TRIPURA GRAMIN BANK
HEAD OFFICE : ABHOYNAGAR
E-mail:tripuragramin@rediffmail.com, tgraminbank@gmail.com,
Website:www.tripuragraminbank.org
APPLICATION FORM FOR ATM CUM RUPAY DEBIT CARD
To
The Sr. Manager / Branch Manager
TRIPURA GRAMIN BANK
……………………………………..….. Branch.
Dear Sir,
Being desirous of availing the facility of using ATM cum RUPAY Debit Card, I/We furnish the information below:
Name (s) :
Date of Birth
(DD/MM/YYYY) : Nationality : ……………………………
A/C. No. SB / CD / OD :
*CD A/C Card will be issued to Proprietor only. **OD A/C Card will be issued to Staff-members only against Staff-OD A/C.
Address (Res):
P I N -
Address (Off):
P I N -
Telephone No.
Mobile No.
E-mail ID:
I/We hereby declare to abide by the rules / terms & conditions as applicable to TRIPURA GRAMIN BANK
RUPAY DEBIT CARD holder. I / We will follow the stipulated guidelines for usage of TGB RUPAY DEBIT CARD
and comply with the existing as also the modifications, if any made by the Bank from time to time
without reference to me/us.
Signature (s) (In case of Joint Account, all A/C holders must sign.)
……………………………………………………………………………………………………………………………………………………………………
FOR BANK USE ONLY
Card No. Date:
Above signature(s) verified
Signature of Authorised officials with seal & Signature serial number. ……………………………
………………………………………………………………………………………………………………………………………………………………………………….
“Received the TGB RUPAY Debit Card, Welcome kit in sealed and good conditions”
Signature Signature Signature
