Fr quick processing of your application, please complete al sections in BLOCK LETTERS y/ Boxes whore appropriate and write N.A.itnot appicble
Pease fin CLEAR BLOCK Lets, whout touching boxeseg AB & use BLACK INK only “scie@ ws Recommended by
Veegpengor?” — GOLD( VISA) GOLD(MASTER) EXCLUSIVE SILVER Name BOB BCL Br. OSA _Oters
PLATINUM. [enh
Cardis /Bills tobe sentto Residence Office Ret No
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‘Your proset residential asress
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Horetnan Once ot Your Present
Have ou changed you Residence 80, intastsvears | Changed Res. is [Sef Owted Rented | Carpany Proved | others
Your permanent adress
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CAAT EON
Occxpaton Presa Sel Enpyed Serica hase We a
Nome of Organisation Employer
Your Designation: | Director Executive! Managersl_ Junior Cleveal__ hers Enpcodo
Department "Ni. of Yearsin Current Oro Months
Your present office adress
ony
Tel. STO cove) Ex,
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Aenualincore (eRe)
Income Pe Month More an 20.000 |_| More han 15000
ran Toxpuid (In Rs)
Bank name
Branch
Nawreotke | Savings Ne |curantAe | Other CBS Al No.
Type oftoan:| | HousingLoan | GarLoan | | Consumer Lean
Loan Arpount
Name of the Institution from whave Loan taken
‘ther nomen. Rs)
Current Outstanding
Spouse Income (In RS.)
ore than 10,000 Customer ID
Year Tax Pais
saress
ony
‘No.of Yrs with Bank
Business Loan |_| others (please specily)
Duration of Loan month
BranenPERE
Bank of Baroda vevit card No. Valid up to.
Incase ekeady hong other Cred Cards, Last bl Statement tobe Atached
Bank's Name card No. Valid up to Credit Limit
pole SSS SSS
DORON
TWiquld Beto apply fr Adon Cards
1 ate of ith
Spause | [Father Mother |_|Son| | Daughtar_ Occupation
2 DeteorBien OP MM | OY
Spouse | |Fathar Mother | |Son| | Daughtor Occupation
5 ate of Bien EP — MMe
‘Spouse | Father Mother | Son) Daughter Occupation
ae SRS
Name 1
dees
Pin Code
(Fe ion) PERS
Name Tel
Aross
Pin Code
N Mee
Name eatonship
Undertaking from applicant ( Mandatory )
‘The Manager
Bank of Baroda
Branch
Sit,
Re: My Bobcard Credit Card application
With regard to my credit card appication, submitted to you for consideration, hereby assure that there willbe ro default in payment agains! my Bobcard
bil
However, inthe evento defaultin making payment of Bobcard dues, you re ievocably authorized to dabit any ofmy SBICAVOther A/Cs maintained with
you egainst he demand raisedby Bobeards Ltd.
Yours faithful
x
Sign:
Name: Datecof Birth
‘AicNo.
{Incase ofoint A’, signatures ofalljointa/c holders required.)CO
rary Alcan ‘eben ‘abon2 naéons
sonar oe Prego het oe Prana
icin ‘toa ‘on! ‘co
In consideration of BOBcards Ltd/Bank of Baroda granting/reviewing facility to use the credit card, | do hereby declare and
confirm that | have personally read and understood and interpreted aim vernacular, in full, before execution of all terms &
conditions that have been received by myself. It is my responsibility to obtain the terms and conditions applying to the
Bobcards International credit card separately and read the same. | wll be bound by the terms and conditions as may be in
force from time to time. | agree to be charged the joining card fee in my first statement. In case of application for add-on(s), |
will be billed for such add-on cards in the monthly statement. | undertake that the usage of the credit card shall be strictly as
per the exchange control regulations of the Regulatory authorities as applicable from time to time which | undertake to keep
myself updated with and in any event of any failure to do so, shall be liable for action under the Foreign Exchange
Management Act 1999, orits statutory modification or re-enactment thereof. Credit limit on my card account may be reviewed
as per the bank policies specified from time to time and the bank will be entitled to cancel my application/cards/alter the credit
‘cash limil/product upgrade at any time without assigning any reasons.
| hereby authorize the Bobcard Itd/Bank of Baroda to provide information about the applicant and /or the card Account to any
office or branch of any company associated with the bank, any bank or financial credit bureau and to third parties engaged
with Boboards Ltd.
| confirm that the attached photograph is present true identity of myself and that of my additional card application, which
authorizes BOBCARD Itd to apply to our credit cards and for which is accepted full responsibility and agree to make claims
against BOBCARDS Itd, in respect thereto. And that this condition applies in addition to the terms of the card member
‘Agreement which governs the use of my card. | also confirm that | am not a defaulter of any Credit Institution/Bank and my
repayments are regular.
