ATM / DEBIT CARD APPLICATION FORM

Thank you for applying for the State Bank ATM / Debit Card. To help us process your request quickly please
fill this form as per the instructions overleaf if you have any questions, please check with your Branch Official.
We are committed to making your life simpler with the State Bank CARDs.
Application No:
New ✔ Renewal Replacement

Name KH U M NE I C H A N G A MOS
Name as you would like it on the card (max. 25 Letters (including spaces)
K H U M N E I C H A W N G A M O
Address D A K S I N F U L E R T A L . S O N B A R I
P . O F U L E R T A L ,
P S L A K H I P U R

Town / City L A K H I P U R
State A S S A M Pin 7 8 8 1 0 6
Telephone Mobile 7 4 6 0 8 2 6 7 1 2
Email rbjoute@gmail.com

My designated account/s on which I require CARD services

Account Type:
Savings ✔ Current Overdraft Male Female ✔

Date of Birth 1 9 / 1 1 / 1 9 8 8

A/C No. 3 0 9 7 5 0 6 1 5 7 4

TYPE OF ATM CARD APPLIED FOR: (Read Overleaf before selecting Card Type)
ATM-cum-Debit Card Yuva Card International Debit Card
SBI Gold International Debit Cards 1.VISA ✔ 2.MASTERCARD

DECLARATION: I am aware of the Terms and Conditions governing the use of the ATM Card and agree to
abide by them. The bank may call me at my residence / office in connection with my ATM transactions.

Place: Lakhipur

Date: / / Applicant's Signature

FOR OFFICE USE

New Renewal Replacement Date: / /

ATM Branch Code

_________________________
CIF of Customer
Branch Official's
Issue Card YES NO Signature & Branch Stamp

Old ATM Card No.

Ticket No.
Old ATM card No. to be mentioned for a replacement or renewal of the card. Ticket No. in case of Lost ATM card.
 INSTRUCTIONS:

Please fill the entire form in CAPITAL LETTERS only.

Leave one box space between each word. Do not write outside the provided boxes.

The address filled in the form must be same as the address in the Account. If different, first change
the address in your account and then apply for new card.

Complete all sections. Sign the declaration.

If joint A/c please fill separate application form for each A/c holder.

Joint A/c to be either or survivor / anyone or survivor.

ATM CARD TYPES:

ATM-cum-Debit Card (Maestro): International Debit Card (Maestro):

Usual type given to all account holders.

Max. 40,000/- withdrawal at ATMs.

Max. 50,000/- at Merchant Establishments.

At all ATMs Displaying MasterCard, Maestro,
Cirrus Logos.

Usual type given to all NRE account holders.

Usable at all ATMs around the Globe.

Max. 50,000/- withdrawal at ATMs.

Max. 1, 00,000/- at Merchant Establishments.
At all ATMs Displaying MasterCard, Maestro Logos.

Yuva Card (Visa): SBI Gold International Debit Card (Visa /

Only for Youngsters within the age group – 18-30
Years.

Max. 50,000/- withdrawal at ATMs.

Max. 2, 00,000/- at Merchant Establishments.

At all ATMs Displaying Visa Logo.
Can undertake transactions through internet for
ticketing, e- commerce. Visa Bill pay, Mobile Top Up,
Virtual cards solution for e-commerce and wide range
of Discount on shopping, entertainment and leisure,
and purchase etc. on use of Yuva Cards.
MasterCard):

Only for Customers who maintain their quarterly
balance as 50,000/-.

Max. 50,000/- withdrawal at ATMs.

Max. 2, 00,000/- at Merchant Establishments.

At all ATMs Displaying Visa / MasterCard Logo
whichever applicable.

Can undertake transactions through internet for
ticketing, e- commerce. Visa Bill pay[For Visa
Cards only], Mobile Top Up, Virtual cards solution
for e-commerce and wide range of Discount on
shopping, entertainment and leisure, and
purchase etc.

o For more details on the cards visit our website: http://sbi.co.in

TERMS AND CONDITIONS

Bank means State Bank of India

Card(s) means SBI ATM / Debit Card issued to customer either in association with MasterCard / VISA.
Cardholder means customer who has been issued ATM / Debit Card

• The card is the property of the Bank and shall be returned unconditionally and immediately to the
Bank upon request by the Bank.
• The Bank reserves the right to cancel the card and stop its operations unilaterally without assigning
any reason.
• The Card is non-transferable.
• The Card Holder is initially allotted a computer generated 4 digit PIN (Personal Identification Number)
which will be in a secured and sealed PIN Mailer. It is mandatory for the card holder to carryout a
successful transaction using the PIN at SBI in order to activate the card.
• Any financial loss due to misuse of Card will be to the Card Holder's account.
• Loss of card should be reported at Bank's all India Helpline No.1800112211 and ticket no should be
obtained in order to apply for replacement card. And also notify the Branch from where he/she has
obtained the card in writing.
• Fresh card will be issued in replacement of lost/damaged card at a charge of Rs.200/- plus taxes, if
any, at present.
• The cardholder can request for regeneration of PIN in case he has lost / forgotten the same. The
Bank provides the customer with a new PIN at a charge of Rs.55/- which will be debited to the
customer’s account.
• The Card holder wishing to close the designated account or surrender the card facility will give the
Bank 10 working days notice in writing and surrender the Card along with the notice.