Royale Credit Card Application Form

Kotak Mahindra Bank Ltd.

(For NRI Applicants only)

FORM NUMBER

NR
PERSONAL INFORMATION
Name
Gender :

Name as desired on the Card :

Male

Female

Maximum 19 characters
Date of Birth :

PAN (Mandatory) :

Aadhar ID :
The contact details
that I have given will
be updated in all
accounts held
by me with Kotak
Mahindra Bank Ltd.
(only for existing
KMBL customers)

Mothers Maiden Name :

Maximum 19 characters
Occupation :

Salaried

Self Employed Professional

Whether Director of any Bank:

Yes

No.

Self Employed Business

Retired

Other (Please Specify)

If yes, Name of the Bank

(To receive information on Email or SMS, please
give us your Email ID or Mobile No.)

Mobile No. 1:
Country Code

(I would like to get my

e-statements and
other important
communication on the
following Email ID)
Please enter a valid
email-id, only estatements would be
sent for your Kotak
NRI Credit Card

Mobile No. 2:
Country Code

Email-ID:
Annual Income / Business Turnover in Rs. Lacs:

MY CONTACT DETAILS
Present Residence Address
Address

Flat Number / Building

Street / Block

Area / Village / Taluka

Land Mark

City / District

State

Pin Code

Tel. No. (Home)

STD Code

Overseas Address
Address
Country Mandatory

Landmark

City / District

State

Pin Code

Tel. No. (Home)

In case the pin code is alphanumeric
or only alphabetic,
mention it in the Address Line 2

ISD Code

Preferred Mailing Address

Indian Residental Address

Overseas Address

I understand that the monthly statements will been mailed to me.

ADD-ON CARD DETAILS

Name of the Add-On Card Applicant
CRN of Add-On Card Applicant (incase the Add-On Card applicant has a Kotak account)
Name as desired on the Card (Maximum 19 characters):
Date of Birth
Relationship with Primary Cardmember:

Gender:
Spouse

Male

Female

Parent

I would like to restrict the spending limit on the Add-On Card to:

Brother / Sister
Rs. 10,000

Rs. 20,000

I would like to aquire the Add-On card at a one time fees of

Rs. 599
I accept that the use of the Add-On card is governed by the acceptance of the card member
agreement.
I accept to pay the appropriate fee for the Add-On card.
Service tax & education cess, would be charged as per the rates approved in the Finance Act each year
on all interest & fees and other charges levied on you Credit Card.

Photograph of the
Add On Card Applicant
to be affixed here

Child
Same as my primary card
Please note that it is
made mandatory for the
Add-On Card applicant
to submit complete KYC
documents for
theissuance of the AddOn Card.
The Add-On Card will not
be issued unless the KYC
documents received are
found to be to the
satisfaction of the Bank.

Applicant Signature

I WANT THE AUTO DEBIT FACILITY (MANDATORY)

I authorise Kotak Mahindra Bank to debit my Kotak Mahindra Bank
Account No.
Minimum Amount Due

every month for

Total Amount Due

(Please ensure your signature is the same

as the specimen signature with the Bank)

Applicant Signature

Filling up this section is

mandatory. You are
required to make the
monthly payment on the
Kotak NRI Credit Card
through Auto Debit from
your Kotak NRE / NRO
Bank Account. Please fill
up the Auto Debit section
else form will not be
processed.

