Professional Documents
Culture Documents
International Atm Form
International Atm Form
my use.
International
Debit
Card.
am
aware
that
C.
Year of
pas sing SSC
YYYY
Year of
Marriage* **
YYYY
Do
not
furni sh
the
surnames
example;
S R. Tendulkar, the name should be Sac hi n.
if
the
name
is
** In respect of Mother s maiden name, you may furnis h mothers name before
m arri age
*** If these dates are not r elevant it may be fi lled as XXXX
I am awar e that the International Card can be used for al l domesti c
trans ac tions and transactions i nvolving foreign exchange permitted under the
Forei gn Exchange Management Act and the Rul es framed there under by
Reserve Bank of India from time to ti me. I undertak e to use the card in strict
com pli ance with the appli cable Exchange Control/Managem ent Regulations and
any violat ion thereof will result in cancell ati on of the card and make me liabl e
under rel evant provision of the Act/Regul ati ons. I al so undertake to furni sh all the
details in res pect of any transaction entered into by me to facilitate any
investigation.
I hereby authori ze you to recover from my account the cost of the car d and all
ot her fees whi ch may be payabl e by SBI to MasterCard (other than transaction
fee) for extra-or dinary services rendered by them (example lost/stolen card).
Place
Date
Name
Address :
Tel. No.:
Mobile :
OFFICE USE
Acc ount partic ulars & s ignature of Applican t & mode of operation
verified. Request for issue of International Debit Card appro ved/dec lin ed
for t he reason
(delete as applicable)
Date
Authorised official