time without giving notice to me, regarding this Credit Card and any other facility/loan product that I avail through this Credit Card or any other Credit
Card that I may be issued by the Bank in the future. I agree to receive my card statements through email on the email IDs mentioned in the Application Form. I am aware that
my new Credit Card would be automatically registered for NetBanking in case I am already an HDFC Bank NetBanking customer. I understand that HDFC Bank will issue the Credit
Card according to the Bank's internal guidelines. I hereby give my consent to the Bank to provide me a different card in case I am not eligible for the product applied
for. I authorise HDFC Bank to transfer my accrued reward points periodically to my JetPrivilege Frequent Flyer Program membership number as provided by me in the
Credit Card application form.

I/We hereby authorize and give consent to the Bank to disclose, without notice to me/us, information furnished by me/us in application form(s)/related documents executed /
to be executed in relation to the facilities to be availed from the Bank, to the Bank's other branches/subsidiaries/affiliates/ Credit Bureaus/Rating Agencies, Service
Providers, banks/financial institutions, governmental/regulatory authorities or third parties for information verification, credit risk analysis, or for other related purposes that
the Bank may deem fit. I/We waive the privilege of privacy and privity of contract"

Primary Applicants signature

Date----------

Online Application

I agree to participate in any or all of the Card upgrade programs and limit enhancement programs that
the Bank may conduct on my card account from time to time as part of periodic portfolio reviews basis
relationship / income details available with the bank as per prevalent policy conditions of the bank.
I do not
to receive information/service for marketing purposes
through Telephone/Mobile/SMS/e-mail/any other mode from the Bank/or its agents
* I Confirm that I have read and understood the MITC (Most Important Terms and Conditions), Product
Features & Pricing and fully accept it.
* I hereby give my consent and specifically confirm that the Online Application form submitted to HDFC
Bank shall be valid, effective and legally enforceable against me though it is not electronically signed by
me. For the purpose hereof, a document shall be deemed to be ELECTRONICALLY SIGNED if it has
been encrypted / Authenticated by using an electronic method or procedure in accordance with the
provisions of the Information Technology Act, 2000 or in any other manner / method / procedure /
technique as is recognised / envisaged as a valid method of encryption / authentication under the
provisions of the Information Technology Act, 2000.
Below mentioned box has to come next to above Information Technology ACT confirmation:

HDFC Bank customers need to sign as per bank records

This application has been authenticated by Name---------------------------------------------------30-jan-2016 02:23:19:PM


on Date & Time-----------------------------------------

101.57.7.219
at IP address----------------------------------------

Kindly note that approximate Credit Card processing time is about 2 -3 weeks from the date of submission of completed form
FormNo.60(seeThirdProvisontoRule114B)
Form of declaration to be mandatorily filled by a person who does not have a Permanent Account Number
4. Address proof attached:
[ ] Passport [ ] Driving Licence [ ] Utillity bill(incl.Mobile postpaid bill) [ ] Ration Card [ ] Voter ID
1. Full Name & Address:---------------------------------------------[ ]Bank account statement/passbook [ ] Leasedeed/Rent agreement copy [ ] registration documents/Ownership proof
--------------------------------------------------[ ]Others(Please specify)
--------------------------------------------------VERIFICATION
--------------------------------------------------I---------------------------do hereby declare that what is stated above is true to the best of my knowledge
and belief.Verified today the-------------------------------2. Are you a tax assessee
[ ] Yes [ ] No
Primary Applicants signature
3. If YES
Date--------------*
A.Details of ward/circle/range where the last ITR was filed---------------------------- day of--------------------------Online Application
Place----------------------------B. Reason for not having PAN Number----------------------------------------------HDFC Bank customers need to sign as per bank records
Acknowledgement of Credit Card application
We acknowledge the receipt of your application for a credit card from HDFC Bank. In case of any queries you may contact our Customer
Service call centers or mail us at customerservices.cards@hdfcbank.com.
Signature of DSA/HBL Rep :
Date-------------------------*
HBL/DSA Name : -----------------------------------Online Application
Mobile no of HBL/DSA -----------------------------Please indicate your choice of HDFC Bank international Credit Card

MONEYBACK CARD INTERNATIONAL ENABLED


Track your Credit Card application Status in our HDFC Bank Website through 16 digit unique application reference number which
you will receive on your mobile number. www.hdfcbank.com -> Cards -> Credit Cards-> Track Your Credit Card

CREDIT CARD BROCHURE CUM APPLICATION FORM


SMARTPAY

We Understand Your World

Name of the Company

City

Details 1

Details 2

Details 3

Telephone
Electricity
Mobile Co 1
Mobile Co 2
Insurance Co 1
Insurance Co 2
Insurance Co 3
* To set a maximum limit of payment that can be made towards the billing company; *Mandatory Field.

