RUPEE CHECKING ACCOUNT MANDATE FORM AUG 09

Document Sample
RUPEE CHECKING ACCOUNT MANDATE FORM AUG 09 Powered By Docstoc
					                                                                              Citibank Rupee Checking Account Mandate Application Form
                                                                                       Assign Your Beneficiary in India to Operate Your Account
                                                                      A. How to designate a beneficiary in India (Mandatee) to operate your Account:
                                                                      1.    Complete the Mandate Application Form with your details
                                                                      2.    Fill the Mandatee details
                                                                                   Choose one of the 2 options given on the withdrawal limits for your Mandatee
                                                                                   Choose any of the co-branded/plain ATM/Debit Card options, in case you wish to extend the ATM/Debit Card facility to
                                                                                   your Mandatee
                                                                                   Mention to extend the ATM/Debit Card facility to your Mandatee
                                                                                   Mention your Account Number, which you will receive along with your ATM/Debit Card and Checkbook
                                                                                   Sign and send the form to your Mandatee in India
                                                                      B. What Does the Mandatee do?
                                                                      1.    Complete form & attach passport size photograph
                                                                      2.    Attach copies of one or more identity documents covering Name, Photograph, Mailing Address, Date of Birth &
                                                                            Signature.
                                                                            Acceptable Documents
                                                                                   Passport
                                                                                   PAN Card
                                                                                   Ration Card
RCA Mandate Form - Version 1.0 Effective 1st September 2009




                                                                                   Driver’s License
                                                                                   Voters ID
                                                                                   Bank Passbook/Bank Statement (not greater than 90 days old)
                                                                                  Utility Bill (not greater than 90 days old)
                                                                      3.    You may send Citibank your documents by:
                                                                                   Visiting us at the nearest Branch (please see overleaf) with your application form & copy of identity
                                                                                   documents                                          OR
                                                                                   By Couriering the application form & copy of identity documents to the address given below:
                                                                                   Centralized Customer Service Unit
                                                                                   ATTN. NRI BUSINESS
                                                                                   P.O. Box 4830
                                                                                   Anna Salai
                                                                                   Chennai 600 002
                                                                      4.    Please ensure the personal information covering Name, Photograph, Mailing Address, Date of Birth & Signature match with the
                                                                            identity documents provided before you send your application form to Citibank, else we will not be able to process the same.
                                                                      C. What happens next?
                                                                      An ATM/Debit Card and/or Checkbook will be sent to the Mandatee in India, along with a brochure containing information about how to use
                                                                      the Account. The Mandatee will be able to do the following transactions on the account:
                                                                                      .   Withdrawals - The Mandatee can issue Rupee Checks, can use ATM Card (only in India), Issue Rupee Demand Drafts at
                                                                                          Branches in India & via Citiphones Toll Free
                                                                                      .   Deposits - The Mandatee can deposit checks in the NRI account holder’s name (via Branch /Drop box)
                                                                                               For NRO A/cs the Mandatee can deposit Rupee Checks & Rupee Cash (> Rs 50,000 A/c holder’s PAN Card is required)
                                                                                               For NRE A/cs the Mandatee can deposit foreign currency checks
                                                                                      .   The mandatee is not enabled to do the following transactions on the account:
                                                                                               Change Address of the accounts
                                                                                               Deposit cheques in the name of Mandatee into the account
                                                                                               Place standing instructions in the account
                                                                                               Deposit or Withdraw Foreign Currency Cash / Drafts/ Traveller’s Checks
                                                                      If you have set a monthly limit for your Mandatee on his/her ATM/Depit Card currently, and in future you would like to extend the Checkbook
                                                                      and Telebanking Facility, the monthly limit will NOT apply to the Checkbook and Telebanking Facility




                                                              NRAF026V1.0
                                                           Mandate Application Form
Account Holder’s Name:

Account No.:                                                                          Account Type:                     NRE                  NRO
City in which Account is held:
With reference to my/our above mentioned Account, I/we hereby request and authorize you to issue the Mandatee facility to:
*Name: Mr./Mrs./Ms.
                                             First Name              Middle Name (Initial)           Last Name
                                            (Please leave one box space between names and underline the surname)
  Date of Birth:
Document Type :                                                                    Document No :
                                                                                                                                                            Please affix
Address:                                                                                                                                                    a RECENT
                                                                                                                                                             passport
                                                                                                                                                         size photograph
                                                                                                                                                               of the
                                                                                                                                                             Mandatee
City:                                                                               Pincode:

Country:

Telephone:                                                                          E-mail Address:

Relationship with Account Holder:                                                  Are you a senior public figure or related to one***?                                    Yes            No
You can choose ONLY ONE between Option A & Option B below:

A.        I/We would like the Mandatee to access up to the Account Balance, and would like to issue the following facilities:
1. ATM/Debit Card                 2. Checkbook             3. Telebanking Personal Identification Number (T-PIN) for Telebanking Facility
                                                                                     OR
B.        I/We would like to issue the Mandatee ONLY an ATM/Debit Card with a monthly limit of: (in figures)Rs.
     (in words) Rs.
Please note that any request for Checkbool/T-PIN issuance for Telebanking Facility shall be automatically construed to be invalid in case you have chosen
a monthly limit for the ATM/DebitCard.

