Application Form for Gift Card

SECTION 1: APPLICANT INFORMATION

Name: Male Female Transgender
Mother’s Maiden Name:
Date of Birth: D D M M Y Y Y Y
Address: PHOTO

City: State: Pin Code:

Mobile: Tel: Email:
SECTION 2: BENEFICIARY INFORMATION
Name:

Address:

City: State:
Pin Code:
Mobile: Tele:
Email:
SECTION 3: PAYMENT DETAILS
Payment Mode: Cash Transfer
Load Amount: ` Fees: `
Total Amount: ` (In Words)
SECTION 4: DETAILS OF KYC DOCUMENTS FURNISHED
Please provide any document/s to confirm identity and address and attach with application form
Federal Bank A/C holder
A/c. No.:
PAN Card (with additional address proof) Voter’s ID Card
Passport Driving License
Any other valid document with photo issued by a Govt. authority confirming the identity and address
DECLARATION
I hereby apply for a Federal Bank Gift Card and agree to abide by the terms, conditions, rules, regulations and other statutory
requirements applicable to the card. I hereby declare that the particulars given herein are true, correct and complete to the
best of my knowledge and belief; the documents submitted along with this form are genuine. I also acknowledge that as part
of purchasing this card, I will be registered at the site www.federalbank.co.in/giftcard for accessing transaction and balance
information.
The Purchaser undertakes to provide the full details of the ultimate beneficiary of the Card (User) for furnishing to the regulator
or government, as and when requested by the Bank.

Date: Customer Signature

FOR BRANCH USE ONLY
Unique Reference No. (URN): Card No (Last 4 Digits): Amount Loaded: `
Date of Issue: Branch name: SOL ID :
We confirm the correctness of the above information and fulfillment of KYC Norms as stated above.

Signature of Bank Official: Name:

THE FEDERAL BANK LIMITED PAY IN SLIP

THE FEDERAL BANK LIMITED Branch:
Br.: ...................................... Date: ...................
Date:
Load Amount ` ..............................................
Payment Mode: Cash Transfer Account No: 00110200000013
Fees ` ..............................................................
Customer Name: URN No.:
Total ` ..............................................................
Finacle Tran ID:
Received ` .........................................
Load Amount: ` Fees: ` Total: `
for issuing a GIFT CARD in favour of
#Total Amount (in words) .......................................................................................... only
...........................................................................

Cashier/Clerk Asst. Manager Cashier/Clerk Asst. Manager Signature of Applicant

C908