Add - on Card (s) Application Form Cum MID

Version 1.15

Appl. No.:

If you are an existing Cardmember, please tick whichever is applicable

CUG Business
Platinum
Times Titanium
Card
JetPrivilege
HDFC Bank
World

Teacher's
Platinum
Times Platinum
Card
JetPrivilege
HDFC Bank
Titanium

Solitaire

MoneyBack

Diners Club
Rewardz
JetPrivilege
HDFC Bank
Diners Club

Diners Club
Premium
JetPrivilege
HDFC Bank
Platinum

Business
MoneyBack
Diners Club
Black
Business Regalia

Credit Card Number

Name of the Primary Cardmember:

ALLMILES

Doctor's Superia

Snapdeal
HDFC Bank Card

Infinia

Regalia

Regalia First

Doctor's Regalia

CUST ID
First name

Middle name

Last name

Please leave one box space between names and surname

Primary Mobile No.

Add-on applicant not holding a HDFC Bank account & staying with Primary cardholder will be required to submit valid photo ID, Pan Card or Form 60 with Address proof.
If Add-on applicant does not hold HDFC Bank a/c and is a sibling of primary applicant then valid photo ID, Pan Card or Form 60 & Address proof will be required.
Please refer to the List of Acceptable valid photo ID & address proof for Add on in the next Page.

I hereby acknowledge the request made for Add-on Card and warrant that the above information is correct and hereby request and authorise that an Account be opened and Card(s) be
issued as indicated herein and renewed and replaced until I give notice to cease, and in connection herewith authorise the exchange and transfer of credit information from / with my Bank
or any other source. I understand that HDFC Bank Ltd., reserves the right decline the application without giving any reason whatsoever. The additional applicant (s) and I agree to be
bound by the terms and conditions of The Cardmember Agreement earlier executed by me. I declare and undertake that the Cards issued to me, if used overseas shall be utilised strictly in
accordance with the relevant exchange control regulations issued and as amended by the Reserve Bank of India (RBI) from time to time. In the event I exceed my entitlemants as per the
exchange control guidelines of RBI, I undertake to bring the same immediately to the notice of HDFC Bank Ltd., in writing. And in the event of any failure to comply with the prevailing
exchange control guidelines issued by RBI, I shall be liable for action under the Foreign Exchange Management Act, 1999 as amended, and be debarred from the Card facility. The
undersigned will be liable for all charges incurred with the Add-on Card(s) issued on the Account and each Add-on Applicant will be liable for all charges incurred with the Add-on Card
jointly and severally with the holder of the Primary Card.
Conditions Apply: Sub-limit on Add-on Card is per statement cycle. Sub-limit will hold good only for ATM and POS transactions but the same will not apply for online transactions.
For detailed terms & conditions visit www.hdfcbank.com.

Primary Cardmembers Signature ........................................................................................................................

By Signing here, I certify that I have read and agree to all applicable Terms & Conditions.

Date : ............................................................

List of acceptable Photo ID for Add on Card holder. (Expired ID proof will not be consider as valid proof)
ANY ONE OF THE BELOW
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

PAN Card
Passport
DL / LL (DL from Uttar Pradesh alone can be accepted without Signature)
Voters ID
Ration Card (In Customer Name)
Company/Institution photo ID card
Student ID card
Club membership card (which carries customer photo)
OBC Photo Card
Insurance / Mediclaim Photo Card
Passbook with Photo
Railway station pass ID - Government recognised
Senior citizen ID - wherever applicable
Government organisation ID card with signature and photo.

List of acceptable Address Proof for Add on Card holder.

ANY ONE OF THE BELOW

3.
4.
5.
6.
7.
8.

9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

Passport
Driving licence(Customer having Driving License Issued from Uttar Pradesh can be accepted with out the Signature on the
same.)
Telephone bill - MTNL / BSNL & all WLL lines' bills can be accepted
Electricity bill - Ebil and Physical Bill
Bank account statement - Bank statement or Pass book can be accepted - In both the address should be mentioned
Ration card
Voters ID (if it has address)
Letter from the society (only Registered societies) - on the letterhead which carries the society's Registration No. The letter
should carry the applicant's name & full address as well as the signatories full name, designation (Secretary, President) and
address.
Monthly outgoings bill from Registered Housing society - on the letterhead which carries the society's Registration No.
(Maintenance charges receipt issued by the society NOT acceptable)
Registration documents/Ownership proof copy
Senior citizens card from Indian Railways/Indian Airlines (if it has address)
Mobile post paid bill
Letter from any recognized public authority (In original)
Company ID card (For CAT AB companies only)
LIC Premium receipt
Address confirmation by the corporate on company letter head as valid address proof (For CAT AB companies only)
Gas Bill
Water Bill
Society Maintenance Bill
Property Tax Receipt

Name of TSE : ________________________________________________________

Team Supervisors Code : _______________________________________________

TSE Code : __________________________________________________________

Signature of Team Supervisor : ___________________________________________

Name of Doc-Ex : _____________________________________________________

PB/RM (Mandatory Field) :

Doc-Ex Code : ________________________________________________________

BRANCH CODE :

Channel : ____________________________________________________________

BDR Code / LC Code :__________________________________________________

Source Code / Activity : _________________________________________________

City : _______________________________________________________________
Sep16

1.
2.