Running S. No.

AP JC29462048

Important: Please fill in BLOCK LETTERS and attach all relevant documents as specified in the attached checklist. 20-08-2024
Please complete all sections to ensure priority processing. All fields marked in blue are mandatory. Tick where
applicable and please write ‘N.A.’ where not applicable. JC29462048

VISA Legend Credit Card Platinum Credit Card Club Vistara IndusInd Bank Explorer Credit Card
Platinum Aura Edge Credit Card EazyDiner IndusInd Bank Credit Card Indulge Credit Card
IndusInd Bank Tiger Credit Card IndusInd Bank Avios Visa Infinite Credit Card Platinum Aura Edge Credit Card Exclusively for
Government Sector Employees
MasterCard Pinnacle Credit Card Platinum Aura Edge Credit Card IndusInd Nexxt Credit Card
Legend Credit Card Platinum Credit Card IndusInd Bank Crest Credit Card
Platinum Aura Edge Credit Card Exclusively for Government Sector Employees
American Express* Celesta Credit Card
Loyalty Plan on Platinum Aura Edge Credit Cards ✔Home Plan ✔
ShopAURA
Plan EDGE(MASTERCARD)
Travel Plan Party Plan
K NARAYANAKUMAR
✔ ✔
We will send the monthly statement to your E-mail ID. We will also send important account related alerts to your mobile phone.

Add-on Name as desired on the Card (Max 19 Characters)

M F T

Mobile No. Email ID:

Business Add-on fourth line embossing name preferably company name (Max 19 Characters)
I confirm that the Add-on applicant is staying/not staying with me at the same residential address as provided in the application form.
If the Add-on applicant is not staying at the same address as the Primary Cardholder, separate address proof of current address or the permanent address for the Add-on Cardholder
to be mandatorily provided. I agree to be fully liable for all transactions and charges on my Add-on Card(s).

✔ ✔ Others
PARAMESWARAN THAMBI NARAYANAKUMAR

Citizenship IN- Indian ✔Others (ISO 3166 Country Code)

22 12 1973 ✔Male Female Third Gender
Mother’s Name USHA THAMPI
Father’s/ Spouse’s Name PARAMESWARAN THAMBI
Virtual UID No. 6370 Aadhaar ID No. PAN No. AHKPN7135Q

Residential Status ✔Resident Individual Non Resident Indian Foreign National Person of Indian Origin

NO22B, ARUMUGA NAGAR, NEAR VALARNAGAR

MADURAINORTH
null
MADURAI 625107 TAMIL NADU
Financed ✔Owned Rented Parental Co. Leased
Mobile No. 9443432505

Personal E-mail kpnk22@gmail.com Duration of stay

NO22B, ARUMUGA NAGAR, NEAR VALARNAGAR

MADURAINORTH
null
MADURAI 625107 TAMIL NADU
Mobile No.

SE
PROFESSIONAL
OTHERS
NO-1, MALLIGAI HOME,
SAMBAKULAM MAIN ROAD
NEAR AKSHAYA NEURO CLINIC
MADURAI 625007 TN
94 43432505 Mobile No.
Office E-mail kpnk22@gmail.com
 ✔
Occupation Type Service ( Private Sector Public Sector Government Sector ) Business
✔Others ( Professional Self-Employed Retired Housewife Student ) Not Categorised
1588524
Call Centre / BPO / KPO Export/ Import Infrastructure Printing / Publications
Advertising/ Marketing Construction/ Real Estate Film / Television IT / ITES Railways
Agriculture Consulting / CA / Legal FMCG Manufacturing Retailing
Armed Forces Education Gems and Jewellery Medical/ Healthcare Shipping / Logistics
Automobile Engineering and Government Bodies Mining / Metal Telecommunication
Aviation Capital goods Hotels/ Restaurants NGO / Charitable institutes Textile
Banking/ Insurance/ Entertainment/ Media Manpower outsourcing Oil and Gas Transportation
Financial Services Pharma/ Biotech Police/ Paramilitary Power/ Electricity Travel/ Tourism
Online - Retail ECOM ✔ Others (pls. specify) LAW

If IndusInd Bank Staff Emp. No.

