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    Application Form For Debit Card: Details of Primary Account Number

    Uploaded by

    ÑiTish Patel
    This document is an application form for a debit card. It collects the applicant's personal information like name, date of birth, address, contact details, and account details. It also collects nomination details if the applicant wants to nominate someone. The applicant declares that they have read and accepted the terms and conditions for using the debit card. The form is then signed by the applicant. The last section is for branch use only, where they will verify the applicant's details and issue the debit card if found eligible.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form For Debit Card: Details of Primary Account Number

    Uploaded by

    ÑiTish Patel
    126 views2 pages
    This document is an application form for a debit card. It collects the applicant's personal information like name, date of birth, address, contact details, and account details. It also collects nomination details if the applicant wants to nominate someone. The applicant declares that they have read and accepted the terms and conditions for using the debit card. The form is then signed by the applicant. The last section is for branch use only, where they will verify the applicant's details and issue the debit card if found eligible.

    Original Description:

    Demo

    Original Title

    Application Debit Card

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    This document is an application form for a debit card. It collects the applicant's personal information like name, date of birth, address, contact details, and account details. It also collects nomination details if the applicant wants to nominate someone. The applicant declares that they have read and accepted the terms and conditions for using the debit card. The form is then signed by the applicant. The last section is for branch use only, where they will verify the applicant's details and issue the debit card if found eligible.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    126 views2 pages

    Application Form For Debit Card: Details of Primary Account Number

    Uploaded by

    ÑiTish Patel
    This document is an application form for a debit card. It collects the applicant's personal information like name, date of birth, address, contact details, and account details. It also collects nomination details if the applicant wants to nominate someone. The applicant declares that they have read and accepted the terms and conditions for using the debit card. The form is then signed by the applicant. The last section is for branch use only, where they will verify the applicant's details and issue the debit card if found eligible.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Application Form for Debit Card

    Branch Name _____________ Date of Application______________

    Name (Person to whom card is to be issued)

    Mr./Mrs./Ms _______________________________________________________________

    Date of Birth_______________________________________________________________

    Father’s/Spouse Name ______________________________________________________

    Name Desired on Debit Card__________________________________________________

    Address:

    (O) __________________________________________________________________

    ______________________________ Pin _______________________________

    Address:

    (R) __________________________________________________________________

    ______________________________ Pin ________________________________

    Tel. No. (R) _________________________ Tel. No. (O)_____________________________

    Mobile No__________________________ e-mail ID _____________________________

    Details of Primary Account Number:-

    I would like to receive my Card and PIN Mailer at (Please tick one option)

    i) Residential Address.
    ii) Office Address.
    iii) Will collect personally from the Branch

    Nomination details

    Name of the Nominee ______________________Relationeship ______________

    If nominee is minor Date of Birth______________________________________

    Name of the Guardian _______________________________________________


    DECLARATION FOR DEBIT CARD UNDERTAKING

    I/We have read and understood the Terms and Conditions governing the usage of
    Union Bank Debit Card. I/We accept to be bound by the said terms and Conditions or
    to any changes made therein from time to time by the Bank at its sole discretion
    without notice to me/us. I/We confirm that I/We are the sole account holder(s) or
    have the required mandate to operate all the accounts linked to the Debit card singly.

    I/We accept full responsibility for my/our Debit Card and agree not to make any
    claims against Union Bank of India in respect there to. I/we agree to provide any
    information from my/our account to Union Bank of India.

    Date:___________ Signature of First Applicant:________________________

    Place:__________ Signature of second Applicant:_______________________


    (In case of joint Account)
    (Debit Card is issued in joint accounts where mode of operation is either or survivor / anyone
    or survivor. It is not issued to trust accounts and accounts having credit facility)

    FOR BRANCH USE ONLY

    Address, signature of Customer and Mode of Operation of the account(s) verified in


    Finacle system. The conduct of the account during the last six months is
    satisfactory/It is a New Account. We hereby issue the Debit Card.

    Card Number : _______________________________________________________

    Signature of the Issuing / verifying Authority: __________________________________

    Name of the issuing /verifying Authority: _____________________________________

    P.A. no. / User ID __________________________

    Date: ______________

    Branch: ______________

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