ATM-cum-Debit card application form - State Bank of Indore

					                    STATE BANK CASH PLUS                                                                                                                   State Bank of Indore
APPLICATION FORM FOR ATM CARDS                                                                                                                                                                                                 FOR OFFICE USE ONLY.
Thank you for applying for the Indore Bank ATM card. To help us process your request quickly, please fill this form as per the instruction below.                                                                         IMPORTANT INSTRUCTIONS: (Please(V lin the
if you have any questions, please check with your Branch Manager, we are committed to making your life simpler with the Indore Bank ATM Card.                                                                             appropriate box)
                                                                                                                                                                                                                          Application Serial No.
Please fill the entire form in CAPITAL LETTERS only                                      • Leave one box space between each word.                          • Joint account holders to fill separate application forms     Mode of Operations:
Complete all Sections                                                                    • Please(V)in the appropriate box.                                • Sign the declaration.
Do not write outside the provided boxes.                                                 • Join ale to be either survivor / anyone or survivor.                                                                                    E ORS                               Single
Your Name

Name as you would like it on the card (max. 25 Letters) with title, if required - including space)                                    MALE                                      FEMALE                                       Anyone or S                               F or S
Address for Correspondence                                                                                                                                                                                                Standallone ATM :

                                                                                                                                                                                                                          ATM Branch Code
TOWN/ CITY/ STATE                                                                                                                                                                                                         Link Branch Code
                                                                                                                                                                   PIN CODE                                               Daily Limit(3000/5000/9000)
                                                                                                                                                                                                                          Issue Card Yes / No
Phone (Office)                                                                                                                   (Residence)
                                                                                                                                                                                                                          Networked ATM
Fax                                                                                                                       For Example             0    7      5       5              2   5     5    1     0     5       4 Card Issuing Branch Code

Email                                                                                                Card Type                 New                    Replacement                        Renewal                          Issue Card Yes/ No

                    My designated accounts on which I require ATM Services.                                                                 PAN Number                                                                    Application Date
                                                                                                                                                                                                                                                            Date      Month             Year
   Primary A/c                  A/c Type                     Saving-1                                Current-01                     Account No.
  Secondary A/c                  A/c Type                    Saving-11                               Current-0l                     Account No.                                                                           Registration Date
* Alc type of Primary & Secondary Alc should be different.                                                                                                                                                                (Date of Entry into the system)   Date      Month             Year
Declaration:                               • I am aware of the Terms and Conditions (overleaf) governing the use of the ATM card and agree to abide by them.                                                              Old ATM Card No.
                                           • The Bank may call me at my residence/office in connection with ATM transactions.                                                                                             New ATM Card No.

Place:                                                                                                                                                                                                                    Staff                             Yes                    No

Date:                                                                                                                                                                                        Applicant's Signature Place :
                                                                                                                                                                                                                                                                              (Branch Manager)
                                                                                                                                                                                                                          Date :                                              Signatue & Stamp

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