Please leave one box space between names and surname
Name of the Primary Cardmember:
First name Middle name Last name
If you are an existing Cardmember, please tick whichever is applicable
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 fully responsible and liable for all transactions and charges incurred on the Add-on Card(s).
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.
By Signing here, I certify that I have read and agree to all applicable Terms & Conditions.
Primary Cardmember’s Signature ........................................................................................................................
Date : ............................................................
Add - on Card (s) Application Form Cum MID
Version 1.17
Credit Card Number CUST ID
Infinia
Primary Mobile No.
Regalia
Regalia First
Milennia
Moneyback +
Moneyback
Freedom
Freedom Titanium Card
Other Cards _____________________________________________________________
Moneyback
InterMiles
HDFC Bank Platinum
InterMiles
HDFC Bank Signature
IndianOil
HDFC Bank Credit Card
Business Regalia
Business Moneyback
Diners Club Black
Diners Club Privilege
DECLARATION
TG
TG
TG
(Copy to be attached)
Mandatorily
(Copy to be attached)
Mandatorily
(Copy to be attached)
Mandatorily
Tata Neu Infinity
Tata Neu Plus
Regalia Gold
Name of TSE : ________________________________________________________
TSE Code : __________________________________________________________
Name of Doc-Ex : _____________________________________________________
Doc-Ex Code : ________________________________________________________
Channel : ____________________________________________________________
Source Code / Activity : _________________________________________________
Team Supervisor’s Code : _______________________________________________
Signature of Team Supervisor : ___________________________________________
PB/RM
BRANCH CODE :
BDR Code / LC Code :
(Mandatory Field) :
__________________________________________________
City : _______________________________________________________________
Acceptable KYC list are:
Aadhaar Card (front & back copy, mask the first 8 digits) OR
E-Aadhaar (download within last 180 days, mask first 8 digits)
Driving Licence(front & back copy)
Passport (1st page & last page with address)
Voters ID Card (front & back copy)
Job card issued by NREGA duly signed by an officer of the STATE
Government
Letter issued by National Population Register containing name and
address
Photo copy of overseas Citizen of India (OCI) card mentioning the
overseas address (For NRI Customers Only)
Documents issued by Govt of Foreign Jurisdiction - OCI/PIO Card, Work
Resident Permit/ Social Security Card/Green Card etc ( Only for Foreign
Citizen holding PIO/ OCI card)
1.
2.
3.
4.
5.
6.
7.
8.
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)
Pan copy (Copy to be attached) Mandatorily
9.
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: ____________
Application for Add-on Card using Aadhaar /e-Aadhaar/
e-KYC for Customers not opting for DBT
Date of Expiry (DD MM YYYY)
Date of Expiry (DD MM YYYY)
Aadhaar Card
Address
Line 1*
Line 2
Line 3
District*
City / Town / Village*
Pin / Post Code* State/ U.T Code*
Card No
CKYC ID
ADDON Customer ID any
Please provide only Addon customer information.
Separate form to be used for each individual addon request*
Addon Signature
Feb’22
