State Bank of Travancore

.. Branch
ATM CUM DEBIT CARD APPLICATION FORM State Bank CASH PLUS
Thank you for applying for the State Bank ATM Card. To help us process your request quickly please fill this
form as per the instructions overleaf if you have any questions, please check with your Branch Manager. e
are committed to making your life simpler with the State Bank ATM CA!".
New Renewal Replacement Application No:
Name
Name as you would like it on the card (max. 25 Letters (includin spaces!
Address "or
correspondence
#own $ %ity
&tate 'in
#elephone 2
nd
#elephone$(o)ile
(y desinated account$s on which * re+uire A#( ser,ices
'rimary Account
&a,ins %urrent -,erdra"t .%% (ale /emale

&a,ins A$% No. -,erdra"t A$% No.
%urrent A$% No . % % A$% No.
01%LARA#*-N: * am aware o" the #erms and %onditions o,ernin the use o" the A#( %ard and aree to
a)ide )y them.
#he )ank may call me at my residence $ o""ice in connection with my A#( transactions.
Remarks2222222222222222222222222222 Applicant3s &inature22222222222222222222222222
. 2222222222222222222222222222 22222222222222222222222222
'lace:
0ate:
IMPORTANT INSTRUCTIONS
'lease "ill the entire "orm in %A'*#AL L1##1R& only
Lea,e one )ox space )etween each word.
0o not write outside the pro,ided )oxes
%omplete all sections.
&in the declaration.
*" 4oint A$c please "ill another application "orm.
5oint A$% to )e either or sur,i,or $ anyone or sur,i,or.
1nsure the application is attested )y your Branch (anaer.
Applica)le Annual &er,ice %hares will )e chared on A#( %ards
FOR SBT Use
New Renewal Replacement 0ate
A#( Branch %ode
Branch (anaer3s
&inature 6 Branch &tamp
%ustomer $ Link Branch %ode
*ssue %ard 7es $ No
0aily Limit Rs.
-ld A#( %ard No.
New A#( %ard No.
-ld A#( card to )e mentioned "or a replacement or renewal o" the card