INDIVIDUAL

ARN: 2514284000699
CUSTOMER RELATION FORM

THIS FORM WILL PASS THROUGH A SCANNER,PLEASE FILL IN BLOCK LETTER E.G ANITA KUMAR

Application : Commercial Vehicle Light Commercial Vehicle Construction Equipment Gold Loan Rural Housing
Tractor Finance Crop Loan Housing Finance Loan against Property Unnati
Business Loan Working Capital Personal Loans Agri Finance Credit Card

PERSONAL DETAILS BORROWER CO-BORROWER GUARANTOR * Fields are Mandatory

*Existing CRN Yes,If yes then provide the CRN no. 911593206 NO Home Branch Code

*CKYCR Create New Existing(No Change) Update Existing Local Global

local change will not be updated in central KYC Repository(CKYCR) and will only be applicable to Kotak Mahindra Bank Limited

*Name ASEET MANDAL

Name as a desired on the credit card ASEET MANDAL *DOB 9/6/1999

*Mother's Name PRAMA MANDAL Maiden Name PRAMA MANDAL

(Mention Mother's Pre-Marriage Name) (applicable to married woman,documentary proof required)

*Father / *Spouse Name *Citizenship Indian Others

(If PAN not available Father's Name Mandatory)

*Residential Status Residential Indian Foreign Nation Non Resident Indian Person of Indian Origin
*Education Non-Graduate Graduate Post-Graduate Others

*Religion Hindu Muslim Christian Sikh Zoroastrian Jain Buddhist Others

*Gender M *Marital Status Single Married Others Single

*Caste *Category General OBC SC ST

*Annual Income 0-2 lakhs > 2-5 lakhs > 5-10 lakhs > 10-25 lakhs > 25 lakhs 0
*Occupation Type Service ( Private Sector Public Sector Government Sector ) Not Categorised Business

Others ( Professional Self Employed Retired Housewife Student Salaried

Permanent/ Indian Address (Upto 90 Characters Only)

Line 1 KALINAGAR UDAY NAGAR

Line 2 .

Line 3 / Landmark RAIPUR

*City / Town / Village UDHAM SINGH NAGAR *PIN Code 263160

*State Uttarakhand *Country India Telephone No.

Residence (Upto 90 Characters Only) Same as Permanent Address

Residence Status: Owned By Self By Parents Rented With Friends With Family Years at Current Residence

Line 1 House no 1
Line 2 Kali nagar dineshpur
Line 3 / Landmark Rudrapur
*City / Town / Village RUDRAPUR *PIN Code 263153
*State Haryana *Country India Telephone No.

Office Address (Upto 90 Characters Only)

Line 1 Maruti suzuki
Line 2 Plot no 1 sector 8
Line 3 / Landmark IMT Manesar
*City / Town / Village GURGAON *PIN Code 122051
*State *Country India Telephone No.
Preferred Mobile No. 8057444208 Alternative Mobile no.
Preferred Email-Id aseetmandal337@gmail.com

*Preferred Correspondence Address Permanent Address Residence Address Office Address Residential
CUSTOMER DECLARATION

I/We hereby declare that the above information is true and correct to the best of my/our knowledge. I/We further agree that any false/misleading information given by me/us
or suppression of any material fact will result in withholding declining of the transaction by the Bank and I/we may be held liable for it. I/We hereby confirm that the
transaction made by me/us is from my / our own source of funds acquired legitimately and it is not in contravention or evasion of any applicable laws or rules in force,
enacted/issued by Statutory or Regulatory Authority from time to time. I/We, authorise the Bank to share my / our transaction details with regulatory/enforcement authorities
whenever such information is called for. I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email
address.I understand that as per directions of Government of India, my KYC information will be updated in Central KYC Registry & I hereby authorise the Bank to open my
account in the same name as registered with UIDAI for issuing Aadhar / Income Tax for issuance of PAN. I also confirm that either of the name as appearing in the above
noted two databases will supersede with name as mentioned in the Account Opening Form.

