HSBC ADD-ON CREDIT CARD APPLICATION FORM

Please complete all sections. Tick  boxes as appropriate. Please fill in the form in block (CAPITAL) letters only.
REQUEST FOR ADD-ON CREDIT CARD
Please complete all the sections. Tick  boxes as appropriate and specify (NA) where not applicable. The Add-on credit card issued will be the same as the primary credit card.

PRIMARY CREDIT CARDHOLDER DETAILS

Your name (as it appears on your credit card) (In the order of First Name, Middle name, Last name)
ggggggggggggggggggggggggggggggggggggggggggggggggg
Your credit card number gggg gggg gggg gggg

E-mail ggggggggggggggggggggggggggggggggggggg

Mobile ggggg ggggggggggg

(ISD code)

ADD-ON CREDIT CARDHOLDER DETAILS

Add-on applicant
Affix
self-attested
recent
Residential status g Resident g Non-Resident g Foreign national g Person of Indian Origin passport size
photo
Salutation g Mr. g Mrs. g Ms. g Mst. g Others
Full name (In the order of First Name, Middle name, Last name)
ggggggggggggggggggggggggggggggggggggggggggggggggg
Are you known by any other names g Yes g No
Former/Other/Maiden name (If any) (In the order of First Name, Middle name, Last name)
ggggggggggggggggggggggggggggggggggggggggggggggggg
Name (Same as per ID proof) (provide if different from Full name)
ggggggggggggggggggggggggggggggggggggggggggggggggg
Name as desired on the card/How would you like to be addressed in our communication?
ggggggggggggggggggggggggggggggggggggggggggggggggg
Date of birth g
D g
D g
M g
M g
Y g
YgY g
Y Gender g M g F g Third Gender Marital status g Married g Single g Others ___________________

Place/City of Birth _______________________________________________________________________________________________________________________________________

Nationality (country/region/territory)/Citizenship of ___________________________________________________________________________________________________________

Multiple Nationality g Yes g No Nationality (country/region/territory)/Citizenship 1 ______________________________________________________________________

Nationality (country/region/territory)/Citizenship 2 ______________________________________________________________________

KYC number gggggggggggggg (number would be given by the Central KYC registry) (If available)

PAN card Number gggggggggg or g ‘Form 60 attached’

Father’s name
ggggggggggggggggggggggggggggggggggggggggggggggggg
Spouse’s name (If available)
ggggggggggggggggggggggggggggggggggggggggggggggggg
Mother’s maiden name
ggggggggggggggggggggggggggggggggggggggggggggggggg
Relationship with Primary Cardholder Education g Undergraduate g Graduate g Postgraduate g Professional
g Spouse g Parent g Children g Brother g Sister g Others __________________________

Officially Valid Documents - Proof of Identity (any one):

UID Aadhaar number gggg (only last 4 digits) or if applied Enrollment number gggggggggggggggg
or Virtual ID gggg gggg gggg gggg
Passport/NREGA Card gggggggggggggg gg
Expiry Date of Passport DD g
MgM g
Y g
Y g
Y g
Y

Voters ID/Driving Licence gggggggggggggg gg

D g
Expiry Date of Driving Licence DMgM g
Y g
Y g
Y g
Y

Officially Valid Documents - Proof of Address (any one):

g Aadhaar card g Passport g Voters ID g NREGA job card g Driving licence g Others __________________________
Correspondence Address: Same as Primary Cardholder

CRS - Individual Tax Residency Self-Certification:

Please complete the following table indicating:
i. The country/region where the accountholder is resident for tax purposes.
ii. The accountholder’s TIN (Tax Identification Number) for each country/region indicated.
If the accountholder is tax resident in more than one country/region please use a separate sheet. If a TIN is unavailable please provide the appropriate reason A, B or C,
details of which are mentioned below the table.
Jurisdiction of tax residence/ If no TIN available enter Reason If ‘B’ is selected, please explain why
TIN
Country/region of TIN issuance A, B or C unable to obtain TIN
1.

2.

3.

Reason A: The country/region where I am liable to pay tax does not issue TINs to its residents.
Reason B: The accountholder is otherwise unable to obtain a TIN or equivalent number. (Please explain why you are unable to obtain a TIN in the above table if you have
selected this reason)
Reason C: No TIN is required. (Note: Only select this reason if the authorities of the jurisdiction of tax residence entered in the table do not require the TIN to be disclosed)
Even if you have already provided information in relation to the United States Government’s Foreign Account Tax Compliance Act (FATCA), you are still needed to provide
additional information for the CRS as this is a separate requirement under the local regulation.