Mandatory as per CKYC

Proof of Identity (Certified copy of any one of the following needs to be submitted)

NREGA Job Card ✔PAN No. AHKPN7135Q

✔Aadhar UID No. 6370 Voter ID Card
Driving Licence Driving Licence Expiry Date
Others (any document notified by the central government) Identification Number
Simplified Measures Account - Document Type code Identification Number
Address Type
Residential / Business ✔
Residential Business Registered Office Unspecified
Proof of Address (Certified copy of any one of the following needs to be submitted)
Passport Driving Licence ✔
UID (Aadhaar) Voter Identity Card Others
Simplified Measures Account - Document Type code
Institution Details (Bank Use Only)
Name [Institution Stamp]
Code
Applicant Declaration
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein,
immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. [Signature / Thumb Impression]
2024-08-20T15:52:35.566
I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address.
Date 20-08-2024 Place MADURAI Signature / Thumb Impression of Applicant

For office use only

Application Type* ✔ New Update Account Type* ✔Normal Simplified
(for low risk customers)
Small
(To be filled by KYC Number
financial institution)
(Mandatory for KYC update request)

2024-08-20T15:52:35.566

I_______________________________________________do hereby assign the

monies payable on the Personal Accident Policy on the Credit Card by The
Oriental Insurance Company Ltd. in the event of my death to
Mr./Ms._______________________________, my _____________________________ (To be witnessed by a person other than
(mentioned relationship) and I further declare that his/her receipt shall be sufficient the Primary Card Member)
discharge to The Oriental Insurance Company Ltd.
Witnessed by:______________________________________ All claims shall be payable by 'The Oriental Insurance Company Ltd." on satisfactory approval of documents
and as per the rules & regulations of "The Oriental Insurance Company Ltd.” subject to the approval of Credit
Card application.
Running S. No. AP JC29462048

JOCATA
Sales Ref.No 1.
Sales Ref.No 2.
I hereby confirm that the prescribed KYC process has been adhered to and recommend this applicant for credit
Sales Ref.No 3. assessment for the issuance of Credit Card.

