| Nominee |
| Name of
Nominee :
_________________________________________________________________________ |
| Relationship : _________________________________ Age :
_______________________________________ |
Address :
_________________________________________________________________________________
_________________________________________________________________________________________
|
I
hereby nominate the above person to receive the claim amount
payable by the Insurance Company in the event of accidental
death after adjustment of dues, if any, payable to the card
issuing bank. I further declare that the Nominee's receipt
shall be sufficient discharge to the Bank/Company
|
| Signature of
applicant |
| |
I/We
hereby authorise you to debit my/our ________ A/c No ______
with VIJAYA BANK _______... branch as and when the bills are
raised.
I/We undertake to use the Global Credit Card
facility strictly in accordance with FEMA and exchange control
regulations of Reserve Bank of India notified from time to
time and within my/our entitlement thereunder. In the event of
exception to the above, I/We accept the bank and/or authorized
dealer of Foreign Exchange to report the same to RBI and I may
be barred from holding banks global Credit Card either at the
instance of Vijaya Bank or Reserve Bank of India. I/We also
undertake not to utilize my card for purposes restricted under
RBI guidelines in force and specifically undertake not to
utilize the card for lotteries, gambling transactions
etc.
I/We agree that the approval of the application is
subject to the banks discretion and that the bank reserves
the right to decline the application without assigning any
reason. I/We authorize the bank to contact my employer,
references & any other source for verification & any
other information required in respect of issuance of the
Vijaya Bank Credit Card. I/We further, authorize the bank to
pass on this information to Credit Information Bureau.
I/We further confirm that all the information given in
the application is true, correct & complete and forms the
basis for issuance of Vijaya Bank Credit Card. If the
application is accepted, I/we will be bound by the set terms
& conditions printed overleaf which are in force or as may
be amended from time to time. |
| |
| Correspondence & bills may be addressed to
Office |
|
Residence |
| |
| |
Date
:
Place: |
| Signature of
applicant |
Signature of
add-on applicant | |
| |
| Branch
Recommendation |
| We
confirm having verified all the particulars furnished in the
application including address of the applicant, we recommend
the issue of VISA GLOBAL card with a credit limit of Rs
_________.. along with ADD-ON CARD in the name of __________.
The Credit Card bills may be debited to ____. A/c No
_______ |
| Branch
Name & Code No : |
| Date of
recommendation : |
Branch Head
Signature with seal |
| NAME OF BRANCH
MANAGER IN CAPITALS
|