Name of the Primary Cardmember:First name Middle name

Please leave one box space between names and surname

Last name

Appl. No.:If you are an existing Cardmember, please tick whichever is applicable

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.

Add-on applicant without HDFC Bank A/c & not staying with Primary cardholder will be required to submit valid photo ID, Pan Card or Form 60 & Address proof. If Add-on applicant does not hold HDFC Bank a/c and is sibling of primary applicant 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.

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.

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

Primary Cardmember’s Signature ........................................................................................................................ Date : ............................................................

Add - on Card (s) Application Form Cum MIDVersion 1.11

Credit Card Number

AFFIXYOURPHOTO

If neither option is chosen clearly, 100% will be set as default Add-on limit.

Add-on Card Regular - (Life Time Free)

ADD-ON SUB-LIMIT OPTION: Please indicate the limit to be set on the Add-on Card per statement cycle:

25% of Credit Limit 50% of Credit Limit Rs.1000 Rs.5000 Rs.10000

Add-on applicant's Email ID

Add-on applicant's Cust ID

Add-on applicant's Mobile no.

I confirm that the add-on applicant is my __________________________________________________ (relationship with Add-on)

and is staying/ not staying with me at the same residential address as provided to the Bank by me. I as primary card holder

take the full responsibility of the add-on card, including all transactions/usage and payments related to the add-on card. I will produce

the ID proof of the add-on card member, as and when requested by the Bank.

Add-on applicant’s HDFC Bank A/c No.

* Mandatory for Add on customer who have an account.

Sex M FDate of Birth D D M M Y Y1 9

Name to be embossed on the Card

Please restrict to 30 characters including Spaces

Title Mr Ms Mrs Dr

Please tick as applicable

Add-on

Applicant

Form of declaration to be mandatorily filled by a person who does not have a Permanent Account Number.

1. Full Name and Address

3. If Yes,

A. Details of ward/circle/range the last ITR was filed

B. Reason for not having PAN

Track your Credit Card application status at the HDFC Bank website through 16-digit unique application

reference number which you will receive on your mobile number.

www.hdfcbank,com->Cards->Credit Cards->Track your Credit Card.

2. Are you a Tax Assessee Yes No

4. Address Proof Attached

Signature of the Add-on Applicant Date

knowledge and belief.

VERIFICATION

I do hereby declare that what is stated above is true to the best of my

Voter ID Bank account statement/Passbook Lease deed/Rent agreement copy

Registration documents/Ownership proof copy Others (please specify)

Passport Driving Licence Utility bill (incl. mobile postpaid bill) Ration card

HDFC Bank customers need to sign as per Bank records.

FORM NO. 60 (SEE THIRD PROVISION TO RULE 114 B)

Place

Verified today the day of

SolitaireTitanium EdgePlatinum Plus Card SuperiaGold Titanium RegaliaBusiness Platinum Credit Card

Visa Signature Chip Card JetPrivilege Titanium JetPrivilege WorldJetPrivilege PlatinumWorld MasterCard

List of acceptable Address Proof for Add on Card holder.

1. Passport

2. Driving licence(Customer having Driving License Issued from Uttar Pradesh can be accepted with out the Signature on the

same.)

3. Telephone bill - MTNL / BSNL & all WLL lines' bills can be accepted

4. Electricity bill - Ebil and Physical Bill

5. Bank account statement - Bank statement or Pass book can be accepted - In both the address should be mentioned

6. Ration card

7. Voters ID (if it has address)

8. 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.

9. 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)

10. Registration documents/Ownership proof copy

11. Senior citizens card from Indian Railways/Indian Airlines (if it has address)

12. Mobile post paid bill

13. Letter from any recognized public authority (In original)

14. Company ID card (For CAT AB companies only)

15. LIC Premium receipt

16. Address confirmation by the corporate on company letter head as valid address proof (For CAT AB companies only)

17. Gas Bill

18. Water Bill

19. Society Maintenance Bill

20. Property Tax Receipt

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

ANY ONE OF THE BELOW

1. PAN Card

2. Passport

3. DL / LL (DL from Uttar Pradesh alone can be accepted without Signature)

4. Voters ID

5. Ration Card (In Customer Name)

6. Company/Institution photo ID card

7. Student ID card

8. Club membership card (which carries customer photo)

9. OBC Photo Card

10. Insurance / Mediclaim Photo Card

11. Passbook with Photo

12. Railway station pass ID - Government recognised

13. Senior citizen ID - wherever applicable

14. Government organisation ID card with signature and photo.

20.5cm x 29cm

Aug

‘10

Name of TSE : ________________________________________________________

TSE Code : __________________________________________________________

Name of Doc-Ex : _____________________________________________________

Doc-Ex Code : ________________________________________________________

Channel : ____________________________________________________________

Source Code / Activity : _________________________________________________

Team Supervisor’s Code : _______________________________________________

Signature of Team Supervisor : ___________________________________________

PB/RM

BRANCH CODE :

BDR Code / LC Code :

(Mandatory Field) :

__________________________________________________

City : _______________________________________________________________