DIRECT DEBIT INSTRUCTIONS FOR CREDIT CARD
I hereby request you to make direct debit arrangements on my account as per the following details:
Branch Banking Account Number: _______________________________________________________________
Customer Name: ______________________________________________________________________________
Credit Card Number (s): ________________________________________________________________________
Credit Card Account Title:_______________________________________________________________________
Type of Direct Debit Payment: Same Party Third Party Staff
DD Effective Date: DD Expiry Date:
I hereby authorize Citibank, N.A Pakistan (“Citibank”) to make automatic monthly deductions from my branch banking
Account stated above and pay such deducted proceeds to my Citibank Credit Card account mentioned above in order to
repay the outstanding or a part thereof on the Credit Card / Supplementary Card (s). Citibank is further authorized to
obtain and read copies of the Citibank Credit Card & Supplementary Card(s) monthly statements of account and
BB - DDA – VC2- 10 - 09
accordingly effect monthly debits to my above mentioned Citibank Credit Card account.
Under these instructions I will be responsible for ensuring that sufficient funds are available in my branch banking
Account at the time of these debits and in case of deficiency of funds I will remain responsible for the payments along
with any late payment or other financial charges levied on my Citibank Credit card(s).
I understand that while every effort is made to ensure compliance with these Direct Debit Instructions, they are accepted
by Citibank on condition that neither Citibank, nor any of its officers or employees, will be liable in any circumstances
for any loss or damage, direct or indirect or consequential, arising out of any failure to comply or delay in complying
with such instructions, whether due to negligence, or any other cause.
I choose to have the following deduction made from my above branch banking Account:
The full amount as billed in the applicable Credit Card monthly statement of account.
Minimum 5% payment (Minimum Rs. 200) of the amount billed in the applicable Credit Card monthly statement
_______________________________ ____________________________ _____________________
Account Holder’s Name Signature & Date Contact No.
FOR BANK USE ONLY
Signature Verified By --- Name /Sign/Stamp Customer’s Identity Confirmed By --- Name /Sign/Stamp
(Branch Cash Counter) (Front Desk Walk-In / Branch Staff)