8/11/2019 Appln Debitcard Rev

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APPLICATION FOR SYNDICATE BANK VISA/MAESTRO GLOBAL INSTANT/

PERSONALISED-CLASSIC/GOLD/PLATINUM/PHOTO DEBIT-cum-ATM CARD

The Head of the branch

Syndicate Bank..Branch.

1. Please issue me/us SYND!"T# B"N$ %S"/&"#ST'( )*(B"* NST"NT/ P#'S(N"*S#D+!*"SS! /)(*D/ P*"TN,&/PH(T( Debit+cum+"T& !ard a-ainst my SB / Staff (D "ccount Number

...ith you.

. Please issue us SYND!"T# B"N$ %S"/&"#ST'( )*(B"* NST"NT/P#'S(N"*S#D+

!*"SS!/ )(*D/ P*"TN,&/PH(T( Debit+cum+"T& !ard to the folloin- 0oint account holders in the

said account

a.

b.2. /3e undertake that /e shall be holly liable/res4onsible for all ty4es of transactions done on my/our

abo5e said account throu-h my/our card6s7 issued by the Bank to me/us. /3e ha5e read the rules and re-ulations

ith re-ard to issue of Syndicate Bank %S"/&aestro )lobal Debit+cum+"T& !ard and /e shall abide by thesame.

8. /3e hereby declare that the transactions under this/these Debit !ard6s7 shall be strictly in conformity iththe -uidelines under 9orei-n #:chan-e &ana-ement "ct 69#&"7 and is not desi-ned for the 4ur4ose of any

contra5ention or e5asion of the 4ro5isions of the 9#&" or any rule; re-ulation; notification; direction or ordermade there under from time to time.

ue 4ersonal identification6?7 nformation for authenticatin- the card holderc7 #+mail D .........

d7 Tele4hone No.

e) Mobil No!"M#$%#&o'( )o' SMS #l'&*+ .........

OR/3e declare that /3e do not ha5e/are illin- to share the &obile number ith the Bank.

Name (ccu4ation/Profession/desi-nation Si-nature",+

a.

b.

D#&......

",+n case of 0oint accounts; all the 0oint holders should si-n the a44lication form."+Please rite any uni>ue identification information; hich ill be useful to the Bank to identify you in case you

for-ot your "T& PN or to ser5ice any other s4ecific re>uests.

Fo' B#$01* u*

'e>uest acce4ted and Debit !ard issue a44ro5ed. 'ele5ant 9la- in the System has been set.

nstant Debit !ard No.@@@@@@@@@@@@@@@@@@@@@ issued / Data forarded to D!! on@@@@@@@@@@@@@@5ide

'ef No.@@@@@@@@@@@@@@@.

Si-nature of Branch Head