I/We hereby declare that the above information is complete and true and IndusInd Bank Limited (“Bank'”) is entitled to verify the same directly or through any third party agency. The Bank reserves the right to verify the details mentioned herein in the Credit
Card application form by contacting me at my residence and/or on business telephone numbers and/or physically visiting my residence and/or business addresses through agencies appointed by the Bank, if so deemed necessary.
I/We understand that such information and documents have been submitted to enable the Bank to sanction and grant the Credit Card to me/us. I/We understand and confirm that the Bank is not obliged to return the documents provided by me/us with the
application form. I/We hereby declare that I/We are fully competent to apply for the Credit Card facility and there is no legal impediment for availing the same. I/We confirm that there are no insolvency or liquidation proceedings instituted against/by me/us and
I/We are not un-discharged insolvent. I/We also authorize the Bank to conduct such credit checks, as it may deem fit, in respect of my application, at its sole discretion. I/We further understand that the Bank may at its sole discretion sanction or decline this
application. I/We certify that all information furnished by me/us is true. I/We the Cardholder(s) hereby authorise the Bank for the purposes of credit verification or reference checks, protection of its interests etc., to disclose all/any information/documents relating
to the Cardholder/this agreement and/or any other agreements or upon default committed by the Cardholder, to the Reserve Bank of India, Income Tax Authorities, tribunals, courts, judicial bodies, other banks, credit bureaus, financial institutions or any other
third party, at any point of time. l/We waive the privilege of privacy & privity of contract. I/We agree to be fully liable and authorize the Bank to debit my/our IndusInd Bank Credit Card account for all spends, charges, fees, interest etc., incurred using the Bank’s
Credit Card (s). The GST at the prevailing rate will be charged on all fees, charges, interest, etc. as applicable and I/We agree to pay the same. I/We authorize the Bank to combine the outstanding on the Credit Card(s) with any liability account maintained by me/us
with the Bank and set-off/transfer any amount outstanding to the credit of such other account, towards the fulfillment of my liability to the Bank. I/We will be fully liable to comply with all applicable laws, rules and regulations including the Foreign Exchange
Management Act 1999 and any amendments thereof, prevailing from time to time. I/We undertake to notify the Bank immediately of any change in any information/records viz. address, telephone number, mobile number, e-mail, Occupation etc. I/We have
read, understood and hereby agree that I/We will be bound by the Cardholder’s Agreement and the Most Important Terms & Conditions (MITC) for IndusInd Bank Credit Cards. I/We hereby acknowledge that a copy of Cardholder's Agreement can be availed at
any time from any branch of the Bank in India, on Bank's website or by sending a request to the Bank by e-mail or through phone banking and the latest version of the Cardholder’s Agreement and MITC updated on the Bank’s website shall prevail. I/We hereby
undertake to read the Bank's special conditions relating to various services including but not limited to accounts, ATM, Phone banking, Mobile banking, Internet banking, bill payment etc. I/We accept and agree to be bound by the said terms and conditions
including those excluding/limiting the Bank's liability. I/We agree that I/We will not use the Bank‘s Credit Card for any purpose other than personal use specifically excluding use in my/our own business establishment. I/We understand that the Bank may at its
absolute discretion, discontinue or modify any of the services in respect of Bank's Credit Card completely or partially. I/We confirm that I/ We am/are a resident of India. I/We understand that the Bank will be entitled to provide under confidentiality, my following
data to programme partners for benefits on the IndusInd Bank Credit Card: Name, date of birth, genders, mailing address, e-mail address, mobile number, telephone number and occupation. In this respective the Bank shall be freed from its obligation towards
banking secrecy. I/We understand that the fees including Joining and Annual fees once charged or accrued shall not be reversed or refunded for any reason whatsoever.
I agree to provide to the Bank such additional documents/information as may be required by the Bank from time to time to comply with the Know Your Customer (KYC) requirements of the Reserve Bank of India and the Bank. I will update the Bank in case of
any change in my details provided at the time of application for the Credit Card which includes address, industry, employment etc. I hereby consent, agree and authorize the Bank to disclose and share information and profile data relating to me/us with risks
scoring system and for profile checks.
I understand that the Welcome Kit for IndusInd Bank Credit Card has now been digitised. The copy of the Benefit Guide, Cardholders’ Agreement and Most Important Terms and Conditions (MITC) are available for download at
https://www.indusind.com/in/en/personal/cards/welcome-kit.html. A physical copy of the same shall be made available by the Bank upon request made by calling our Phone Banking Number.

IndusInd Bank reserves the right at its discretion to: I) E-mail the statement of Account to my e-mail ID provided. ii) Send Account related alerts through SMS and e-mail. I/We authorize the Bank to keep providing me information of the Bank’s new products and
offers through email, SMS or phone calls as convenient. I understand that the information including Landline number, Mobile number and E-mail ID as mentioned above (apart from being used for mandatory account verification and maintenance purposes) may
also be used by IndusInd Bank to contact me and offer carefully selected products and services from time to time either itself or through its agents or authorized representatives.
I do not wish to register my contact number in the ‘Do Not Call Registries’ (DNCs).
[ ] Yes [ ] No

Consent to Use, Share and Disclose Registered Communication Contact Details

I/We hereby ACCEPT, AUTHORISE, CONFIRM AND PERMIT IndusInd Bank Limited (“Bank”) to USE, SHARE AND DISCLOSE any/all of my/our registered communication contact addresses/details (postal, e-mail, mobile number, social media platforms/channels etc.),
that I/we have willingly registered/shared with the Bank for the purpose of (A) receiving information, either from the Bank, Central KYC Registry and/or through any of the Bank’s authorised Service Providers / Agency(ies)/Professional Advisors related to the
operations of my/our account(s)/services availed by me /us from the Bank; and/or (B) API based authentication where my/our details are being auto fetched/ populated to process my banking requests/applications on/through the Bank’s Web
Applications/Systems; and/or (C) any kind of promotional/research/feedback based exercise about the Bank’s products/services that I/we must/may be made aware for general consumption or to provide feedback as an existing customer of the Bank; until such
time I request/notify the Bank to stop sending communication to any/all of my/our registered communication addresses/details as per the Bank’s defined process and knowing that the Bank will ensure security and confidentiality to all my communication
contact details provided by me/us. If I am /we are or become a Non Resident Indian (NRI) / foreign national, I confirm that the following consent is well within my capacity as a Non-Resident Indian and by doing so I do not violate or breach in any manner the
regulations or statutes of the country of my residence as are applicable to me.
[ ] Yes [ ] No