SIGNATURE / THUMB IMPRESSION & PHOTOGRAPH

DOCUMENTS COLLECTED DETAILS

Document Name ID Address Document Name ID Address

(only one id and address proof mandatory) Proof Proof (Cont.) Proof Proof
Passport Number Simplified Documents No.

Passport Expiry Date Identity card with applicant's photograph issued by

Govt. Dept.
Voter ID Card Letter issued by a Gazetted Officer NA
PAN FUMPM5464D NA Simplified Documents (Address Proof)
Utility Bill
Driving License
Property or Municipal Tax Receipt
Bank account statement / Passbook NA
Driving License Expiry Date
Pension or family pension payment orders(PPOs)
E-UID(AADHAR)
Letter of allotment of accommodation from employer
NAREGA Job Card issued by state or Central Government departments
Others (any document notified by the Central Documents issued by Govt. Dept. of Foreign
Government) Jurisdiction / Foreign Embassy / Mission in India
Document Name:
Number:

NAME DECLARATION

I Mr. / Mrs. / Ms. , state and declare that many of my official records bear my
name as since I am also known by this name. I say that I desire to open a loan/credit card account with you under the
name and style of , although the documents submitted by me are bearing my name as .I
request you therefore to open the account with your bank on my aforesaid representation as per the form duly filled in by me and accept the documents
furnished by me in support thereof.

Signature

BANK USE

Key Verification carried out by Approved by

DD MM YYYY Emp. Code Emp. Branch

Sales Official (Sign & Code)Branch Official (Sign & Code)
Emp. Name
Employee Sign
Emp. Designation Designation Designation

Account Type Normal Simplified Small Risk Profile High Medium Low Customer Segment RA CC
CRN No. Apac No. Form No.
Other Documents Collected Form 60 Marriage Certificate

Application Form for Kotak Credit Card Kotak Mahindra bank Ltd.
 THIS FROM IS PASS THROUGH SCANNER,PLEASE FILL IN BLOCK LETTERS E.G
ASEET MANDAL
FORM NUMBER

CM90863629

I want to apply for a Kotak IOCL Credit card

Tick Box Joining Fees Annual Fees

0 0

Key Features:
Save 5%* on IndianOil (Indian Oil Corporation Ltd) Fuel spends
Save 2%** back as Reward Points on Grocery and Dining spends
Save 0.5% back as Reward Points on all other spends
Annual Fee waiver on retail spends of Rs. 50,000 in the previous anniversary year

Waiver of fees for Credit Cards linked to Programme is subject to maintaining eligibility of respective Programme.
Programme refers to Kotak Bank and Group product propositions, like Privy League Black / Privy League Platinum / Privy League Neon programme / Private
Banking / Corporate Salary programme. For details on the programme eligibility and cards offered, please visit www.kotak.com.
In case, programme eligibility is not met or if customer is degraded from higher variant programme to lower variant, customer will not be given programme linked
fee waiver and will be required to pay Joining/Annual fees.

Customer Consent

I/Customer hereby consent and authorize Kotak Mahindra Bank to make enquiries with NSDL, Credit Bureaus, Karza (for employment verification checks from EPFO), Perfios
(for Bank statement and Credit Card statement analysis and Account Aggregator),Cersai (for CKYC updation), EPFO, Bureau.id (for NSDL registered details) and conduct the
required checks using internal /external data sources and Bank’s affiliates for the purpose of credit underwriting and storage for Bank records. Further I/Customer consent to
receive calls/communications from Kotak Mahindra Bank/its representatives and confirm that the consent shall prevail over my current or any subsequent registration of my
number for NDNC and shall continue to be treated as my consent/acceptance. By clicking on the checkbox, I/Customer hereby give my consent and authorize Kotak Mahindra
Bank and its affiliates to cross – sell products and services to me.

Whatsapp Consent

I/Customer authorize Kotak Mahindra Bank to send communications and notifications to me on Whatsapp.

