activation/de-activation of international debit card · pdf fileactivation/de-activation of...

1
ACTIVATION/DE-ACTIVATION OF INTERNATIONAL DEBIT CARD USAGE Date: D D MM Y Y YY ACCOUNT DETAILS DECLARATION (To be signed by the card holder) Name : Branch/City: Account No. : CV/BAN/AIDCU/Ver1.0/06-14 c Activate international usage on the above-mentioned Debit Card Debit Card No. : International usage limits to be applied to the Debit Card per financial year, which includes ATM cash withdrawals, purchase at merchant outlets and internet purchases : _____________________ USD Note: International Debit Card usage is subject to a maximum allowable limit of USD 10,000 per financial year (at present), as per extant foreign exchange regulations. PASSPORT DETAILS Only if your passport details need to be updated on the account. Passport No. : D D MM Y Y YY Expiry Date: Place of issue : To validate the passport details, please carry your original passport (along with a photo-copy) as proof for verification. TERMS AND CONDITIONS All foreign currency withdrawals on your Debit Card are allowed only as permitted under the Foreign Exchange Management Act, 1999 (FEMA). Use of the Debit Card is permitted only for private travel and is not valid for business use. Your Debit Card is valid for cash withdrawal outside India. It is, however, not valid for making foreign currency Cash Withdrawals in Nepal and Bhutan. In the event of any failure to adhere to the FEMA guidelines, as outlined in the Banking Terms and Conditions, you would be liable for penal action under FEMA. In case you access foreign exchange through International Credit Cards, Travelers' Cheques and/or cash and/or any other means, it is solely your responsibility to ensure that the total foreign exchange drawn by you does not exceed the overall limit permissible, which is currently USD 10,000 per person per financial year. Additionally, the daily transaction limit for your Debit Card shall also apply. Resident account holders going abroad for employment or on emigration are not permitted to use the Debit Card for drawing foreign exchange. I/We declare that the information included in this application is true and correct. I/We shall indemnify and hold harmless Citibank from any/all consequences arising from non-compliance with exchange control regulations of the RBI. DEBIT CARD DETAILS Please tick the desired option and fill in the required details; Strike out other options or fields that are not required. c De-activate international usage on the above-mentioned Debit Card This is to request Citibank to: Please sign the form only after all the details are completely filled. Signature verified by : Emp. ID: __________________ Signature: __________________ Name:________________________ ID Number: _________________ ID Type:__________________________ Date & Time : Number called: _____________________ _________________________________________ Callback details (if applicable) : Person spoken with: _______________________________________________________________________ c Yes c No Complete set of originals received : Instruction received by : c In Person c Mail/Representative FOR BANK USE ONLY Signature: __________________ Emp. ID: __________________ Name:________________________ (2) Customer met in person by : Signature: __________________ Emp. ID: ___________________ Name:________________________ (1)

Upload: hoangdieu

Post on 16-Mar-2018

220 views

Category:

Documents


0 download

TRANSCRIPT

ACTIVATION/DE-ACTIVATION OF INTERNATIONAL DEBIT CARD USAGE

Date: D D M M Y Y Y Y

ACCOUNT DETAILS

DECLARATION

(To be signed by the card holder)

Name :

Branch/City:Account No. :

CV

/BA

N/A

IDC

U/V

er1

.0/0

6-1

4

c Activate international usage on the above-mentioned Debit Card

Debit Card No. :

International usage limits to be applied to the Debit Card per financial year, which includes ATM cash withdrawals, purchase at merchant outlets and internet purchases : _____________________ USD

Note: International Debit Card usage is subject to a maximum allowable limit of USD 10,000 per financial year (at present), as per extant foreign exchange regulations.

Channels to be enabled Apply individual limits* Apply a consolidated limit across selected

channels*

c ATM Cash withdrawal USD

USD c Purchase at merchant

outlets USD

c Internet purchases USD

PASSPORT DETAILS Only if your passport details need to be updated on the account.

Passport No. : D D M M Y Y Y YExpiry Date:

Place of issue :

To validate the passport details, please carry your original passport (along with a photo-copy) as proof for verification.

TERMS AND CONDITIONS

All foreign currency withdrawals on your Debit Card are allowed only as permitted under the Foreign Exchange Management Act, 1999 (FEMA). Use of the Debit Card is permitted only for private travel and is not valid for business use. Your Debit Card is valid for cash withdrawal outside India. It is, however, not valid for making foreign currency Cash Withdrawals in Nepal and Bhutan. In the event of any failure to adhere to the FEMA guidelines, as outlined in the Banking Terms and Conditions, you would be liable for penal action under FEMA. In case you access foreign exchange through International Credit Cards, Travelers' Cheques and/or cash and/or any other means, it is solely your responsibility to ensure that the total foreign exchange drawn by you does not exceed the overall limit permissible, which is currently USD 10,000 per person per financial year. Additionally, the daily transaction limit for your Debit Card shall also apply. Resident account holders going abroad for employment or on emigration are not permitted to use the Debit Card for drawing foreign exchange.

I/We declare that the information included in this application is true and correct. I/We shall indemnify and hold harmless Citibank from any/all consequences arising from non-compliance with exchange control regulations of the RBI.

DEBIT CARD DETAILS Please tick the desired option and fill in the required details; Strike out other options or fields that are not required.

c De-activate international usage on the above-mentioned Debit Card

This is to request Citibank to:

Ple

ase

sig

n t

he

fo

rm o

nly

aft

er

all t

he

de

tails

are

co

mp

lete

ly f

ille

d.

c Yes c NoComplete set of originals received :ID Number: _________________ID Type:__________________________

Date & Time : Number called:_____________________ _________________________________________

Callback details (if applicable) : Customer spoken with: ___________________________________________________________________

Instruction received by : c In Personc Mail/Representative

Signature: __________________ Emp. ID: __________________Name:________________________(2)

Signature verified by : Emp. ID: __________________Signature: __________________Name:________________________

ID Number: _________________ID Type:__________________________

Date & Time : Number called:_____________________ _________________________________________

Callback details (if applicable) : Person spoken with: _______________________________________________________________________

c Yes c NoComplete set of originals received :

Instruction received by : c In Personc Mail/Representative

FOR BANK USE ONLY

Signature: __________________ Emp. ID: __________________Name:________________________(2)

Customer met in person by : Signature: __________________ Emp. ID: ___________________Name:________________________(1)