Add On Card Application Form

Date……….…
Punjab National Bank
Credit Card Processing Centre,
Ground Floor,C-24, Sec-58,
Noida, Uttar Pradesh 201301

Please issue me an Add on Card as per detail given below:

Personal Details- Primary PNB Global Credit Cardholder

Full Name: Mr./Mrs./Ms/Dr.

First Name Middle Name Surname

PNB Primary Card No.

Details of the Add on PNB Credit Card Applicant

Full Name: Mr./ Mrs./Ms./Dr.

Date of Birth (DD/MM/YYYY)

Mobile no

Name as would appear on the Add On Card

Relationship with the primary Card holder

□ Spouse □Parent □ Son/Daughter □ unmarried daughter
(above 18 years) (above 18 years)
Declaration

I hereby apply to PNB global Credit Card for the issuance of a Add ON Credit Card(s) as mentioned here above and
declare that the information given by me in this form is true, correct and complete in all respects. I hereby agree that
PNB,CCVD reserves an absolute right to approve or reject my application without giving any reason. I and the Add
on Card holder agree unconditionally to be bound by the terms and conditions of the Cardholder Agreement earlier
entered by the Primary Card holder. I, the undersigned Primary Card holder, shall be liable for all charges incurred
by the Add on Card holder(s) and each add on applicant/ Card holder will be liable for charges incurred with the Add
on Card jointly and severally with me. I agree that the Add on Card membership will stand automatically suspended/
terminated in case of suspension/ termination of the Primary Card. I am fully aware of and understand the
regulations governing the Card outside India and my obligations under the applicable exchange control/
management regulations and guidelines issued by Reserved Bank of India/ applicable exchange control/
management regulations, otherwise the Card may be cancelled at the instance of RBI and/ or PNB,CCVD. In the
event that I or the Add on card member are not in compliance with the usage restrictions, foreign exchange
entitlements and other applicable regulations, I/ we shall bring the same to the notice of PNB,CCVD in writing
forthwith.

Date

D D M M Y Y Y Y
Signature of Primary Car1d Holder

Signature of Add on Card Holder

1 a