  Disclaimer:

I/We, the Account Holder(s) and the Mandatee (Holder of the Mandate Facility) have read and understood the Citibank Account Terms and Conditions in the Citibank. Account
Application Form as well as the Mandate Form. I/We, the Account Holder(s) and the Mandatee, agree to be bound by the said Terms Conditions excluding/limiting your liability.
I/We,the Account Holder(s) also confirm that the Mandatee can avail of all facilities as provided/will be provided to me/us by Citibank and I/we authorize the Mandatee to conduct all
local transactions permitted as per FEMA/receive information on my/our behalf.
I/We,the Account Holder(s) accept that at my/our request you have agreed to provide the Mandatee (details as provided by me/us above) the facility of carrying out banking
transaction by giving telephonic Instructions (which will be accepted by you either manually or by an automated system) apart from any written Standing Instructions now given or
that may hereafter be given to you. The Mandatee would be provided a CitiCard and a Telephone-Personal Identification Number (T-PIN) to access and transact on the account on
CitiPhone. All communication for the Mandatee shall be addressed at the Mandatee mailing address as provided by me/us. I, the Mandatee, am aware that in connection with such
telephonic facility, the Mandatee is required to provide to you over the telephone the Account Number/CitiCard Number details and T-PIN as advised by the Bank to the Mandatee or as
subsequently changed by oral instructions or otherwise. This telephonic facility shall cover and be applicable to all my/our Accounts (whether savings, current, fixed deposit,
loan/overdraft, credit card account or otherwise) now existing or which may hereafter be opened by me/us. I/We, the Account Holder(s) unconditionally agree that (I) I/we shall
not hold the bank liable on account of the Bank acting on instructions from the Mandatee: (ii) in following such instructions, the Bank will be doing so on a best-effort basis and
I/we/the Mandatee shall not hold the Bank liable on account of delay or inability on the part of the bank to act immediately or at all on any of my/our theMandatee instructions: (iii)
the Bank may in its discretion, withdraw or suspend the facility wholly or in a part at any time; (iv) in case of a Joint Account, the Bank may act on instructions from either/any of us/the
Mandatee; (v) the bank may in its discretion decide not to carry out any instructions where the bank has reason to believe (which decision of the Bank I/we shall not question or
dispute) that the instructions are not genuine or otherwise improper or unclear or raise a doubt; (vi) the Bank may in its discretion tape or record such instructions and may rely on
transcripts of such telephonic instructions in evidence in any proceedings;(vii) at either of our (Account Holder(s)/Mandatee) request the Bank may send to me/us by fax (at a fax
number given by me/us) financial information(sought for by me/us) regarding my/our Account(s) which may be of a private and confidential nature and I/we shall not hold the
Bank liabile in any manner should such information come to the knowledge of any third party. In the event there is a discrepancy in the particulars or details of any transactions carried
out by the Bank in any of my/our Account(s), I/we shall be obliged to intimate to you in writing any discrepancy in my/our Accounts within 10days of receiving your advice or within 10
days from the date of receipt of my/our periodic statement of account, whichever is earlier, failing which the transaction shall be deemed to be correct and as accepted by me/us. In
consideration of your providing the said facility, I/we agree to indemnify and hereby keep you indemnified from and against all actions, claims, demands, proceedings, losses,
damages, costs, charges and expenses whatsoever which your Bank may at any time incur, sustain, suffer or be put to as aconse quence of or by reason of or arising out of providing
me/us the said facility or by reason of your Bank in good faith taking or refusing to take or omitting to take action on my/our/the Mandatee instructions. I/We further certify that the
details in my/our/the Mandatee relationship record are correct
I/We, the Account Holder(s) understand that the co-branded ATM/Debit card comes with the charges as mentioned. I/We further understand and agree that our aforementioned
Saving/Current Account be debited towards such charges.
I/We, the Account Holder(s)and the Mandatee further understand that the usage of the Mandatee ATM/Debit Card, Including co-branded ATM/Debit Cards in restricted to India.
Also the redemption of the Reward Points associated with the co-branded ATM/Debit Cards can happen within India only.
I/we, the Account Holder(s) and Mandatee understand and acknowledge that Citibank, N.A. reserves the absolute right to accept or reject this application in its sole discretion without
assigning any reason thereof.
Terms & Conditions Governing Senior Public Figure***
A “Senior Public Figure” is senior official in the executive, legislative, administrative, military or judicial branches of a government, whether or not elected, a senior official of a major
political party, or a senior executive of a government-owned or government-funded corporation, institution or charity. A “ Senior Public Figure” also includes any entity that has been
formed by or on behalf of a Senior Public Figure, in which the Senior Public Figure is a beneficial owner of at least twenty-five percent of the entity.
In addition, a “Senior public Figure” includes the immediate family of a Senior Public Figure and any close associate or relative of a Senior Public Figure. A close associate is person
who is widelyand publicly known to maintain an unusually close relationship with and able to conduct financial transactions on behalf of a Senior Figure.