Aadhaar Consent

I/Customer agree to voluntarily use my Aadhar details for doing full KYC of my credit card. I/Customer agree and hereby authorize Kotak Bank to fetch my personal details from
UIDAI.I/Customer authorize KMBL to use my Aadhar details and core biometric information to authenticate and verify my identity. I/Customer hereby give my free consent to link
my Aadhar Number to all my existing bank accounts and customer profile for the purpose of availing the Banking Services for operation of account.

Current Address Declaration

Residence Address -
I/Customer confirm that I am currently residing at the address mentioned as my communication address. I/Customer have provided this address to apply for Credit Card and I
wish to receive my Credit Card on this address and to use the same as my local address for any communication purpose.
I/Customer are aware that any new phone number, mobile number, email id, address, DOB provided by an existing Customer while opting for any product of KMBL(eg–Credit Card,
Personal Loan etc.) shall be automatically updated in the records of KMBL in lieu of the phone number, mobile number, email id, address, DOB provided at the time of opening the account
or previously registered with KMBL. All further intimations / communications pertaining to the Bank Account shall also be sent by KMBL only to the new phone number, mobile number,
email id and no intimations / communications shall be sent to the phone number, mobile number, email id provided at the time of opening the Bank Account or previously registered with
KMBL.

Office Address -
I/Customer confirm that I am currently working at the office address mentioned as my communication address. I/Customer have provided this address to apply for a Credit Card
and I wish to receive my Credit Card on this address and to use the same as my local address for any communication purpose.
I/Customer are aware that any new phone number, mobile number, email id, address, DOB provided by an existing Customer while opting for any product of KMBL (eg–Credit
Card, Personal Loan etc.) shall be automatically updated in the records of KMBL in lieu of the phone number, mobile number, email id, address, DOB provided at the time of
opening the account or previously registered with KMBL. All further intimations / communications pertaining to the Bank Account shall also be sent by KMBL only to the new
phone number, mobile number, email id and no intimations / communications shall be sent to the phone number, mobile number, email id provided at the time of opening the
Bank Account or previously registered with KMBL.
 Credit Card MITC

Credit Limit is not promised by sales executive, it will be assigned as per the Bank’s risk policy. I/Customer accept the Kotak Bank Credit Card Terms and Conditions. I am
aware that I can request for physical copy of MITC at my postal address by calling the bank at 1860 266 2666.

Nationality Consent

I/Customer hereby confirm that my nationality is Indian and I am resident Indian.

E-Statement Consent

I/Customer provide my consent to register for e-statement.

Overlimit Consent

I/Customer wishes to avail over limit facility on my Kotak Credit Card. I/Customer understand that this facility allows transactions to get approved above assigned credit limit to
meet my emergency needs and it’s at Bank’s discretion. I/Customer also understand that bank will levy charges & fees, as applicable, in case of over limit utilization.
Click here to know more on fees and charges.

Director Consent

I/Customer confirm that I am not a Director of any Bank.

DOB Consent

I/Customer agree to allow Bank to update DOB as per PAN in bank records.

Applicant Signature

ABOUT ME

Name of the Company MARUTI SUZUKI INDIA LIMITED

Department Company Code (For Bank use only) 9105

Designation Engineer
Whether Director of any Bank: Yes No If yes,Name of the Bank
If Salaried: Total Work Experience Years If Self Employed: Total Duration in Business Years
Ownership: Proprietorship Partnership Pvt. Ltd. Company HUF

Type of Vehicle: Four Wheeler Two Wheeler Both None

Think Green; Save the Environment. Say no to paper statement. I consent to receive only e-statements on the email address.
Industry Section IT / Software / BPO Infrastructure / Real Estate Export / Import Trading / Retailing
Advertising / Marketing / Media / Publication Manufacturing Travel / Transport / Courier / Cargo Freelancer / Consultancy
Verification / Collection / DSA / DST HR / Security Services Legal Services Spare Parts / Accessories
Government / PSU / NGO Banking / Finance Medical / Healthcare Professional Services
Others (Please specify)