SIGN UP & DECLARATION

I want the Kotak NRI Credit Card with annual fee of Rs. 1000.
(Service tax & Education Cess applicable)
I here by declare that the particulars contained herein above are complete, true and correct to the best of my knowledge and Kotak Mahindra Bank Ltd. (Bank) is
entitled to verify the same directly or through any third-party agency. I undertake to notify the Bank immediately of any change in the above details and information
given by me. I declare that I am a Non Resident Indian. I understand that the Kotak NRI Credit Card (Credit Card) will be issued on the basis of the
statements/declarations made by me in this application as well as on the supporting documents to be submitted with the application. I/We hereby undertake to intimate
you my/our return to India for permanent residence immediately on arrival. I further understand that the Bank may at its sole discretion accept or reject this application. I
further agree to be fully liable and authorise the Bank to debit my Kotak Mahindra Bank Credit Card account for all spends, fees and other charges, interest, etc. on my
Photograph to be
Card. Service tax and surcharge at applicable rates will be charged on all fees, charges, interest, etc. and I agree to pay the same. In case I have applied for an Add-On Card
affixed here
I will be billed separately for the Add-On Card in the monthly statement. I will be liable for all charges incurred on the Add-On Card. I hereby declare that I have read the
Terms and Conditions for the Banks Credit Card and I agree that I will be bound by these Terms and Conditions including those excluding/limiting the Banks liability and
relating to the Credit Card. I agree to receive my cardholder agreement in the electronic format and I understand that upon my request, printed copy of the same would
be couriered to me by the Bank. I further agree and understand that all documents given to the Bank in connection with this application including, but not limited to
photocopies of original documents, signatures verification, address verification and bank details shall become the property of the Bank and shall not be returned to me. I
state that as security for availing of the Credit Card I have opened a NRE/NRO term deposit (TD) with the Bank or I have an existing TD and I am allowing the Bank to
mark a lien on the said term deposit in Banks favour. I also agree that the TD will be auto renewed on maturity. I hereby confirm that I need to make all payments due on
the Credit Card through my NRE/NRO account or from remittances from outside India through normal banking channels. I agree and authorize the Bank to debit my
NRE/NRO Savings Account held with the Bank for the Minimum Amount Due payable or my Card Account Statement. I agree and hereby authorize the Bank to convert
such remittances to the Indian Rupee equivalent thereof at the then prevailing exchange rate as notified by the RBI from time to time. I hereby confirm that I have read and understood the terms and
conditions governing the entire business relationship with the Bank and relating to variour services including but not limited to Cardholder Agreement, ATMS, Phone Banking, Home Banking, Net
Banking and Bill Payment. I understand that the Bank may at its absolute discretion, discontinue or modify any of these services completely or partially without any prior notice to me. I state that the TD is
subject to the terms and conditions and rules for accounts and service of the Bank. I also understand that the renewal of my Credit Card is subject to the renewal of underlying TD. The validity of the Credit
Card is subject to the validity of underlying TD and premature closure of the TD will automatically result in cancellation of the Credit Card. I also understand that if I fail to pay at least the Minimum
Amount Due on my Credit Card within 90 days from the Card Account statement or if I wish to withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by
me or the Bank, the Bank shall have the unfettered right to liquidate the entire TD amount without prior notice or reference to me and to appropriate and set off from the TD amount, the outstanding
amount payable by me to the Bank against the Credit Card and only the balance amount post deduction shall be refunded.

Please use my existing deposit no.:

I wish to open new term deposit for this purpose

on the said term deposit in Bank's favour.

I allow the Bank to mark a lien of Rs.

Date:

Primary Applicant Signature

Declaration (in case of jointly held Term Deposits)

I /We state that I/We are joint holder/s of the NRE/NRO/term deposit (TD) with Kotak Mahindra Bank Ltd. along with the above named Applicant of the Kotak NRI Credit Card. I/We state that we have read
and undeerstood the terms relating to the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant. I/We hereby authorize the Bank to mark a lien on the
TD in Banks favour as security for the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant from the Bank. I/We state that the TD will be auto renewed
on maturity. I/We state that I/We understand that if the Applicant fails to pay the amount outstanding on the said Credit Card/Add-On Card within 90 days from the Card Account statement or if I/We wish to
withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by the Applicant or the Bank, the Bank shall have the unfettered right to liquidate the entire TD
amount without prior notice or reference to me/us and to appropriate and set off from the TD, the outstanding amount payable by the Applicant to the Bank against the said Credit Card and any Add-On
Card issued by the Bank and only the balance amount post deduction shall be refunded to me/us. I/We allow the Bank to mark a lien on my/our term deposit No. _____________________ in the Banks favour.

