VIJAYA BANK Head Office, Credit Card Division 41/2, M G Road, Bangalore 560 001 Phone No : 091-80-5584066 (20 lines) Telex : 0845 8842 (VBHO IN) Fax : 091-80-5582915, E-mail : ccd@vijayabank_co_in / vijayacard@vsnl_com Vijaya Bank Visa Global Credit Card Application For Corporates * A minimum of 3 officials are required to be sponsored * Tick where appropriate   Company Name : __________________________________________________________________________ Public Private Address : State: ____________ Pincode:___________ Tel No:_____________ Telex : ____________ Fax No: ______________ E-mail ID: ____________________________________________   Name & Address of Bankers 1.   A/c No _________________ 2.   A/c No _________________ 3.   A/c No _________________   Financial Information (As per latest Balance sheet and Profit & Loss a/c) Copy to be enclosed Authorised Capital _____________________ Issued Capital _____________________ Subscribed Capital _____________________ Paid up Capital _____________________ Reserves & Surplus _____________________ Fixed Assets _____________________ Current Assets _____________________ Current Liabilities _____________________ Net Profit _____________________ Turnover _____________________ Carry forward loss(if any) _____________________

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/We 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/our card for purposes restricted under RBI guidelines in force and specifically undertake not to utilize the card for lotteries, gambling transactions etc. I/We hereby agree to accept liability for all charges incurred or in any way arising from the use of the Vijaya Bank VISA Global Credit Card issued hereon including any re-issue of the card. I/We hereby agree to surrender the card should I/We discontinue my/our services with the Company for any reason.   Sl.No Name of the Official to be embossed on the card Designation Date of Birth Residential Address with Telephone No Gross Annual Income Specimen signature 1.             2.             3.             4.             5.               The Company hereby applies for the issue of Vijaya Bank VISA Global Credit Card/s to the above mentioned official/s and authorises them to incur charges on Company account through the use of the Vijaya Bank VISA Global Credit Card/s so issued and agrees to accept liability for all charges incurred by and arising from the use of Vijaya Bank VISA Global Credit Card/s issued hereon including any re-issued Credit Card/s. The Company authorises Vijaya Bank and/or their representative/s to contact the Companys bankers or any other source to obtain any other information Vijaya Bank may require. We have gone through the Terms & Conditions of this application and agree to abide by the same. We authorise you to debit our CA / CC / OD A/c No ___________________________ with branch ________________________________________ as and when the bills are raised towards utilisation of cards issued to the above officials of the Company. Signed for & on behalf of the above Company by the Managing Director/Authorised signatory.   _______________________________________ Signature _______________________________________ Name & Designation with Company Seal