MY BANK DETAILS

MAIN BANK DETAILS

Name of Bank

Account Number Branch

Account Type Saving Current Other (Please specify)

Customer Relationship Number

Incase you have a Kotak account

APAC ID PARTY ID

MY CREDIT CARD DETAILS

Name of the Bank

 Card Number Member Since MM YY Credit Limit

LOAN DETAILS

Loan Account Number

Issuing Bank/Branch Type of Loan MM YY

I WANT THE AUTO DEBIT FACILITY

I authorise Kotak Mahindra Bank to debit my Kotak Mahindra Bank

Account No. every month for
Minimum Amount Due Total Amount Due

I WANT AN ADD-ON CARD

Name of the Add-On Card Application

CRN of the Add-On Card Application (If has a Kotak Account)

Name as desired on the Card ( Max 19 Characters ):

Date Of Birth Gender Male Female

Relationship with Primary Card Holder : Spouse Parent Brother/Sister (above 18y of age) Child (above 18y of age)

I would like to restrict the spending limit on the Add-On Card to: Rs. 10,000 Rs. 20,000 Same as my primary card

Contact details of Add-On Card Holder

Residence No.. STD. Code: Tel. No.

Mobile Number

APAC ID PARTY ID

Email ID

I aceept that the use of the Add-On Card is governed by the acceptance of the card number aggrement.
I accept the complementary Add-On Card.

Primary Applicant Signature

OVER-LIMIT CHARGES

Accepted

I wish to avail over limit facility on my Kotak Credit Card. I understand that this facility allows transactions to get approved above assigned credit limit, to meet my emergency needs and it’s at Bank’s discretion. I
also understand that bank will levy charges & fees, as applicable, in case of over limit utilization. Click here to know more on fees and charges https://www.kotak.com/en/personal-banking/cards/credit-
cards/mitc-and-ca.html

Applicant Signature

ONEASSIST PROGRAM

Your wallet is protected 24x7,

whether you lose it or not!

One call from anywhere in the world

Block all lost Bank Cards
Emergency travel and hotel assistance
Fraud protection
Block lost SIM card
Docusafe: Free online storage for your
documents

I hereby authorize Kotak Credit Cards to debit the amount indicated below:

PRICES*

Annual

Please tick the appropriate plan

* The above prices are inclusive of Government taxes
(including service tax, GST, any/all applicable taxes from time to time)

Applicant Signature

Yes, I hereby agree and accept to purchase the OneAssist Program on my Kotak Credit Card. I hereby agree that the above declaration shall be the basis on my
admission to OneAssist Program on approval of my Kotak credit card application and if found untrue or is misleading or any material information is withheld here form,
no claim under this coverage will be payable by OneAssist Consumer Solutions Pvt Ltd. I authorize OneAssist Consumer Solutions Pvt. Ltd.(OneAssist) and Kotak
Mahindra Bank Ltd.(KMBL) to charge the amount indicated above and subsequent annual payments when due to my Kotak Credit Card at the prevailing rate, until this
authorization is revoked or withdrawn by me in recorded line to OneAssist. I authorize KMBL to disclose, from time to time, any information relating to my card(s) as
KMBL may deem fit and proper to OneAssist for the purpose of issuance and administration of the OneAssist Program membership. I also authorize OneAssist/ KMBL
to contact me over riding my NDNC registry. I understand that the OneAssist Program is a product from OneAssist Consumer Solutions Private Ltd. and KMBL does not
endorse the offer, nor is it liable for any loss, claim or damage arising out of usage of the product.

CARD PROTECTION PROGRAM

Protect more than just your cards-your peace of mind!

