I.

PERSONAL DETAILS

Application Form No: Application Number: 2726713003034

First Name: BHAVNA Last Name: TANEJA

Middle Name: Father's Name:

Mother's Maiden Name: JAITALEE Gender: FEMALE

Date Of Birth: 27/04/1997

Official Email ID:

Personal Email ID: [email protected]

Embossing Name: BHAVNA TANEJA

Card Type: SBICard SimplyClick on Card Category: GOLD CARD

Mastercard
Marital Status:

Mobile: 8076888163

Account Type: Loyalty No:

Form 60: NO PAN: EFUPB4771N

Nationality: INDIAN

Easy Pay Consent: NO Easy Pay Date:

Enable Marketing: NO Statement Type:

Preferred Mail Address:

Signature Declaration : NO

International txn sign GIVEN / Disable int txn check box NOT selected:

Contactless Domestic:

Contactless International:

Domestic Online:

International Online:

POS-International:

Consent Given:

II. RESIDENTIAL DETAILS

House No: B H-224 EAST SHALIMAR BAGH

NORTH WEST
Phone: Phone 2:

Locality:
Address Line 2: DELHI

Landmark: City: NEW DELHI

Pincode: 110088 Years At Current Residence:

State: DELHI

Same As Permanant: NO

International Contact No. NA International Contact No. :

Given:
Status:

☐ I declare this is my current address

III. PERMANANT RESIDENTIAL

Address Line 1:

Address Line 2:

Landmark:

City: State:

Phone: Pincode:

IV.OFFICE DETAILS

Company Name: COGNIZANT Designation: SENIOR PROCESS

EXECUTIVE
Occupation Type: SALARIED Employee ID:

Department: Years At Current Employer:

Address Line 1: State:

Address Line 2: Phone:

City: Extension No:

Pincode: Monthly Income:

Industry Type:

V. OTHER DETAILS

Mid No: SE BRE Code:

ASM OHR ID: Aadhar Consent: NO

Form Sign Date: GSTN: NA

CKYC KIN No:

VI. BANK DETAILS

Bank Name:

Type of A/c:

Account No:

Year Of Opening Account:

CIF No:

Amount To Transfer: 0.0

Card Issuing Bank:

Amount In Words:

Primary Applicant Signed: NO

Secretarial Details:

Authorised Person Name:

 Authorised Person DOB:

Authorised Person Mother

Maiden Name:

Authorised Person Email:

Authorised Person Phone:

Penny Drop Account Number: 50100268316352

Penny Drop IFSC Code: HDFC0000331

Penny Drop Bank Name:

VIII. UTILITY BILL DETAILS

ELECTRICITY BILL

Consumer ID:

Service Provider:

PNG

Consumer ID:

BP Number:

Service Provider:

LPG

Consumer ID:

Customer Authorization Given: NA

WHATSAPP CONSENT GIVEN: NA

VIII. ADDON CARD DETAILS

ADDON 1

Addon Relationship :
Addon Embossing Name :
Addon Dob :
Addon Gender :
Addon Primary Applicant Signature : NA
Addon Mob No :
Addon Email Id :
Addon Stay with Primary : NA

ADDON 2

Addon Relationship :
Addon Embossing Name :
Addon Dob :
Addon Gender :
Addon Primary Applicant Signature : NA
Addon Mob No :
Addon Email Id :
Addon Stay with Primary : NA

ADDON 3

Addon Relationship :
Addon Embossing Name :
Addon Dob :
 Addon Gender :
Addon Primary Applicant Signature : NA
Addon Mob No :
Addon Email Id :

Addon Stay with Primary : NA

ADDON 4

Addon Relationship :
Addon Embossing Name :
Addon Dob :
Addon Gender :
Addon Primary Applicant Signature : NA
Addon Mob No :
Addon Email Id :

Addon Stay with Primary : NA

Notwithstanding any earlier instructions given by me, I hereby authorize and consent sharing of any of
my information (details mentioned in the application form and/ or any other document, transaction
details) and sending me SMS/email alerts or / calling on my Registered mobile number for the purposes
of operation of the card, marketing and offering of various products and services of SBICPSL through
agent(s) and/or any third party(ies) or any of the product(s) of its group companies, subsidiaries,
affiliates, cobrand partners.