By signing this application, | understand that all the transactions effected through my card account, | including my successor,
legal heirs, assignees shall be lawfully responsible for making payments of the same, as per the payment schedule in force
time to time. | further understand that mere disputing the transaction shall not absolve my prime liability to defer/delay the
payment of my credit card dues and | along with my successor, legal heirs, assignees will be fully responsible for making
payments of the same, as per the payment schedule in force time to time. | further understand that mere disputing the
transaction shall not absolve my prime labiity to defer /delay the payment of my eredit card dues and | along with my
‘successors, legal heirs, assignees shall be solely liable for all the dues as may be billed to me from time to time.
| understand that Bobcard Itd/Bank of Baroda will provide the credit card as per Bank's intemal guidelines and | give my
consent for issuance of different card in case | am not applicable to the product applied for.
| agree to abide by the terms and conditions as may be amended by the bank from time to time, without giving notice to me.
The most important terms & conditions as available on the website www.bobcards.com has been read by me and | agree to
abide by them:
Pease Note :11) Pease aia he error reat dour. 2 The bark resent lo rete spar wth crore iarmatin sala He bark anahe Bark ober Ui,
agsexsmae scat ang Ts egpeor om Gos tatoos alr carbon anion peter) Tebank reo eno som ees epson WIA yea 8
ites wh vis.
Enclosed Required Documents ResideneProt:| Elscricty Telephone ll aton Card Ezcon card
Ineeme reel: Income Prool—Latast Return Form 1648 Salary sip | Latest mors Bank Siatamant
Account Type | linidval doit NOTE: Incase of int aonount, Undertaking rom applicant ito be ity sgnadby al Alc oléers)
(Copy of PAN card | _|Coleure hotegraph
aera
Prime Card No. Date of sue
‘Add-on 1 Card No,
Verified by :O Officer / C0 Executive / Ol AVP
spas eae Nos Sanctioned by : CQ EVP /O VP-1 / 01 VP-2/ 01 AVP
‘Adon 3 Card No Co Executive ' 0 PSS(For Auto Debit Fa
Sir
Re: Authority toDebit my $B \CAa‘c against my Bobcard dues.
| have applied for Boboard (Type) card |irevocably authorize Bobcards 1d. to debt my (SB/CA}_AVc no.
mmeiniginedatBank of Baroda, branch, asingicatedbelow
DTotalamountdue; O Minimumamountdue; C1 Customer Specific %
| hereby alsa confirm that am an authorized signatory ofthe above stated a & i pertains tome.
‘Wo Recommend & Verity the above signature
Bank of Baroda
Yours faithfully 7
Authorised Signatory
Name Signature No.
VERIFICATION REPORT FROM BANK OF BARODA BRANCH
BoB Branch Name : BoB Branch Code :
BoB Branch Phone No. :
Name of the Applicant
‘Account Type: Savings Alc Current A’ Fixed Deposit Loan Ac Others.
Alc, No. : ‘Avg, Gly. Bal. ;
Ieee pt, pros
‘Type For Amount
Lien Noting Date For Amount
Heo Ae Pee Set: Ast ceten secu peg a:
Address in BoB Records
Phone No. : Mobile No.
Card Type: Normal. «= VIP-_—Staff(CL/B08)-—_Limit Recommended :
Documents Verified from the Originals: Yes. No
Any Ac maintained by other Family Members: Yes No. tyes, Ac Type & No,
Conduct / Report of the Applicant with Bank Olficials
Remarks, If any
Declaration Weconfirm, 1. The details furnished above are correct, address and other particulars mentioned in the appliction are verted frorn
ourrecords.
2. The conductof te aocountis satistactory
Branch Recommendation Yes No
Information Veritied by & Date :
Sign & Seal; Branch Manager Slonture Cove
Note: Requisite information is mandatory. Incomplete details may lead to rejection of the application
For further details you are welcome to nearest Area Oifice of BOBCARDS or any branch of Bank of Baroda or visit: www.bodcards.com for any information
For any queries call at Toll Free No. 1800 225 110 or email at mkig@bobeards.com
PU TTR EG]
Fg. & Corporat fice "BARODA HOUSE’ Betind Dewan Shopping Cet. V. Road, dogesar [Murai -400 102 INDIA. Phone: 91 22 4206 8502; Fan: 91 222877 7560