Add - on Card (s) Application Form Cum MID
Version 1.16
If you are an existing Cardmember, please tick whichever is applicable
Appl. No.:
CUG Business
Platinum
Times Titanium
Card
JetPrivilege
Teacher's
Platinum
Times Platinum
Card
JetPrivilege
Solitaire
Diners Club
Rewardz
JetPrivilege
MoneyBack
Diners Club
Premium
JetPrivilege
Business
MoneyBack
Diners Club
Black
ALLMILES
Infinia
Doctor's Superia
Regalia
Snapdeal
HDFC Bank Card
Regalia First
HDFC Bank
World
Credit Card Number
HDFC Bank
Titanium
HDFC Bank
Diners Club
HDFC Bank
Platinum
Business Regalia
Doctor's Regalia
CUST ID
Diners ClubMiles
Name of the Primary Cardmember:
First name Middle name Last name
Primary Mobile No.
Please leave one box space between names and surname
Add-on applicant not holding a HDFC Bank account & staying with Primary cardholder will be required to submit valid photo ID, Pan Card or Form 60 with Address proof.
If Add-on applicant does not hold HDFC Bank a/c and is a sibling of primary applicant then valid photo ID, Pan Card or Form 60 & Address proof will be required.
Please refer to the List of Acceptable valid photo ID & address proof for Add on in the next Page.
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.
Date : ............................................................
By Signing here, I certify that I have read and agree to all applicable Terms & Conditions.
Primary Cardmember’s Signature ........................................................................................................................