ADD-ON CARD

APPLICATION FORM
PLEASE FILL THE FORM IN CAPITAL LETTERS

YES BANK Credit Card No. (If already issued) : X X X X X X

Additional Mandatory Information (Customer Id ( For Account Holders ) / Registered mobile number / Registered Email ID)

Title: Mr Ms Mrs Dr First Name Middle Name Last Name

Name of the Primary
Cardmember / Applicant :

Add-on Applicant Information (All fields are mandatory)

Title: Mr Ms Mrs Dr
First Name Middle Name Last Name

Name:

Maiden Name (if any):

Name as desired on the card:

Title: Mr Ms Mrs Dr
First Name Middle Name Last Name

Father's/Spouse's Name:

Title: Ms Mrs Dr
First Name Middle Name Last Name
Mother's Name:

Marital Status: Single Married Other

Gender: M F T

Date of Birth: D D M M Y Y Y Y

Identification Numbers (To be filled for Valid Photo ID and Address Proof provided for Add-on applicant)

PAN Card*

UID (Aadhaar)*:

Passport Number: Passport Expiry Date: D D M M Y Y Y Y

Driving Licence: Driving Licence Expiry Date: D D M M Y Y Y Y

NREGA Job Card: Voter ID Card:

Nationality: Indian NRI Foreign National Person of Indian Origin (PIO)

Country of Citizenship:

Address Details (Address should match Valid Address proof provided for the Add-on applicant or Provide registered address if Add-on applicant is existing YES BANK customer)

Flat/Door No. & Building Name:

Road Number/Road Name:

Area/Locality Name/Landmark:

City: State:

Country: Pin Code:

Personal Contact Details:

Mobile*:

Country code Number

Personal Email ID:

Occupation: Salaried Self-Employed Retired Home Maker Student

In case Add-on Applicant has YES BANK Account, provide following details:

Account No.: Customer ID:

Fields marked as * are mandatory

 Declaration
I confirm that the Add-on Applicant is my [ ] SPOUSE / [ ] SON / [ ] DAUGHTER / [ ] PARENT / [ ] SIBLING (relationship with Add-on Cardmember). I as Primary Cardmember, 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 Cardmember, as and when requested by the Bank. Add-on
Applicant not holding YES BANK account will be required to submit recent photograph, Valid photo ID proof and Valid Address proof. Mailing address of Add-on applicant will be considered to be same as
Primary Applicant’s mailing address. Please refer to the list of acceptable valid photo ID & Address proof for supplementary card below.
Also, I hereby acknowledge the request made for Add-on Card and represent and warrant that the above information is correct and hereby request and authorise that an Account be opened and an Add-on
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 YES BANK Ltd., reserves the right to reject the application without giving any reason whatsoever. The additional Applicant(s) and I agree to be bound by the Terms & 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 entitlements as per the exchange control guidelines of RBI, I undertake to bring the same
immediately to the notice of YES 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 additional
Applicant will be liable for all charges incurred on the Add-on Card jointly and severally with the holder of the Primary Card.

Date D D M M Y Y Y Y

Primary Cardmember's Signature

By signing here, I certify that I have read and agree to all applicable Terms & Conditions

LIST OF ACCEPTABLE PHOTO ID FOR ADD-ON APPLICANT (Only Valid Documents will be considered as Photo ID Proof)
ANY ONE OF THE BELOW
1. PAN Card

2. Driving Licence

3. Passport

4. Voter's ID Card

5. Aadhaar Card / Letter issued by Unique Identification Authority of India (If it contains photo)

6. National Rural Employment Guarantee Scheme (NREGA) Card (If it contains photo)

LIST OF ACCEPTABLE ADDRESS PROOF FOR ADD-ON APPLICANT (Only Valid Documents will be considered as Address Proof)
ANY ONE OF THE BELOW
1. Driving Licence

2. Passport

3. Voter's ID Card

4. Aadhaar Card / Letter issued by Unique Identification Authority of India (if it contains Address)

5. National Rural Employment Guarantee Scheme (NREGA) Card (if it contains Address)

6. Identity Card issued to employees of Govt. Organisations where the Applicant’s Photo and Address is mentioned

7. Latest Bank Statement issued by Commercial banks

8. Utility Bill (Electricity Bill / Telephone Bill / Post Paid Mobile Bill / Piped Gas Bill) not more than 2 months old from the date of application

FOR OFFICE USE ONLY

AM Code Source Code LC1 Code LC2 Code

CRM Lead No. LG Code Branch Code

Please download and print this form, and send it across to the below address:

To,
Credit Cards Division
YES BANK Ltd.,
YES BANK Tower,
Plot No. 14,
3rd Main Road,
Ambattur Industrial Estate,
Ambattur,
Chennai - 600058.