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Global Credit Card Application

1. Mr. X applies for an Indian Bank Gold or Classic credit card and provides personal details like name, date of birth, address, employment details, and financial information. 2. He attaches required documents like income proof, PAN card, and address proof and requests billing statements be sent to his residential address. 3. If approved, he agrees to the terms and conditions of the card member agreement and authorizes automatic debit of payments from his Indian Bank account.

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vv_nathan
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751 views2 pages

Global Credit Card Application

1. Mr. X applies for an Indian Bank Gold or Classic credit card and provides personal details like name, date of birth, address, employment details, and financial information. 2. He attaches required documents like income proof, PAN card, and address proof and requests billing statements be sent to his residential address. 3. If approved, he agrees to the terms and conditions of the card member agreement and authorizes automatic debit of payments from his Indian Bank account.

Uploaded by

vv_nathan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FOR CREDIT CARD

I wish to apply for Gold Classic Credit Card


INSTRUCTIONS TO FILL UP THE APPLICATION FORM

1 Fill all columns with requisite details in CAPITAL LETTERS.


Please paste
2. Proof of annual income and PAN Card copy is mandatory.
your recent
3. Please sign in full in the space provided and on the 2nd page of the application form. passport size
4.Terms and conditions and card member agreement are available at Indian bank Branches and on color photograph
the website www.indianbank.in which may be referred before applying for the card. here

Please sign here in black ink 


PERSONAL INFORMATION

Name: Mr./Mrs./Ms./Dr./Prof.
First Name Middle Name Last name

Name to be embossed on card (max of 20 characters)

Date of birth: Sex: M F Nationality

Legal Status: Resident NRI PIO Marital Status: Single Married No. of Dependents:

PAN No Passport No Place of Issue ….…………………………

Voter’s ID Driving License No. Place of Issue…………………

Your Vehicle: 2-wheeler 4-wheeler None Vehicle Make ……………... Regn No

Mother’s Maiden Name: .


RESIDENCE

Current Residential Address:

City State

Pin Tel no.(with STD code) Mobile no


Personal Email ID …………………………………………... Land Mark ……………………………………………..

Permanent Residential Address:

City/State Pin

Tel no.(with STD code) Mobile no


Personal Email ID …………………………………………... Land Mark …………………………………………..
Current Living with: EMPLOYMENT DETAILS
residence is Occupation: If Salaried, Industry details :
Parents employed with:
Owned Salaried Aviation/Hospitality IT/Telecom
Spouse Whether Confirmed PSU/Govt
Family Banking/Finance Travel/Tourism
Owned Children Yes No Public ltd
Mfg/Engg Entertainment/Media
Rented Alone Professional / Self- Private ltd
Employed Details : Real Estate/Construction
Others Partnership
Company …………………. …. Others (please specify) …………
leased Proprietorship ……………… ………………………...
Period of stay: Retired Student
…………
Housewife
Months
Company/Employer Name : ………………………………….…………………………………….…………………………..

Employee (Applicant’s) Designation……………………………. Emp. No./ID / SR No………………………………………..

Office Address: ……………………………………………………………………………………………………………………

City/State.……………………….. Pin……………….. Official Email ID.………………………………………………………

Tel no. (with STD code) ………………………… Fax ……………………..……… Mobile ……………………………

FINANCIAL INFORMATION

Gross Annual Income (Rs): Name of your Banker: …………………………

Account Type: Savings Current Account No…………………..


Branch:…………………………………………..
Account held for: ………………………. months
Additional Annual Income , if any (Rs): ……………………… and Source:…………………………………………..

DETAILS OF CREDIT CARDS HELD


SNO ISSUING BANK/INSTITUTIONS CARD NO CREDIT LIMIT (RS)

1 ………………………..

2. ….. ……………………..
DOCUMENTS ATTACHED

Copies of: Statement of Accounts for last 3 months (other than Indian Bank) IT Proof/Latest Pay Slip

PAN Card*** Age Proof Passport Driving License Voter’s ID

BILLING INSTRUCTIONS

Mail my billing statements to Current Residential Address Official Address

Do you want automatic debit on your Indian Bank A/c? ( for Indian Bank Customers only) Yes No

If yes, A/c type: Savings Current Branch: …………………………… Account No. ……………………….

Amount to be debited: Full amount due Minimum amount due ECS Debit*
* A copy of the cheque leaf / cancelled cheque leaf issued by the existing bank to be enclosed.
DECLARATION
Assignment clause for insurance cover: I, …………………………………………………..do hereby assign the money
payable in the event of my death by the United India Insurance Co. Ltd., to (Name)………………………………..(relation to the
insured)………………and I further declare that his/her receipt shall be sufficient discharge to the Company.
I hereby declare that I has personally read and understood the terms and conditions governing the issue and usage of
the credit card. I verify that the contents stated in the above application are true to the best of my knowledge. I
hereby authorize the Bank and/or its associates to verify any information provided in this application form at any
given time. I also confirm that I shall promptly inform the Bank of any change in the information mentioned above.
The Bank may further use the said information for marketing, administrative and for other value addition purposes.
I agree that the Card will be issued to me upon the prevailing Terms and Conditions (which are subject to change
from time to time) of the Card Member Agreement. I, as the applicant of the Primary Card, shall be liable for all
charges incurred on the Primary Card and all Additional Cards on my account. For any enhancement of credit limit ,
I shall undertake to specifically apply for banks consideration.

Place ______________ Date:___________ Signature of Applicant


____________________________________________________________________________________________________
RECOMMENDATION BY BRANCH : IBGA CODE : 3. Value of connections:
1. KYC requirements have been fulfilled. 2. Recommended for issue of Credit Card
Customer Identification No.CIF:
Branch Manager’s
signature
Branch :______________________ Date:___________ Name Specimen
signature No.

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