E-mail ID (Mandatory for LIC) -----------------------

1) You can apply from only the list of the billers provided in the table under smartpay on Regular Card Offerings
2) Please sign on the reverse side for smartpay after reading the terms and conditions
3) Please provide a copy of the latest bill (any of the last three bills received from your utility company); for each utility company opted above to enable us to verify the
customer account details.
4) Only duly completed forms will be accepted.
5) Continue making bill payments towards the above mentioned utility company bill outstandings until you receive a SmartPay activation confirmation through email /SMS / Letter.
I agree to be levied processing fee of Rs. 10/- plus service tax for each bill paid on my behalf on my HDFC Bank Credit Card. I agree and accept that HDFC Bank reserves the right to withdraw this
offer without any prior information to me. I hereby declare that the above information is correct and complete and request that SmartPay facility be provided to me. I acknowledge that I have read,
understood and agree to be bound by the SmartPay Terms & Conditions that are currently in effect and as may be amended from time to time. I declare that I have not registered for any other
alternate mode of payment for any of the bills mentioned above and I agree that my registration would be rejected if already registered with any other service provider.
Primary Applicants signature

Date---------------

*
Online Application
HDFC Bank customers need to sign as per bank records

BALANCE TRANSFER APPLICATION FORM


Issuing Bank---------------------------

Card No------------------------

Expiry Date-----------------------

Amount to be transferred--------------------------(Minimum amount.Rs.2500)

Name as it appears on your existing card


This is to confirm that I am applying for:
Regular Bt [ ] ROI : 0% TENURE : 3 MONTHS Processing fee : 2% MIN Rs. 250, (+ Service Tax as prevailing rate)
After approval and subsequent issuance of HDFC Bank International Credit Card, I wish to avail of the Balance Transfer Facility on the following terms and conditions:
1) Transfer amount is subject to a minimum of Rs. 2500, but shall not be in excess of the outstanding balance on the other card account 2) Balance Transfer is not applicable from other card accounts which have an
overdue status or where the credit limit has been exceeded. 3) Balance Transfer will notbe accepted from other existing HDFC Bank Credit Card accounts. 4) The cardmember will continue to make payments to the other
card issuer until he receives a cheque/DD/pay order from HDFC Bank favouring the other card issuer. HDFC Bank will not be liable for any new charges, overdue payments, interest charges, etc. on the said card account.
5) The preferential rate of interest for regular balance transfer will be for a period as communicated while applying for the balance transfer facility. This period will be calculated from the date of cheque/DD/pay order
favouring the other card issuer, or the date when the balance transfer amount is charged to your HDFC Bank Credit Card, whichever is earlier. 6) HDFC Bank reserves the right to accept or reject any Balance Transfer
request. These terms and conditions shall be deemed to be a part of The Cardmember Agreement and are incorporated therein by reference. 7) Balance Transfer request once approved and processed cannot be cancelled.
* Applicable for selected locations only.
Primary Applicants signature

Date-------------

Online Application

HDFC Bank customers need to sign as per bank records

C A S H O N C A L L A P P L I C AT I O N F O R M
Amount in Fig. (Rs.) UPTO CASH LIMIT MAX 50,000
only
Tenure (in months) 24 Rate of Interest (p.m.) 1.35%
Processing fee ( Rs.) 2% Min 250, Max 1250 (+ Service Tax as prevailing rate)
Please note that Monthly Payment = Principal Amount+Interest Amount+Service Tax on the interest amount.
Please refer to the Amortization Schedule (will be sent after your loan is set up) for details of Principal Amount & Interest Amount.
Service Tax at the prevailing rate (Currently 10.3%) will be levied on the Interest Amount of the EMI.
Credit to my Savings (in my name) held with HDFC Bank.
HDFC Bank A/c No.:
I agree and abide by the following Terms & Conditions :
Primary Applicants signature

Date-----------------

Online Application

HDFC Bank customers need to sign as per bank records

I hereby agree to accept the COC of an amount / tenure /ROI/ Processing fee as mentioned above.* The COC amount
approved for would be blocked against my HDFC Bank Credit Card limit.* The above offer is subject to approval of the
COC amount applied for * Approval of COC at the sole discretion of the Bank * Normal Terms and Conditions are applicable .
* HDFC Bank will charge preclosure fees (3% of principal outstanding) and the Interest on the principal outstanding from last
statement date till date of loan preclosure.

I N S U R A N C E D E C L A R AT I O N
Customer Name : -------------------------------------------------------------------------------I/We hereby declare that HDFC Bank has disclosed to me/us the Referral Fee payable to them for the policy recommended to me/us.
Primary Applicants signature

Date----------------

*
Online Application
HDFC Bank customers need to sign as per bank records

DO'S & DONT'S WITH YOUR E-MAIL ID


1. Your e-mail ID is one of the important channels of communication through which the Bank shall communicate with you.
2. Register only valid and functional e-mail ID's with us as, a lot of sensitive information such as statements, PIN mailers, OTP requests, etc.
shall be communicated through e-mail.
3. Never register Generic ID's as your e-mail ID as this may result in Confidential Information pertaining to you being viewed by others.
4. Also, please do not share your e-mail ID and password with others as it increases the risk of your information being compromised.

App. No.

16013003181