APPLICATION FOR SYNDICATE BANK VISA/MAESTRO GLOBAL INSTANT/

PERSONALISED-CLASSIC/GOLD/PLATINUM/PHOTO DEBIT-cum-ATM CARD

The Head of the branch
Syndicate Bank
..Branch.

1. Please issue me/us SYND!"T# B"N$ %S"/&"#ST'( )*(B"* NST"NT/ P#'S(N"*S#D+
!*"SS! /)(*D/ P*"TN,&/PH(T( Debit+cum+"T& !ard a-ainst my SB / Staff (D "ccount Number
....ith you.
/. Please issue us SYND!"T# B"N$ %S"/&"#ST'( )*(B"* NST"NT/P#'S(N"*S#D+
!*"SS!/ )(*D/ P*"TN,&/PH(T( Debit+cum+"T& !ard to the follo.in- 0oint account holders in the
said account1
a.
b.
2. /3e undertake that /.e shall be .holly liable/res4onsible for all ty4es of transactions done on my/our
abo5e said account throu-h my/our card6s7 issued by the Bank to me/us. /3e ha5e read the rules and re-ulations
.ith re-ard to issue of Syndicate Bank %S"/&aestro )lobal Debit+cum+"T& !ard and /.e shall abide by the
same.
8. /3e hereby declare that the transactions under this/these Debit !ard6s7 shall be strictly in conformity .ith
the -uidelines under 9orei-n #:chan-e &ana-ement "ct 69#&"7 and is not desi-ned for the 4ur4ose of any
contra5ention or e5asion of the 4ro5isions of the 9#&" or any rule; re-ulation; notification; direction or order
made there under from time to time.
<. /3e further undertake that it .ill be my/our sole res4onsibility to adhere to the 4ro5isions of the 9#&" or
any rule; re-ulation; notification; direction or order made there under from time to time; .hile transactin- .ith
this/these Debit !ard6s7.
=. Please dis4atch the SYND!"T# B"N$ %S"/&"#ST'( )*(B"* NST"NT/ P#'S(N"*S#D+
!*"SS!/)(*D/P*"TN,&/PH(T( Debit+cum+"T& !ard to my/our follo.in- address.
a) "ddress for communication/dis4atch of the !ard6s7 1.
.....
b7 ,ni>ue 4ersonal identification6?7 nformation for authenticatin- the card holder1
c7 #+mail D1 .........
d7 Tele4hone No.1
e) Mobil No!"M#$%#&o'( )o' SMS #l'&*+ 1.........
OR
/3e declare that /3e do not ha5e/are .illin- to share the &obile number .ith the Bank.
Name (ccu4ation/Profession/desi-nation Si-nature ",+
a.
b.
D#&-......
",+ n case of 0oint accounts; all the 0oint holders should si-n the a44lication form.
"/+ Please .rite any uni>ue identification information; .hich .ill be useful to the Bank to identify you in case you
for-ot your "T& PN or to ser5ice any other s4ecific re>uests.
Fo' B#$01* u*-
'e>uest acce4ted and Debit !ard issue a44ro5ed. 'ele5ant 9la- in the System has been set.
nstant Debit !ard No.@@@@@@@@@@@@@@@@@@@@@ issued / Data for.arded to D!! on@@@@@@@@@@@@@@5ide
'ef No.@@@@@@@@@@@@@@@.
Si-nature of Branch Head