1st Jointholder's Signature

2nd Jointholder's Signature

I want to apply for Credit Card with Domestic Usage only

3rd Jointholder's Signature

Domestic & International Usage

I agree that if I have selected the Credit Card with Domestic & International usage, the entire credit limit on the
card will available for both Domestic and International Transactions. The said credit limit will also be applicable to
the Add-On card, subject to the spending limit as agreed by the Primary Applicant if any.
Please note that you can change the credit limit for International usage on the card and the Add-On card
(if any) once the card is issued by calling the customer contact centre of the Bank.

FOR BRANCH USE

CRN:

TD Number:

Type of TD:

Individual

Tenure of TD:

Joint

days

TD End Date:
Lien Amount:

TD Amount:
Lien Marked

TD Start Date:

Lien Revocation Authority Marked

Employee ID (Branch Official):

SR Number

Branch Official Signature

FOR BANK USE

Channel Code:

Source Code:

Card Sales Exclusive:

Promo Code:

CSM Code:

Fee Code:

Other Credit Sale Exclusive:

Cross-Sell Telecaller:

Cross-Sell Reference No.

Employee Code:

Branch Code:

TD Promo Code:

T D C C 0 9

Applicant Signature

CUSTOMER CHECKLIST
Sr. No.
1.

Signature Checklist

Check Box

Primary Applicant Signature 1 - Annual Fee of Rs. 1,000 p.a.

2.

Primary Applicant Signature 2 - Add-on Card Fee of Rs. 599 (if applied)

3.

Primary Applicant Signature 3 - Auto Debit Section - Total Amount Due / Minimum Amount Due

4.

Primary Applicant Signature 4 - Sign up and Declaration (Two places)

5.

Primary Applicant Signature 5 - Sign up and Declaration (in case of Joint TD)

6.

Photograph of the applicant at the top left of the application form needs to be affixed

Sr. No.
1.

Personal Information Checklist of Information Registered with the Bank

Check Box

Applicant - Name, Middle Name, Last Name

2.

Applicant - Name as desired on the card

3.

Applicant - Date of Birth

4.

Applicant - PAN number or Form 60 (Mandatory)

5.

Applicant - Mothers Maiden Name

6.

Applicant - Mobile Number (Mandatory)

7.

Applicant - ISD / Area Code should be mentioned, before the mobile number

8.

Applicant - Email ID (all statements sent will be e-statements) (Mandatory)

9.

Applicant - Tick the relevant option for Occupation as applicable

10.

Applicant - Annual Income / Business Turnover in Rs. Lacs

11.

Applicant - Preferred Mailing Address

12.

Applicant - If pin code in the overseas address is alpha-numeric or only alphabetic, then mention it in the Address Line 2.

13.

Applicant - Country name should be mentioned in the Address line 3 (Mandatory)

14.

Add-on Card Applicant - CRN number of the add-on card applicant should be mentioned in the add-on card details,
if the add-on card holder has an existing relationship with the Bank. In case the add-on card applicant does not
have a relationship with the Bank, KYC will be required

15.

Applicant - NRE/NRO Account Number for Auto Debit (Mandatory)

SIGN UP & DECLARATION (To be retained by the applicant)