One free call to block all cards

24 hours helpline
Emergency travel and hotel assistance
Fraud protection
PAN Card Replacement
SIM Card Blocking

I hereby authorize Kotak Credit Cards to debit the amount indicated below:

PRICES*

Annual

Please tick the appropriate plan

*The above prices are inclusive of Government taxes
(including service tax, GST, any/all applicable taxes from time to time)
 Applicant Signature

Yes, I hereby agree and accept to purchase the Card Protection Program on my Kotak Credit Card. I hereby agree that the above declaration shall be the basis on my
admission to Card Protection Program membership on approval of my Kotak credit card application and if found untrue or is misleading or any material information is
withheld here form, no claim under this coverage will be payable by CPP Assistance Services Private Limited (CPP). I authorize CPP and Kotak Mahindra Bank Ltd.
(KMBL) to charge the amount indicated above to my Kotak Credit Card and subsequent annual payments when due at the prevailing rate until this authorization is
revoked or withdrawn by me in recorded line to CPP. I authorize KMBL to disclose, from time to time, any information relating to my card(s) as KMBL may deem fit and
proper to CPP for the purpose of issuance and administration of the Card Protection Program membership. I also authorize CPP/KMBL to contact me over riding my
NDNC registry. I understand that the Card Protection Program is a product from CPP and KMBL does not endorse the offer, nor is it liable for any loss, claim or
damage arising out of usage of the product.

SIGN UP & DECLARATION

I hereby declare that the particulars contained herein above are complete, true and correct to the best of my knowledge and Kotak Mahindra Bank Ltd.
("Bank") is entitled to verify the same directly or through any third-party agency. I authorise the Bank and its affiliates to use information from this
application for administrative purpose. I confirm that I am a resident of India. I hereby give my consent to the bank for obtaining my KYC details from
CERSAI CKYC portal and to receive information from Central KYC Registry through SMS/ Email on the above number/ email address. I further understand
that the Bank may at its sole discretion accept or reject either one or both cards applied for by me in this application. The Bank would convey in writing
the reason for rejection. I further agree to be fully liable and authorise the Bank to debit My Kotak Mahindra Bank Credit Card account(s) for all spends,
fees and other charges, interest, etc. on my Card(s) Government taxes (including service tax,GST,any/all applicable taxes from time to time) and
surcharge at applicable rates will be charged on all fees, charges, interest, etc. and I agree to pay the same. I have also read and understood the
contents of the Schedule of Charges and disclosure details, and agree to various charges mentioned in the Cardholders Agreement as may be
supplemented or amended from time to time. In case, I have applied for an Add-On Card(s) I will be billed separately for the Add-On Card in the
respective monthly statement(s). I will be liable for all charges incurred on the Add-On Card. I undertake to notify the Bank immediately of any change in
the above details and information given by me. I agree that my signature on the charge slip will amount to an unconditional undertaking by me to pay
Kotak Bank the amount stated in the charge slip and agree that a copy of my periodic statement of accounts will be a conclusive evidence of my liability
for the charges stated in the charge slip. My liability under the charge slip signed by me shall not withstand any dispute I may have with respect to the
quality/quantity of goods purchased or quality of services obtained. I will not hold the bank responsible if any outlet/franchisee refuses to accept the card. I hereby declare that I have
read the Terms and Conditions for the Bank's Credit Card and I agree that I will be bound by these Terms and Conditions including those excluding/limiting the Bank's liability.I have
read the Cardholders Agreement (including MITC) and I understand that it is available for reference in English and other regional languages on Kotak Bank website. I further agree
and understand that all documents given to the Bank in connection with this application including, but not limited to photo copies of original documents, signatures verification, address
verification and bank details shall become the property of the Bank and shall not be returned to me. I hereby confirm that I have read & understood the terms and conditions governing
the entire business relationship with the Bank and relating to various services including but not limited to Card holder Agreement, ATMs,Phone Banking, Home Banking, Net Banking
and Bill Payment. I understand that the Bank may at its absolute discretion, discontinue or modify any of these services completely or partially and prior notice to this effect would be
communicated to me. I authorise the Bank, its group companies and their agents to exchange or share all the information relating to me and my repayment history with banks, financial
institutions, credit bureaus, agencies, statutory bodies etc. as may be required or as they deem fit. I confirm that I have no insolvency proceedings pending against me nor have I ever
been adjudicated insolvent. I understand that at the time of card delivery, Domestic POS and ATM transactions will be enabled on the card. In case both Domestic and International
transactions are enabled on my card, I understand that the entire credit limit on the card will be available for these transactions. The said credit limit will also be applicable on the Add-
On card, subject to the spending limit as agreed by the primary applicant if any. I also understand that I can set/modify my transaction limits through online channels.

