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This document is a supplementary credit card application form for a primary cardholder to request adding additional cardholders. It requests information such as the primary cardholder's name and account, the name and date of birth of the proposed supplementary cardholder, their relationship to the primary cardholder, and the credit limit to be set for the supplementary card. It also lists the required identity and address verification documents that must be submitted along with the completed application form.

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21 views

CC Sup

This document is a supplementary credit card application form for a primary cardholder to request adding additional cardholders. It requests information such as the primary cardholder's name and account, the name and date of birth of the proposed supplementary cardholder, their relationship to the primary cardholder, and the credit limit to be set for the supplementary card. It also lists the required identity and address verification documents that must be submitted along with the completed application form.

Uploaded by

easymurugan
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SUPPLEMENTARY CREDIT CARD APPLICATION

(Liability of the Supplementary Credit Card will be on the Primary Card Member)

PRIMARY CARDHOLDERS DETAILS: Name Card Account:

Supplementary Card can be issued to family members (over 18 years of age) of the Primay Card Member
Please issue a Supplementary Card for my* Spouse Name* Father Mother Son Daughter Brother Sister

Date of Birth* D D M M Y Y Y Y Name as desired on Card*

Gender

Male

Female

(Maximum 19 characters, including spaces)

I would like to set the refresher limit (spend limit on the Supplementary Credit Card set by the Primary Card Member which is refreshed every at billing cycle) for the Supplementary Credit Card at Rs.___________________ (multiples of000 only) **Instructions Please enclose the following documents. A self-attested copy of proof of identity (any one of the following)* Passport Voters ID
Driving License

PAN Card Photo Ration Card Government ID Card A self-attested copy of proof of residential address (any one of the following)* Passport Voters ID Latest Electricity Bill Ration Card
Driving License

Latest Telephone Bill (Mobile/Landline)

Signature of Add on Applicant ( Please Signature Across the Photograph )

Photo of Supplementary Card Applicant

Please send colour Photograph(s) only. This would be retained by us for our records. Please do not use pins, tapes or staples to affix your photograph.

Signature of Primary Card Applicant

Date

D D MM Y Y Y Y

*Please provide separate self attested documents for proof of identity and proof of residential address. Only a valid passport will be accepted in both cases. At any given time, a maximum of up to 2 supplementary cards will be issued to a Primary Card Member including any supplementary cards issued against any other ICICI Bank primary credit card. **As per the provisions of Reserve Bank of India Master Circular (RBI / 2009-10/73; DBOD. AML. BC. No. 2/14.01.001/2009-10) on Know Your Customer (KYC) norms dated 01 July 2009, it is mandatory for all banks to update the customer identification documents (including photographs). Please send the completed form along with the documents to: ICICI Bank Ltd, Credit Card Operation, Electronic Sadan IV (ES-4), MIDC, TTC Industrial Area, Mahape, Navi Mumbai- 400 710

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