Add - on Card (s) Application Form Cum MID

Version 1.5 for web

Appl. No.: If you are an existing Cardmember, please tick whichever is applicable Silver Card
Credit Card Number Name of the Primary Cardmember:

Gold Card

Business Gold Card

Titanium Card

Platinum Plus Card

Visa Signature Card

World MasterCard

First name

Middle name
Please leave one box space between names and surname

Last name

Name to be embossed on the Card
Date of Birth

Title Mr Ms Mrs Dr
Please tick as applicable

Please restrict to 30 characters including Spaces

D D MM 1 9 Y Y
Spouse Son

Sex

M

F

HDFC Bank A/c No.
* Mandatory for Add on customer who have a HDFC Bank account.

Add-on A Applicant

Relationship:

/ Daughter

(over 18 years)

Parent

Brother (over 18 years)

Sister (over 18 years)
Yes / No

I confirm that the add-on applicant who is my ________________________________________ ( relationship with Add-on) is staying with me .

Add-on Card
25% of Credit Limit

Regular - (Life Time Free)
50% of Credit Limit 100% of Credit Limit Rs.1000 Rs.5000 Rs.10000

ADD-ON SUB-LIMIT OPTION: The limit to be set on the Add-on Card of the Applicant per statement cycle is as indicated below:

If neither option is chosen clearly, 100% will be set as default Add-on limit.

Name to be embossed on the Card
Date of Birth

Title Mr Ms Mrs Dr
Please tick as applicable

Please restrict to 30 characters including Spaces

D D MM 1 9 Y Y
Spouse Son

Sex

M

F

HDFC Bank A/c No.
* Mandatory for Add on customer who have a HDFC Bank account.

B

Add-on Applicant

Relationship:

/ Daughter

(over 18 years)

Parent

Brother (over 18 years)

Sister (over 18 years)
Yes / No

I confirm that the add-on applicant who is my ________________________________________ ( relationship with Add-on) is staying with me .

Add-on Card
25% of Credit Limit

Regular - (Life Time Free)
50% of Credit Limit 100% of Credit Limit Rs.1000 Rs.5000 Rs.10000

ADD-ON SUB-LIMIT OPTION: The limit to be set on the Add-on Card of the Applicant per statement cycle is as indicated below:

If neither option is chosen clearly, 100% will be set as default Add-on limit.

My City Benefit Program - Applicable only to Primary Card Holder (My City Benefit is applicable only to Silver, Value Plus & Gold Card Holder)
My City Benefit Program

*(OTF - One Time Fee)

Petrol Rs. 99 (OTF*)

Utilities Rs. 99 (OTF*)

Petrol & Utilities Rs. 198 (OTF*)

Add on applicant who do not hold HDFC Bank account, please submit valid Photo ID proof. Add on applicant without HDFC Bank A/c & not staying with Primary cardholder needs to submit his/her Address proof. Please refer to the List of Acceptable valid photo id & address proof for Add on in the next Page.

I hereby acknowledge the request made for Add-on Card and warrant that the above information is correct and hereby request and authorise that an Account be opened and Card(s) be issued as indicated herein and renewed and replaced until I give notice to cease, and in connection herewith authorise the exchange and transfer of credit information from / with my Bank or any other source. I understand that HDFC Bank Ltd., reserves the right decline the application without giving any reason whatsoever. The additional applicant (s) and I agree to be bound by the terms and conditions of The Cardmember Agreement earlier executed by me. I declare and undertake that the Cards issued to me, if used overseas shall be utilised strictly in accordance with the relevant exchange control regulations issued and as amended by the Reserve Bank of India (RBI) from time to time. In the event I exceed my entitlemants as per the exchange control guidelines of RBI, I undertake to bring the same immediately to the notice of HDFC Bank Ltd., in writing. And in the event of any failure to comply with the prevailing exchange control guidelines issued by RBI, I shall be liable for action under the Foreign Exchange Management Act, 1999 as amended, and be debarred from the Card facility. The undersigned 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.

Primary Cardmember’s Signature ........................................................................................................................ By Signing here, I certify that I have read and agree to all applicable Terms & Conditions. Date : ............................................................

Please mail the form with documents (If any) To, HDFC Bank Cards Division, P.O Box No. 8654, Thiruvanmiyur P.O., Chennai – 600 041.

List of acceptable Photo ID Proof for Add on Card holder. ( Expired ID proof is not accepted)
• PAN Card • Passport • DL / LL (DL from Uttar Pradesh alone can be accepted without Signature) • Voters ID • Ration Card (In Customer Name) • Company/Institution photo ID card • Student ID card • Club membership card (which carries customer photo) • OBC Photo Card • Insurance / Mediclaim Photo Card • Passbook with Photo • Railway station pass ID - Government recognised • Senior citizen ID - wherever applicable • Government organisation ID card with signature and photo.

List of acceptable Address Proof for Add on Card holder
1 2 Passport Driving licence(Customer having Driving License Issued from Uttar Pradesh can be accepted with out the Signature on the same.) 3 4 5 6 7 8 Telephone bill - MTNL / BSNL & all WLL lines' bills can be accepted Electricity bill - Ebil and Physical Bill Bank account statement - Bank statement or Pass book can be accepted - In both the address should be mentioned Ration card Voters ID (if it has address) Letter from the society (only Registered societies) - on the letterhead which carries the society's Registration No. The letter should carry the applicant's name & full address as well as the signatories full name, designation (Secretary, President) and address. 9 Monthly outgoings bill from Registered Housing society - on the letterhead which carries the society's Registration No. (Maintenance charges receipt issued by the society NOT acceptable) 10 11 12 13 14 15 16 17 18 19 20 Registration documents/Ownership proof copy Senior citizens card from Indian Railways/Indian Airlines (if it has address) Mobile post paid bill Letter from any recognized public authority (In original) Company ID card (For CAT AB companies only) LIC Premium receipt Address confirmation by the corporate on company letter head as valid address proof (For CAT AB companies only) Gas Bill Water Bill Society Maintenance Bill Property Tax Receipt

20.5cm x 29cm

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