APPLICATION FOR SYNDICATE BANK GLOBAL VISA OR MAESTRO
INSTANT OR PERSONALISED DEBIT CARD
The Head of the branch
Syndicate Bank
………………………………..Branch
Type of Syndicate Bank Global Debit Card required (Please tick appropriate box)
VISA INSTANT NON-PERSONALISED
VISA PERSONALISED
MAESTRO INSTANT NON-PERSONALISED
MAESTRO PERSONALISED
1. Please issue me the above mentioned SyndicateBank Global Debit Card against my SB / Staff OD Account Number…………………….…………..with you.
2. Please also issue Add-on Card to the following joint account holders in the said account:
a.
b.
I/We undertake that I/we shall be wholly liable/responsible for all types of transactions done on my/our above said account through my/our card(s) issued by the Bank to me/us. I/We have read the rules and regulations with regard to issue of Syndicate Bank VISA/Maestro Global Debit/ATM Card and I/we shall abide by the same.
I/We hereby declare that the transactions under this/these Debit Card(s) shall be strictly in conformity with the guidelines under Foreign Exchange Management Act (FEMA) and is not designed for the purpose of any contravention or evasion of the provisions of the FEMA or any rule, regulation, notification, direction or order made there under from time to time.
I/We further undertake that it will be my/our sole responsibility to adhere to the provisions of the FEMA or any rule, regulation, notification, direction or order made there under from time to time, while transacting with this/these Debit Card(s).
Please dispatch the Syndicate Bank Global PERSONALISED VISA or MAESTRO Debit Card to my/our following address.
Name Occupation/Profession/designation Signature(#)
a.
b.
c.
Date:
Address for communication/dispatch of the Card(s): …………………………………………………
[for personalised card only] ……………………………………………….……..
Telephone/Mobile No. ...……...…….………………..
e-mail ID ...……...….…………………..
Unique personal identification(*) Information for authenticating the card holder:
_______________________________________________________________________________
(#) In case of joint accounts, all the joint holders should sign the application form.
(*) Please write any unique identification information, which will be useful to the Bank to identify you in case you forgot your ATM PIN or to service any other specific request.
_______________________________________________________________________________
For Bank’s use:
Request accepted and Debit Card issue approved. Relevant Flag in the CBS System has been set.
Card issued / PIN Selection made by Customer/Data Authorised in Instant Card Software on______________.
Signature of Branch Head