APPLICATION FORM FOR ATI UM-DEBIT CARD e SBI CASH ‘Thank you for applying for the SBI ATM-CUM-DEBIT Card. To help us process your request quickly, please fill this form as per the instructions below. If you have any questions, please check with your Branch Manager. We are committed to making your life simpler with the SBI ATM-CUM-DEBIT Card. IMPORTANT INSTRUCTIONS Please fill the entire form in CAPITAL LETTERS only Leave one box space between each word, Complete all sections. Sign the declaration Do not write outside the provided boxes. Joint account holders to fill separate application forms. Joint a/c to be either or survivor/anyone or survivor ‘Your Name Tlalwlofs] TerTapay sts T I (Name as you would lke it on the card (max.25 letters) with fitle, if required including spaces) For example Ait R{ stu] xt [sli tn[ofu Sigiwoldio [& TA mTets Tat TeTeyAIn] ppaja & fh [A [tI]t MothersNeme [i [ew [ATWIAIRTAT [a [nla lt hi Sex Male [7 ]Femate[ ]ateot sith [fcr Date of Marriago| Address of v ft fe qe Blo ET oleh Teyaty correspondence Tivhcb ealaia Town'City, tT Tele TAB [aja State fy TlaAte Ja TT JA TXT PinCode [2 ]é S 7 Telephone T ‘2nd Telephone/Mobii ePhone [7 [4 [5 Tela le [ep fo [2 My designated account/s on which | require ATM services Primary Account Savings[ <7 ] Or Current Branch [PT [r |e be [RA 1G Rh RIW Saving Alc No afore 4laleiale le ‘Current A/c No [ Declaration : + | am aware of the Terms and Conditions (overeat) governing the use of the ATM-CUM-DEBIT Card and agree to abide by them + The Bank may call me at my residence/ office in connection with my ATM transactions. — f [en Jie (Applicants Signature) For Office Use Only Mode of operation ‘SINGLE, Eors Fors Anyone or S NETWORKED ATM. Application Sr.No. OT I Old ATM Card No. Card issuing Branch Code L [ Issue Card Yes/No J New ATM-CUM-DEBIT Card No. TTT TT ‘Et } TU | J (Br Mgr's Signature & Stamp) AJAY TRADERS (Ml) 8077815462