MOST IMPORTANT DOCUMENT

Subject : Confirmation of application for SBI Card and Card fees

DECLARATION
This is to confirm that I am submitting my SBI Card application form along with the
required document for processing.

I, Mr. / Ms. ___________________________,

BHAVNA TANEJA hereby acknowledge that I have applied
for the card ticked below and agree to pay the annual fee mentioned in the
corresponding column

SBI Card Year 1 Annual Fee* Year 2 Onwards Maximum Minimum

Offering Annual Fee* Limit Limit

SBICard SimplyClick
on Mastercard Rs. 499 Rs. 499 Rs. 500000 Rs. 15000

*All applicable taxes on above

I am agreeable to
1. Any Variation in credit limits assigned to multiple credit cards issued to me. 2.
Any Alternate Card being issued to me 3. Any Transfer of existing card to the
new card applied for by me whether on notice or otherwise and done at the sole
option and discretion of SBICPSL based on its
 I am aware that the joining and the annual fee will reflect in my first card statement
issued to me and I need to pay the same before the payment due date of the 1st
statement. I am also aware that this declaration does not necessarily guarantee card
approval.

I further state and declare that while sourcing the application of SBI Credit Card: No
Cash has been collected from me; No Credit limits have been promised to me. I shall
contact the SBI Credit Card Customer helpline in case I have any doubts/clarifications

I hereby confirm and declare that :

