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Decl

arat
ionf
orcur
rentr
esi
dent
ialaddr
essbyi
ndi
vidual
s

(
Pur
suantt
oRBICi
rcul
aronDBOD.
AML.
BC.
No.
119/
14.
01.
001/
2013-
14dat
ed9t
hJune2014)

To
SBICar ds&PaymentsServi
cesPvt
.Ltd.
PostbagNo.1,DLFQut abEncl
avePostOff
ice
Gurgaon-122002,Har
yana

DearSi
r,

MyCr
edi
tCar
dNo.

Iher
ebyconf
ir
m mycur
rentaddr
essandper
manentaddr
essasbel
ow

Name Mr
. Ms. Fi
rstName Mi
ddl
eName

Sur
name

Curr
entResi
dence
Address

Ci
ty Pi
ncode

Resi
dencePh.No

PermanentResi
dence
Address

Ci
ty Pi
ncode

Of
fi
ceAddr
ess

Ci
ty Pi
ncode

Iwi
l
lnot
if
ySBICar
doft
henewaddr
essf
orcor
respondencewi
thi
ntwoweeksofsuchachange.

Si
gnat
ureoft
heCr
edi
tCar
dhol
der Dat
e:

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