                              Signature of Mandatee




         1st Joint Account Holder                                                2nd Joint Account Holder                                        3rd Joint Account Holder
                                                       (In case of Joint Account, signatures of all Joint Holders are required)
                                         CITIBANK BRANCHES IN INDIA

Ahmedabad:                               Faridabad :                                     Ludhiana :                                          Citicenter for Non-Resident Indians,
Citicenter for Non-Resident Indians,     Citicenter for Non-Resident Indians,            Citicenter for Non-Resident Indians,                D-11, South Extension Part-II,
Ground Floor, Rembrandt, C.G. Road,      24-27, Lower Basement, Ansal Plaza,             Ground Floor, Stock Exchange Building,              New Delhi 110 049
Near Panchvati Circle,                   Mathura Road, Faridabad 121 007                 Firoze Gandhi Market, Ludhiana 141 001              Tel: +91-124-254-2484 (CITI)
Ahmedabad 380 006                        Tel: +91-124-254-2484 (CITI)                    Tel: +91-161-501-2484 (CITI)
                                                                                                                                             Citicenter for Non-Resident Indians,
Tel: +91-79-2642-2484 (CITI)
                                                                                                                                             Plot No. 33, Basant-Lok Vasant Vihar,
                                         Gurgaon:                                        Mumbai:
                                                                                                                                             New Delhi 110 057
Aurangabad :                             Citicenter for Non-Resident Indians,            Citicenter for Non-Resident Indians,
                                                                                                                                             Tel: +91-124-254-2484 (CITI)
Citicenter for Non-Resident Indians,     Ground Floor, DLF Square, M - Block,            293, Dr. D.N. Road, Fort, Mumbai 400 001
Saraswati Sankul, Opp. S.B. Bus Stand,                                                   Tel: +91-22-2823-2484 (CITI)                        Noida:
                                         Jacaranda Marg, DLF City, Phase II,
Aurangpura, Aurangabad 431 001                                                                                                               Citicenter for Non-Resident Indians,
                                         Gurgaon 122 002                                 Citicenter for Non-Resident Indians,
Tel: +91-240-563-2484 (CITI)                                                                                                                 A-6, Sector 4, Noida 201 301
                                         Tel: +91-124-254-2484 (CITI)                    West View Building,
                                                                                                                                             Tel: +91-124-254-2484 (CITI)
                                                                                         Linking Road and Khar Danda Junction,
Bangalore:                               Hyderabad:                                      Linking Road, Khar, Mumbai 400 052                  Pondicherry:
Citicenter for Non-Resident Indians,     Citicenter for Non-Resident Indians,            Tel: +91-22-2823-2484 (CITI)                        Citicenter for Non-Resident Indians,
102-104, Prestige Meridian II, 30,       Ground Floor, Queens Plaza,                                                                         Citibank, N.A.
                                                                                         Citicenter for Non-Resident Indians,
Mahatma Gandhi Road,                     S P Road, Begumpet,                                                                                 No. 22, Rue Bussy Street,
                                                                                         Kalpachandra, 150, S.V. Road,
Bangalore 560 001                        Secunderabad 500 003                                                                                (Lal Bahadur Shastri Street),
                                                                                         Andheri West, Mumbai 400 058
Tel: +91-80-2227-2484 (CITI)             Tel: +91-40-6666-2484 (CITI)                                                                        Pondicherry 605 001
                                                                                         Tel: +91-22-2823-2484 (CITI)
                                                                                                                                             Tel: +91-98940-22484
Citicenter for Non-Resident Indians,     Indore:                                         Citicenter for Non-Resident Indians,                Pune:
# 91, Southend Road, Opp.                Citicenter for Non-Resident Indians,            B/1, V Mehta Road, Ground Floor,                    Citicenter for Non-Resident Indians,
Surana College,                          UG-1, Apollo Square, 7/2 Race Course Road,      JVPD Scheme, Mumbai 400 049                         2413, Kumar Capital, East Street,
Jayanagar, Bangalore 560 004             Indore 452 001                                  Tel: +91-22-2823-2484 (CITI)                        Pune 411 001
Tel: +91-80-2227-2484 (CITI)             Tel: +91-3970-2484 (CITI)
                                                                                         Citicenter for Non-Resident Indians,                Tel: +91-20-5601-2484 (CITI)
                                                                                         Mahatma Phule Bhavan,
