Add - on Card (s) Application Form Cum MID

Version 1.17

If you are an existing Cardmember, please tick whichever is applicable

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

Please submit PAN Copy

TG

Please submit PAN Copy

TG

Please submit PAN Copy

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 : _______________________________________________________________

 Application for Add-on Card using Aadhaar /e-Aadhaar/
e-KYC for Customers not opting for DBT

To,

The Branch Manager, _______________________________________Branch.

HDFC Bank Limited (“Bank” which term shall include its successors and assigns)

Subject : Aadhaar- informed consent

1. I voluntarily opt forAadhaar OVD KYC or e-KYC or offline verification, and submit to the Bank my Aadhaar number, Virtual ID,
e-Aadhaar, XML, Masked Aadhaar, Aadhaar details, demographic information, identity information, Aadhaar registered mobile
number, face authentication details and/or biometric information (collectively, “Information”).

2. Iam informed by the Bank, that:

(i) submission of Aadhaar is not mandatory, and there are alternative options for KYC and establishing identity including by
way of physical KYC with officially valid documents other than Aadhaar. All options were given to me.

(ii) For e-KYC/authentication/offline verification, Bank will share Aadhaar number and/or biometrics with CIDR/UIDAI, and
CIDR/UIDAI will share with Bank, authentication data, Aadhaar data, demographic details, registered mobile number,
identity information, which shall be used for the informed purposes mentioned in 3 below.

3. I authoriseand give my consent to the Bank (and its service providers), for following informed purposes:

(i) KYC and periodic KYC process as per the PML Act, 2002 and rules thereunder and RBI guidelines, or for establishing my
identity, carrying out my identification, offline verification or e-KYC or Yes/No authentication, demographicor other
authentication/verification/identificationas may be permitted as per applicable law, for all accounts, facilities, services and
relationships of/through the Bank, existing and future.

(ii) collecting, sharing, storing, preserving Information, maintaining records and using the Information and
authentication/verification/identification records: (a) for the informed purposes above, (b) as well as for regulatory and
legal reporting and filings and/or (c) where required under applicable law;

(iii) enabling my account for Aadhaar enabled Payment Services (AEPS);

(iv) producing records and logs of the consent, Information or of authentication, identification, verification etc. for evidentiary
purposes including before a court of law, any authority or in arbitration.

4. I understand that the Aadhaar number and core biometrics will not be stored/ shared except as per law and for CIDR
submission. I have downloaded the e-Aadhaar myself using the OTP received on my Aadhaar registered mobile number. I will
not hold the Bank or its officials responsible in the event this document is not found to be in order or in case of any incorrect
information provided by me.

5. The above consent and purpose of collecting Information has been explained to me in my local language.

Customer Name:___________________________________________

Signature :___________________

Date: ____________
Please provide only Addon customer information. ADDON Customer ID any
Separate form to be used for each individual addon request*

Card No

CKYC ID

Date of Expiry (DD MM YYYY)

Date of Expiry (DD MM YYYY)

Aadhaar Card

Address

Line 1*

Line 2

Line 3 City / Town / Village*

District* Pin / Post Code* State/ U.T Code*

Addon Signature
Feb’22