I want the Kotak NRI Credit Card with annual fee of Rs. 1000.
(Service tax & Education Cess applicable)
I hereby declare that the particulars contained herein above are complete, true and correct to the best of my knowledge and Kotak Mahindra Bank Ltd. ("Bank") is entitled to verify the
same directly or through any third party agency. I undertake to notify the Bank immediately of any change in the above details and information given by me. I declare that I am a Non
Resident Indian. I understand that the Kotak NRI Credit Card ("Credit Card") will be issued on the basis of the statements/declarations made by me in this application as well as on the
supporting documents to be submitted with the application. I/We hereby undertake to intimate you my/our return to India for permanent residence immediately on arrival. I further
understand that the Bank may at its sole discretion accept or reject this application. I further agree to be fully liable and authorise the Bank to debit my Kotak Mahindra Bank Credit
Card account for all spends, fees and other charges, interest, etc. on my Card. Service tax and surcharge at applicable rates will be charged on all fees, charges, interest, etc. and I agree to
pay the same. In case I have applied for an Add-On Card I will be billed separately for the Add-On Card in the monthly statement. I will be liable for all charges incurred on the Add-On
Card. I hereby declare that I have read the Terms and Conditions for the Bank's Credit Card and I agree that I will be bound by these Terms and Conditions including those
excluding/limiting the Bank's liability and relating to the Credit Card. I agree to receive my cardholder agreement in the electronic format and I understand that upon my request,
Photograph to be
printed copy of the same would be couriered to me by the Bank. I further agree and understand that all documents given to the Bank in connection with this application including, but
affixed here
not limited to photocopies of original documents, signatures verification, address verification and bank details shall become the property of the Bank and shall not be returned to me. I
state that as security for availing of the Credit Card I have opened a NRE / NRO term deposit ("TD") with the Bank or I have an existing TD and I am allowing the Bank to mark a lien on the
said term deposit in Bank's favour. I also agree that the TD will be auto renewed on maturity. I hereby confirm that I need to make all payments due on the Credit Card through my NRE /
NRO account or from remittances from outside India through normal banking channels. I agree and authorize the Bank to debit my NRE/NRO Savings Account held with the Bank for
the Minimum Amount Due payable on my Card Account Statement. I agree and hereby authorize the Bank to convert such remittances to the Indian Rupee equivalent thereof at the
then prevailing exchange rate as notified by the RBI from time to time. I hereby confirm that I have read and understood the terms and conditions governing the entire business
relationship with the Bank and relating to various services including but not limited to Cardholder Agreement, ATMs, Phone Banking, Home Banking, Net Banking and Bill Payment. I
understand that the Bank may at its absolute discretion, discontinue or modify any of these services completely or partially without any prior notice to me. I state that the TD is subject to
the terms and conditions and rules for accounts and service of the Bank. I also understand that the renewal of my Credit Card is subject to the renewal of underlying TD. The validity of
the Credit Card is subject to the validity of underlying TD and premature closure of the TD will automatically result in cancellation of the Credit Card. I also understand that if I fail to pay at least the Minimum Amount Due
on my Credit Card within 90 days from the Card Account statement or if I wish to withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by me or the Bank, the Bank shall
have the unfettered right to liquidate the entire TD amount without prior notice or reference to me and to appropriate and set off from the TD amount, the outstanding amount payable by me to the Bank against the
Credit Card and only the balance amount post deduction shall be refunded.

I wish to open new term deposit for this purpose

I allow the Bank to mark a lien of Rs.

Please use my existing deposit no.:

on the said term deposit in Bank's favour.

Date:
Declaration (in case of jointly held Term Deposits)

Primary Applicant Signature

I / We state that I / We are joint holder/s of the NRE / NRO / term deposit ("TD") with Kotak Mahindra Bank Ltd. along with the above named Applicant of the Kotak NRI Credit Card. I / We state that we have
read and understood the terms relating to the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant. I / We hereby authorize the Bank to mark a lien on the
TD in Bank's favour as security for the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant from the Bank. I / We state that the TD will be auto renewed on
maturity. I / We state that I / we understand that if the Applicant fails to pay the amount outstanding on the said Credit Card / Add-On Card within 90 days from the Card Account statement or if I / We wish to
withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by the Applicant or the Bank, the Bank shall have the unfettered right to liquidate the entire TD
amount without prior notice or reference to me / us and to appropriate and set off from the TD, the outstanding amount payable by the Applicant to the Bank against the said Credit Card and any Add-On
Card issued by the Bank and only the balance amount post deduction shall be refunded to me/us. I / We allow the Bank to mark a lien on my / our term deposit No._____________________ in the Banks favour.

1st Jointholder's Signature

2nd Jointholder's Signature

3rd Jointholder's Signature

RM CHECKLIST
Sr. No.

All Fields are Mandatory to be filled

Check Box

1.

RM Signature - RM should sign in the 'For Branch Use' Section

2.