Date

Name

I understand that at the time of card delivery, Domestic POS and ATM transactions will be enabled on the card. In case both Domestic and International transactions are enabled on my card,
I understand that the entire credit limit on the card will be available for these transactions. The said credit limit will also be applicable on the Add-On card, subject to the spending limit as
agreed by the primary applicant if any. I also understand that I can set/modify my transaction limits through online channels.

Applicant Signature

FOR BANK USE

Promo Code: Fee Code:

PA06 187
Channel Code Source Code

CSM Code : Card Sales Executive:

Referrer's Emplopyee Code Other Card Saled Executive:

Employee Group Code: Cross Sell Tracker:

Employee Code: Cross Sell Reference No:

Branch Code

INDICATIVE LIST OF DOCUMENTS THAT CAN BE PROVIDED WHILE APPLYING FOR CREDIT CARD

Identity Proof:
• Passport • Driving Licence • PAN Card • Valid Photo Credit/Debit Card issued by Banks ­ Only if the Photo and signature are imprinted on the front of the Card
• Voter's ID card Identity document issued by government and/or Statutory/Regulatory body if photo included) Bank passbook Active accounts) with photograph
only of scheduled commercial banks only along with the bank seal/stamp and signature of the bank official. (Updated not more than 3 months old) Aadhar
Card

Signature Proof:
• Passport • Driving Licence • PAN Card Valid Photo Credit/Debit Card issued by Banks ­ Only if the Photo and signature are imprinted on the front of the Card
Identity document issued by government and/or Statutory/Regulatory body (if signature included)

Residence Proof:
• Passport • Driving Licence Voter's ID card • PAN intimation Letter • Ration Card • Identity document issued by government and/or Statutory/Regulatory body (if
address included) • Utility Bill (Elec./Tele./Mobile/Piped Gas/Water bill/Broadband bill not more than 3 months old for bank account). Original and photocopy
statements allowed. E­statements should be PDF printouts. • Credit Card Statement not more than 2 months old. F­statement should be PDP printouts. •
Registered Leave & license agreement (For tenants) ­ Letter from Housing Society (Only for owners) with latest 2 moths Maintenance Bill • Sale deed • Bank
Statement (Active Account) - signed & stamped o with logo/printed by Bank and not more than 2 months old. F-statements should be PDF printout with logo of
the bank. Bank passbook (Active accounts) of schedule commercial banks only along with the bank seal/stamp and signature of the bank official. (Updated not
more than 3 months old) Gas Connection Copy (Front Page of the booklet signed of by a PSU Official) with computerized gas bill not more than 3 months 3
old/photocopy of gas connections copy showing cylinder purchases not more than 3 months old Aadhar Card
 Check your application status:

VISIT www.kotak.com | SMS CCAPP < space > application reference number> to 5676788

FORM NUMBER

CM90863629

FORM NUMBER
CM90863629

I, the undersigned have applied for a Kotak Credit Card from Kotak Mahindra Bank Limited (hereinafter referred to as the "Bank") and in connection with my
Application, have submitted various documents and information to the Bank. am aware that the Bank and its group companies / associates offer various other
products and services and I would like to be informed about the various products services offered by the Bank and its group companies / associates. For this purpose,
the Bank may need to share my documents / information l across group companies / associates.

I hereby expressly authorise the Bank to exchange, share, disclose, or use in any manner whatsoever, any and or all information / document provided by me to the
Bank with its group companies! associates and to make telephone calls and! or send SMS's and / or emails and / or use any other form of communication to offer and
or market and or sell to me any of the products or services or any enhancements / upgradation/ revisions thereof offered from time to time, by the Bank or its group
companies / associates.

Applicant Signature

KOTAK MAHINDRA BANK LIMITED