Manage Your Credit Card Transaction Preferences

As per RBI guidelines on Enhancing Security of Card Transactions, your IndusInd Bank Credit Card will be enabled only for Domestic Point of Sale (POS) and ATM transactions. You can enable Online, Contactless and International transactions using any
of the following options:
1. Website (www.indusind.com) > Quick Links > Credit Card Related > Set Credit Card Transaction Preferences
2. Login to IndusMobile App to manage your Credit Card Transaction Preferences
3. Login to IndusNet > Service Requests > Credit Card Requests > Set Transaction Preference

Other Bank Credit Card copy, card number imprint and latest statement.

Interest Charge Monthly Rate Annual Rate Balance Enquiry Charges on

₹25
Non-IndusInd Bank ATM
Platinum Aura Edge,
3.95% 47.40%
Platinum & Legend Railway Booking Surcharge As applicable
EazyDiner, Nexxt , Pinnacle 3.83% 46.00% Cash Deposit Charges ₹100 at IndusInd Bank Branch
Celesta, Crest , Platinum Aura 3.5 %,
2.99% 36.00% Legend Card, Indulge - 1.8%, IndusInd Bank Tiger Credit Card - 1.5%,
(For Government Sector) Foreign Currency Mark-Up
Avios Visa -1.5% at preferred destination, 3.5% all other destinations,
Club Vistara 2.85% 34.00%
Waived for Club Vistara
Indulge 1.79% 21.48% Fuel Surcharge 1% waived for transactions between ₹400 – ₹4000; (GST on fuel surcharge
IndusInd Bank Avios Visa (Subject to a minimum of INR 10) as per standard rate shall be applicable and borne by the customer)
3.00% 36.00%
GST
IndusInd Bank Tiger Credit Card 3.50% 42.00%
Duplicate Physical Statement Request ₹100 per statement (beyond last 3 months)
Late Payment Charges Outstanding Balance
up to ₹100 - Nil Reissue/ Replacement Card Others – 100, Club Vistara – Nil
Between ₹101- ₹500 - ₹100 Charge-slip Request ₹300
Between ₹501- ₹1,000 - ₹350
Between ₹1,001- ₹10,000 - ₹550 Up to US $27 per person per visit (Charges shall be billed to your
Between ₹10,001- ₹25,000 - ₹800 Priority Pass Usage Fee IndusInd Bank Credit Card) Not applicable for Celesta,
Between ₹25,001- ₹50,000 - ₹1,100 Platinum Aura (For Government Sector)
Above ₹50,000 - ₹1,300
Waived for Club Vistara Reward Redemption Fee ₹100
2.5% of Over Limit Amount subject to a minimum of ₹500 1% Markup fee plus taxes on all transactions carried out in Indian Currency
Over Limit Charges Dynamic CurrencyConversion at an international location/ merchants located in India but registered
Waived for Club Vistara
(DCC) overseas. Fee will not be levied on Club Vistara Explorer, Indulge, Celesta,
Returned Payments ₹250
2.5% of the advance amount subject to a minimum of ₹300 1% Fee + GST levied on each transaction
Cash Advance Charges Waived for Club Vistara, Indulge, Platinum Aura (For Government Sector), Rent payments through
Fee will not be levied on Club Vistara Explorer, Indulge, Celesta, Crest,
third-party merchants

Application S. No. AP
We are entering the digital world and as a step in this direction, we have now digitised your Welcome Kit. Your Credit Card Welcome Kit shall carry the Welcome letter and Card plastic only. The detailed Benefit
Guide, Cardholders’ Agreement and Most Important Terms and Conditions (MITC) are available online in PDF format. To download, please visit https://www.indusind.com/in/en/personal/cards/welcome-kit.html
A physical copy of the Benefit Guide, Cardholders’ Agreement and MITC shall be made available by IndusInd Bank upon request made by calling our Phone Banking Number 1860 267 7777.

E-mail us at priority.care@indusind.com

For more details & MITC: www.indusind.com