Stamp - RM should put a stamp in the 'For Branch Use' Section

3.

CRN - The CRN of the customer should be entered in the 'For Branch Use' Section

4.

TD number - The correct TD number on which the lien has to be marked should be entered in the TD number space

5.

Type of TD - 'For Branch Use' Section

6.

TD Start Date - 'For Branch Use' Section

7.

Tenure of TD - 'For Branch Use' Section

8.

TD End Date - 'For Branch Use' Section

9.

TD Amount - The total amount for which TD is booked in the 'For Branch Use' Section

10.

Lien Amount - The amount for which the customer has asked to mark a lien on in the 'For Branch Use' Section

11.

SR Number - SR number should be mentioned in the 'For Branch Use' Section for marking a lien on Term Deposit in
case of existing Term Deposit

12.

Channel Code - LRBN is the channel code that should be entered in the 'For Bank Use' Section

13.

Source Code - Input the source code as shared with the team in the 'For Bank Use' Section

14.

Promo Code - AQNR is the promo code which should be entered in the 'For Bank Use' Section

15.

Fee Code - 270 should be entered in the 'For Bank Use' Section

16.

CSM Code -

17.

If the preferred mailing address of the customer is an Indian Residential Address, then the CSM code will be INDI

If the preferred mailing address of the customer is an Overseas Address, then the CSM code will be INTL

DSE Code - DSE code should be entered in the 'Other Cards Sales Executive Column' in the 'For Bank Use' Section

18.

Employee Code - To be entered in the 'For Bank Use' Section

19.

Copy of sign up and declaration to be handed over to the customer

Signature of the RM

2X REWARDS ON INTERNATIONAL SPENDS

Earn 2X rewards on international spends; i.e. earn 2
rewards points for every Rs. 200 spent internationally
Earn 1X reward for every Rs. 200 spent within India
1 Reward point = Re 1

CHOICE ON REWARDS
Accumulate your reward points and redeem it online at
www.kotak.com against a host of redemption options like
movie tickets, air tickets, air miles, cash and more.
Instead of redeeming your reward points online you can
also choose to activate the auto redemption feature by
calling the Customer Care Centre - 1800 102 6022. In the
auto redemption feature your accumulated reward points
will get automatically encashed for cash @ Re. 1/ reward
point to your statement every 3 months.

ATTRACTIVE EMI OPTIONS

Call us to convert any transaction above Rs. 3000 into an
EMI. For more details, please visit www.kotak.com
Service Tax and education Cess would be charged as per
statutory regulations on the interest and fees and other
charges charged on your Credit Card.

FREEDOM TO PURCHASE AND PAY IN INR

When travelling to India, save the mark up fee charged
on your credit card issued outside India or the hassles of
currency exchange.
Enjoy the benefit of paying for your purchases, travel and
dining in Indian rupees.

FUEL SURCHARGE WAIVER

While travelling in India enjoy 2.5% fuel surcharge waiver
across all petrol pumps. Applicable on all transactions done
between ` 500 and ` 3000 Maximum fuel surcharge waiver
allowed in a calendar year is ` 3500.

VISIT www.kotak.com EMAIL Contact Us section on website

Call 24x7 on our Toll free number 1800 102 6022

CROSS-SELL CONSENT FORM

NR
I, the undersigned have applied for a Kotak Credit Card from Kotak
Mahindra Bank Limited (hereinafter referred to as the Bank) and in
connection with my Application, I have submitted various documents
and information to the Bank. I am aware that the Bank and its group
companies / associates offer various other products and services and I
would like to be informed about the various products / services offered
by the Bank and its group companies / associates. For this purpose, the
Bank may need to share my documents / information across group
companies / associates.
I hereby expressly authorise the Bank to exchange, share, disclose, or use
in any manner whatsoever, any and / or all information / document
provided by me to the Bank with its group companies / associates and to
make telephone calls and / or send SMSs and / or emails and / or use any
other form of communication to offer and / or market and / or sell to me
any of the products or services or any enhancements / upgradation /
revisions thereof offered from time to time, by the Bank or its group
companies / associates.