1. I/We declare that the information provided by me in this form is true, correct and complete in all respects and authorize SBI
Cards & Payment Services Limited (formerly known as SBI Cards & Payment Services Private Limited) / or its affiliates &
associates to verify any information at my office / residence, with my employer, financial institution, credit bureau or any third
party engaged by SBICPSL. I have read and understood the contents of the SBI Credit Card Application form, Card Member
Agreement and the attached Most Important Terms and Conditions and agree and give my consent to all its content. 2. I/We
accept that SBICPSL is entitled in its absolute discretion to accept or reject this application. 3. I confirm that I have no
insolvency proceedings pending against me nor have I ever been adjudicated insolvent by a court of competent jurisdiction. 4.
I and the additional cardholder(s) agree unconditionally to be bound by the terms and conditions of the card holder agreement
accompanying each SBI Credit card unless the card is cut in half and pieces returned to SBICPSL. 5. I will be liable for all
charges incurred on the primary credit card and all Additional cards issued and each additional Card holder will be liable for all
charges incurred on all such credit cards jointly and severally with me. 6. I agree that charge slip or a payment requisition or
requisition or an electronic record resulting from or generated by the use of the card will amount to an unconditional
undertaking by me to pay SBICPSL the amount stated therein and agree that a copy of my periodic billing statement sent to
me by post or e-mail, at the e-mail address provided by me will be final and conclusive evidence of my liability for the charges
stated therein. 7. I authorize SBICPSL, at its sole discretion to transfer my outstanding balances on other credit cards and
credit facilities availed by me from other companies and financial institutions as provided in the application. 8. I authorize
SBICPSL to disclose any information relating to my / our card(s) as mentioned by me in the application form or any information
reflected in the documents submitted including any default in payments to a credit bureau, financial institutions, any parent,
subsidiary, affiliate or associate of SBICPSL, my employer, co brand partner, third parties engaged by SBICPSL for proper
operation of card accounts, verifications and other administrative services. 9. I authorize sharing of any of my information for
purposes such as marketing and offering of various products and services of SBICPSL or any of the product(s) of its Group
Companies, subsidiaries, affiliated, associates of co brand partner. 10. I also authorize SBICPSL to send me SMS Alerts on
marketing / account related information on my mobile phone number. All documents submitted in support of the application
shall become the sole and absolute property of SBICPSL and shall be treated in accordance with all applicable Laws and
Rules established in India. 11. I am fully aware and understand the regulations governing the use the Card outside India and
my obligations under the applicable exchange control / management regulations and guidelines issued by Reserve Bank of
India / applicable authority from time to time. 12. I undertake that my and Additional Card members use of the card shall be in
strict compliance with applicable exchange control / management regulations, otherwise the card may be cancelled at the
instance of RBI and / or SBICPSL in the event the I or the additional card member(s) are not in compliance with the usage
restriction, foreign exchange entitlements and other applicable regulations. I/We shall bring the same to the notice of SBICPSL
in writing forthwith. 13. I accord the above consent notwithstanding the issuance / non issuance maturity of the card(s) or its
discontinuance by me. 14. I accept the fee structure mentioned below. I understand that the Joining & Annual fee mentioned
below shall be required to be paid by me on receiving the first statement of account. Paid insurance is OPTIONAL and has
been clearly communicated to me at the time of selling the credit card. 15. I/We hereby unconditionally agree that SBICPSL
may in its discretion consider to use the information supplied by me/us on the application form and sell insurance to me/us at
their sole discretion, even in the event of me/us not having been issued the card. Finance charges @ 3.35% per month. GST
extra, as applicable. 16. I further state and declare that while sourcing the application of SBI Credit Card : No Cash has been
collected from me. No credit limits / gifts etc. have been promised to me. I shall contact the SBI Credit Card Customer Helpline
in case I have any doubts / clarifications. 17. I authorize SBICPSL to use my KYC/PAN number to verify KYC details submitted
by me in the Application form. Any such verification will be from an authorized forum only. The application form will not be
processed pending completion of KYC verification. Further, if SBICPSL requires any information on account of compliance with
the KYC and AML Guidelines, I will provide the same. 18. I am agreeable to any variation in credit limits assigned to multiple
credit cards issued to me whether on notice or otherwise and done at the sole option and discretion of SBICPSL based on its
internal policy. 19. I further give specific consent to the blocking and deactivation of any of my credit cards and its aligned
accounts in all circumstances where at any instance I commit default in timely payments of my outstanding on any of such
credit cards issued by SBICPSL to me. 20. In the event of my application getting approved, I/We agree to receive my card
statement through email on the email id mentioned in this application form and the said email id will be considered as my
Registered email ID for the purpose of transactions alerts and One Time Password (OTP). 21. I understand that I may be
issued a SBI Card from SBI Card portfolio at the absolute and sole discretion of SBI Card to which I, hereby give my full and
free consent and I further undertake that subsequently I shall not raise any demure, protest and/or contest with regard to any
matter connected therewith. I confirm that I have been duly communicated and I have fully understood all accompanying terms
and conditions of SBI credit cards. 22. In all events of payments not being paid by the due date, SBI Card reserves the right to
carry out follow ups by means of personal visits, post, fax, telephone, e-mail, SMS and/or engaging third party to remind,
follow-up and collect due payments in any manner deem fit by SBI Card keeping the intent in view. 23. In all events where SBI
Card or its authorized representatives are unable to contact me, SBI Card shall be at liberty to leave payment due messages
with any third parties which may include without restriction your spouse, parents, other family

I hereby undertake to comply with all directives from SBICPSL in my capacity of the beneficial owner of the SBI Credit card if
and when such credit card is issued by SBICPSL to me based upon approval of my SBI credit card application form. 25. I have
read and understood all SBICPSL policies regarding data privacy and security procedures published on its web site
www.sbicard.com and acknowledge all its content.

I have submitted the following document(s):

a) KYC Document(s)

The MITC is provided in English and I am fully conversant with English to understand the MITC and would request SBI card to
provide further request in English.

Digitally Signed By : BHAVNA TANEJA

Date and Time: 2024-09-23 08:52:57

Place : NEW DELHI

To view detailed information on schedule of charges, please download the Key Fact
Statement fromhttps://sbicard.com/KeyFactStatement