Add - on Card (s) Application Form Cum MID

Version 1.16

If you are an existing Cardmember, please tick whichever is applicable Appl. No.:

Infinia Regalia Regalia First Milennia Moneyback + Moneyback Freedom Diners Club Black Diners Club Privilege

Moneyback Freedom Titanium Card InterMiles InterMiles IndianOil Business Regalia Business Moneyback
HDFC Bank Platinum HDFC Bank Signature HDFC Bank Credit Card

Other Cards _____________________________________________________________

Credit Card Number CUST ID

Name of the Primary Cardmember: First name Middle name Last name

Please leave one box space between names and surname

Primary Mobile No.

TG

TG

TG

DECLARATION

I hereby acknowledge the request made for Add-on Card and warrant that the above information is correct and hereby request and authorise that an Account be opened and Card(s) be
issued as indicated herein and renewed and replaced until I give notice to cease, and in connection herewith authorise the exchange and transfer of credit information from / with my Bank
or any other source. I understand that HDFC Bank Ltd., reserves the right decline the application without giving any reason whatsoever. The additional applicant (s) and I agree to be
bound by the terms and conditions of The Cardmember Agreement earlier executed by me. I declare and undertake that the Cards issued to me, if used overseas shall be utilised strictly in
accordance with the relevant exchange control regulations issued and as amended by the Reserve Bank of India (RBI) from time to time. In the event I exceed my entitlemants as per the
exchange control guidelines of RBI, I undertake to bring the same immediately to the notice of HDFC Bank Ltd., in writing. And in the event of any failure to comply with the prevailing
exchange control guidelines issued by RBI, I shall be liable for action under the Foreign Exchange Management Act, 1999 as amended, and be debarred from the Card facility. The
undersigned will be liable for all charges incurred with the Add-on Card(s) issued on the Account and each Add-on Applicant will be liable for all charges incurred with the Add-on Card
jointly and severally with the holder of the Primary Card.
Conditions Apply: Sub-limit on Add-on Card is per statement cycle. Sub-limit will hold good only for ATM and POS transactions but the same will not apply for online transactions.
For detailed terms & conditions visit www.hdfcbank.com.

Primary Cardmember’s Signature ........................................................................................................................ Date : ............................................................

By Signing here, I certify that I have read and agree to all applicable Terms & Conditions.
 Acceptable KYC list are:

1. Aadhaar Card (front & back copy, mask the first 8 digits) OR 6. Letter issued by National Population Register containing name and
E-Aadhaar (download within last 180 days, mask first 8 digits) address
2. Driving Licence(front & back copy) 7. Photo copy of overseas Citizen of India (OCI) card mentioning the
3. Passport (1st page & last page with address) overseas address (For NRI Customers Only)
4. Voters ID Card (front & back copy) 8. Documents issued by Govt of Foreign Jurisdiction - OCI/PIO Card, Work
Resident Permit/ Social Security Card/Green Card etc ( Only for Foreign
5. Job card issued by NREGA duly signed by an officer of the STATE
Citizen holding PIO/ OCI card)
Government

Note:
a). Document of proof to be self-attested by the applicant
b). Non DBT Consent to be submitted by customers who provide Aadhaar Card / e-Aadhaar / e- KYC as Address Proof ( available in Next Page)

Name of TSE : ________________________________________________________ Team Supervisor’s Code : _______________________________________________

TSE Code : __________________________________________________________ Signature of Team Supervisor : ___________________________________________

Name of Doc-Ex : _____________________________________________________ PB/RM (Mandatory Field) :

Doc-Ex Code : ________________________________________________________ BRANCH CODE :

Channel : ____________________________________________________________ BDR Code / LC Code :__________________________________________________

Source Code / Activity : _________________________________________________ City : _______________________________________________________________

Sep’16