bob pony | BB iirc Application form for Issuance / Re-issuance / Blocking of Debit Card 1 ish to apply fr Bank of Baroda Debit Card Name ofthe Beane [———— MylOur Account Type [] Account Number Request for [F New [5] Retssuance ["] card Blocking [] ard Account Link /Delink 1. Name dae orsin TF) FD] Gender [] Male [] Female [“] others (00 FM rYYYY) (no exend 20 carer) fo Waar) lav ave one Bk opeas Bowe ooh ane) 2. Card Variants (Tek any one) [J uisacisss [ws rtsrum [arose 8°cu Nowe [5] isa Wapaar [Elrapayciasse Nowe [5] RuPay Platnum NCC [5] RuPay Select NCC [Ei mastercard Classic © [] Mastorcard Ptatnum —[] VISA Infirite (Opulonce) [E visa signature Male (Sapphire) [[] visa signature temate (Sapohie) FJuosnmeresnentins tbo osiAqiwer Nowe esp nodes Ste (bo world Pudhumai Penn NOMC any otter 3. Mobile No, [ ] emai [ 4. xing Deb cara, [——_] CARD WILL BE DELIVERED TO THE AVAILABLE COMMUNICATION ADDRESS IN YOUR BANK ACCOUNT, Haters cab eee ae es yaa we understand and uncer tht he usage ofthe Debi Card halle syn accordance wth he Exchange Correlation an inthe event entra. wb ati cin uo Faron Exchange Marat ct 19 rdw art es spe by We acaptulresponbiy or myout Dab Cad an agree not to make any clams against Bank Of Bards In espet hee ‘The Bank eserves the rghtto else n ert concen, to Banke serve rouse, such frmton canting he Debt Card | hereby, give my consent for renewal of debit card, on its expiry In case of non-renewal, please vist your base branch login to bob World / bob World Internet, for blocking the car [L! hereby give my consent to receive Online/Ofine promotional communication from the Bank regarding various products, services, offerings, security ips otc. (Applicants Signature) (Other Account Holdels Signature) (Incase of joint account holers, all account halders shall put their signatures) | Branch Cade; [——_} Faruse in Branch Name ofthe Offear [Signe [Signature verified by Etiity verted by