Bhopal:                                  Jaipur:                                         Palm Beach Road Junction, Sector - 17,              Surat:
Citicenter for Non-Resident Indians      Citicenter for Non-Resident Indians,            Vashi, Navi Mumbai 400 705                          Citicenter for Non-Resident Indians,
Kay Kay Business Centre                  Bhagwati Bhavan, Government Hostel Crossing,    Tel: +91-22-2823-2484 (CITI)                        14, Adarsh Society, Opp. Kakadia Complex,
133, Zone 1, M.P. Nagar, Bhopal          MI Road, Jaipur 302 001
                                                                                                                                             Ghod Dhod Road, Surat 395 007
Tel: 1800-180-2484 (CITI)                Tel: +91-141-237-2484 (CITI)                    Citicenter for Non-Resident Indians,                Tel: +91-261-653-2484 (CITI)
Bhubaneshwar:                                                                            Ground Floor, Air India Building,
                                         Jalandhar:                                      Nariman Point, Mumbai 400 021                       Vadodara:
Citicenter for Non-Resident Indians,
                                         Citicenter for Non-Resident Indians,            Tel: +91-22-2823-2484 (CITI)                        Citicenter for Non-Resident Indians,
98, Janpath, Bhubaneshwar 751 001
                                         36, Gobind Niwas, G.T. Road (Opp. Bus Stand),                                                       Ground Floor, Pelican, Gotri Road,
Tel: +91-3970-2484 (CITI)                                                                Nasik:
                                         Jalandhar 144 001                                                                                   Opp. Race Course Towers,
                                                                                         Citicenter for Non-Resident Indians,
                                         Tel: +91-181-464-8006/08                                                                            Vadodara 390 007
Chandigarh:                                                                              Rushiraj Presidency, Opp. Bhosla Military School,
                                                                                                                                             Tel: +91-265-232-2484 (CITI)
Citicenter for Non-Resident Indians,                                                     Plot No. 52&53, D'Souza Colony,
SCO 132/133, Sector-9C, Madhya Marg,                                                     College Road, Nasik 422 005                         Vapi:
                                         Kochi:                                                                                              Citicenter for Non-Resident Indians,
Chandigarh 160 017                                                                       Tel: +91-3970-2484 (CITI)
                                         Fotofast House, 38/1581, M.G. Road,                                                                 Citibank, N.A., The Emperor,
Tel: +91-172-508-2484 (CITI)
                                         Padma Junction, Kochi 682 035                                                                       Vapi-Daman Road, Chala, Vapi 396 191
                                                                                         New Delhi:
Chennai:                                 Tel: +91-484-237-2484 (CITI)                    Citicenter for Non-Resident Indians,                Tel: +91-95-232-2484 (CITI)
Citicenter for Non-Resident Indians,                                                     Ground Floor, International Trade Tower,
164, Anna Salai,                                                                         Hotel Royale Park Complex, Nehru Place,             India Toll Free : 1800-22-NRIs (1800-22-6747)
Chennai 600 002                          Kolkata:                                        New Delhi 110 019                                   from MTNL/BSNL connection and 3970 5555
Tel: +91-44-2852-2484 (CITI)             Citicenter for Non-Resident Indians,            Tel: +91-124-254-2484 (CITI)                        from non-MTNL/BSNL connection
                                         Kanak Building, 41, Chowringhee Road,                                                               SMS 'NRI' to 52484
Citicenter for Non-Resident Indians,     Kolkata 700 071                                 Citicenter for Non-Resident Indians,
No. 50, C P Ramaswamy Road,              Tel: +91-33-2283-2484 (CITI)                    Jeevan Bharati Building,
3rd Street, Abhiramapuram,                                                               124, Connaught Circus,
                                         Citicenter for Non-Resident Indians,
Alwarpet, Chennai 600 018                                                                New Delhi 110 001
                                         Ground Floor, 9, Brabourne Road,
Tel: +91-44-2852-2484 (CITI)                                                             Tel: +91-124-254-2484 (CITI)
                                         Kolkata 700 001
                                         Tel: +91-33-2283-2484 (CITI)
Coimbatore :                                                                             Citicenter for Non-Resident Indians,
Citibank, N.A.                           Lucknow:                                        27, Central Market, Sector II,
Tristar Towers, Plot No. 657             Citicenter for Non-Resident Indians,            Western Avenue Road, Punjabi Bagh,
Avinashi Road, Coimbatore 641 037        17/1 Ashok Marg, Lucknow 226 001                New Delhi 110 026
Tel: +91-422-232-2484 (CITI)             Tel: +91-522-220-1022                           Tel: +91-124-254-2484 (CITI)