Customer Declaration Credit Cards

(To be filled by applicant only)

To,
The Manager, Application Processing Unit, Date: D D M M Y Y Y Y

One India bulls Park, Tower C, 3rd Floor,

Plot No: 14, 3rd Main Road, Application Ref No.
Ambattur Industrial Estate,
Ambattur, Chennai - 600 058.
Quote your application reference no above
I have applied for YES BANK credit card. Please consider the below mentioned request or declaration (s) on my behalf
(Tick Relevant Sections).

) SECTION 1 - AUTO PAY OPTION

I accept the auto pay facility and unconditionally and irrevocably authorize YES BANK to debit my below Savings/Current
Account towards Credit Card payments as indicated on payment due date as per my Credit Card Statement.

YES BANK Savings/Current Ac. No.:

Minimum Amount Due Total Amount Due

) SECTION 2 - DATE OF BIRTH UPDATE

I hereby confirm that my date of birth is ____________________ (DD-MM-YYYY) and enclosing below self-attested copy
of document as proof with my date of birth mentioned (enclose any one).
™ PAN Card ™ Driving License ™ Aadhaar Card ™ Voter id ™ Passport

) SECTION 3 - CONTACT NUMBER UPDATE

I hereby confirm that my contact numbers is as mentioned below,
Residence Mobile:
Landline:
STD Code Number Number

Office Alternate
Landline: Mobile No.:
STD Code Number Number

) SECTION 4 – EMAIL ID UPDATE

I hereby confirm that my email id is as mentioned below, Email Statement to:
Personal ™ Personal
Email ID
™ Office
Office
Email ID

) SECTION 5 - PAN NUMBER UPDATE

I hereby confirm that my contact numbers is as mentioned below,
Update my PAN Number: (Please enclose a self-attested copy of PAN Card)

) SECTION 6 - AADHAAR NUMBER UPDATE

Update my AADHAAR Number:

I hereby give my voluntary consent in updating my Aadhaar Number to all my Credit Cards. I hereby state and
undertake that I have no objection in authenticating myself with Aadhaar based authentication system and to provide
my identity information (Aadhaar number, biometric information & demographic information) for Aadhaar based
authentication and/or any similar authentication mechanism provided by the Government from time to time, for the
purpose of availing banking services including operations of account or any other facility relating to banking operations.

) SECTION 7 – REPROCESS THE CREDIT CARD APPLICATION

™ I hereby request you to reprocess my Credit Card application.

(1)
 Customer Declaration Credit Cards
(To be filled by applicant only)

) SECTION 8 – RESIDENCE & OFFICE ADDRESS UPDATE

I hereby confirm my address & enclosing below self-attested copy of document as proof with address mentioned (any one).
™ Driving License ™ Aadhaar Card ™ Voter id ™ Passport ™ NREGA
Residence Address with Landmark

City Pin code

Office Address with Landmark

City Pin code

) SECTION 9 – PERMANENT ADDRESS UPDATE

I hereby confirm my permanent address and permanent address contact number as below,

City Pin code

Landline with Mobile
STD Code:
STD Code Number Number
) SECTION 10 - MINOR MAILING ADDRESS VARIATIONS AS PER KYC
My address in the KYC document has minor variation as below
Address as per KYC Document

City Pin code

Correct Address

City Pin code

I request you to consider the ‘Correct Address” as my address. Enclosing my KYC Address Proof.

) SECTION 11 - SIGNATURE MISMATCH

My signature in the bank records differs from the signature on the Credit Card application form.
My signature in the bank records is as given below: My signature to be used for credit card is as given below:

I hereby confirm that my signature provided above shall be construed to be latest and Bank shall use the same for YES
BANK Credit Card. I also understand that if I had opted for auto pay facility in the Credit Card application form, the
same will be maintained.
) SECTION 12 – KYC ID PROOF ENCLOSED
I hereby enclosing below self-attested copy of document as address/identity proof (tick documents enclosed).
™ PAN Card ™ Driving License ™ Aadhar Card ™ Voter id ™ Passport ™ NREGA
) SECTION 13 – YES BANK ACCOUNT NUMBER & CUST ID UPDATE
I hereby confirm that I hold below mentioned YES BANK Savings/Current Account with YES BANK LTD.
YES BANK Savings/ Customer
Current Account No.: ID
DECLARATION
I hereby declare that all the above information furnished by me is true, correct and complete. I hereby agree and
undertake to hold the YES BANK and its officers and Directors harmless and indemnified for any loss, damage, costs
and charges incurred or suffered by the Bank and against any claims, suits, proceedings and actions instituted against
the Bank due to acceptance of any of my above request(s).
Date D D M M Y Y Y Y

Place
Primary Applicant Signature