ADDRESS-RESIDENTIAL AND EMPLOYMENT

Current Address/Valid In-force Address (as per OVD):
ggggggggggggggggggggggggggggggggggggg
Flat number and building name

Road number/name gggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country/region gggggggggggggggggggggggggggggggg Pin code gggggg

Telephone number (Res.) ggggg gggggggggg Mobile number gggggggggg

(STD code)

E-mail ggggggggggggggggggggggggggggggggg
1. Is this address residential and business g Yes g No 2. Is your current address same as permanent address g Yes g No
(if No then please provide the address details in Additional Details Section)
3. Is this current resident address less than 12 months g Yes g No 4. Years at present address gg Years gg Months
(if Yes, please provide the address details in Additional Details Section)

5. Current Address in the jurisdiction details where applicant is resident for Tax Purposes
Same as Current Resident address g Same as Permanent address g Others g (if others, please provide the address details in the Additional Details Section)

House ownership g Company residence g Fully owned private house g Mortgaged property g Rented house g Living with parents/relatives
g Others g PG/hostel
Office address:
Company name ggggggggggggggggggggggggggggggggggggggggg
Building name ggggggggggggggggggggggggggggggggggggggggg
Road number/name ggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country/region gggggggggggggggggggggggggggggggg Pin code gggggg

Telephone (office) gggg gggggggg ggggg

(STD code) (Extn#)

E-mail ggggggggggggggggggggggggggggggggg
Permanent address:
ggggggggggggggggggggggggggggggggggggg
Flat number and building name

Road number/name gggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country/region gggggggggggggggggggggggggggggggg Pin code gggggg

I would like to opt for statement by e-mail. g Yes g No Note: If you opt for statement by e-mail, you will no longer receive a printed copy of your credit card statement.

EMPLOYMENT DETAILS
Employment status g Employed (Salaried) g Self-employed g Retired g Housewife g Student*
If you are a student please provide
Course start date ________________________ Course end date ________________________
*Please provide a self attested photo copy of your student ID card.
Salaried

Nature of organisation Occupation details

g MNC g Government g PSU g Senior Management g Manager/Executive g Non-Executive

g Public Limited g Private Limited g Proprietorship g Teacher g Police g Armed forces
g Partnership g HUF g Salaried g Seafarer
g Others (please specify) _______________________
Self-employed

Your firm is g Proprietorship g Partnership g Private Limited

Employment Role Business Owner __________________________________________________ Employee __________________________________________________
Key Controller __________________________________________________ Sole Trader __________________________________________________

To be filled by both salaried and self-employed customers:

Your business type Category __________________________________________________ Sub-category __________________________________________________

If salaried:
Designation ___________________________________________________________________ Department ________________________________________________________________

Annual Salary _______________________________________ Total no. of years in employment/business gg No. of years in present employment/business gg
ADDITIONAL SECTION FOR ADDRESS DETAILS
Other residential address
Previous Address: (if resident at current address for less than 12 months)
ggggggggggggggggggggggggggggggggggggg
Flat number and building name

Road number/name gggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country/region gggggggggggggggggggggggggggggggg Pin code gggggg

Years at previous address gg Months gg Years

Current Address in the jurisdiction details where applicant is resident for Tax Purposes:
If Same as Current Resident/Permanent address/Overseas address g Yes g No
If different, Address Type: g Residential/Business g Residential g Business g Registered office
ggggggggggggggggggggggggggggggggggggg
Flat number and building name

Road number/name ggggggggggggggggg Area and landmark ggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country/region gggggggggggggggggggggggggggggggg Pin code gggggg

KEY THINGS YOU SHOULD KNOW

1. Credit cards from HSBC have been designed to complement your lifestyle. We currently offer VISA Platinum, VISA Smart Value and HSBC Cashback Credit Cards. The cards
extend a host of offers ranging from travel privileges to dining, shopping and more.
2. Please visit the credit cards section of our website www.hsbc.co.in for more details on:
- Lost card liability and how to reduce the chances of your credit card being subject to misuse
- Transaction fee and applicable interest for cash advances against your credit card, finance charge (interest) in case the credit card outstanding is not repaid
in full by the due date
3. You need to pay the minimum payment due (you may choose to pay higher) by the payment due date specified on your monthly card statement to avoid transactions getting
declined and levy of late payment fee. Non-payment would impact:
- Your credit rating (reporting to Credit InformationCompanies)
- Other credit facilities availed fromHSBC
- In addition to the above, the Bank can cancel the credit limit and initiate recovery proceedings to recover the dues.
4. Making only the minimum payment every month would result in the repayment stretching over time with consequent interest payment added to the outstanding balance.
Please refer to Most Important Terms and Conditions (MITC) on www.hsbc.co.in
5. The Bank will notify you of any changes in the terms and conditions of this product with prior notice of one month.
6. All Cards will now allow contactless payments wherein PIN is not required at the Point Of Sale (POS) terminals and supports contactless payments up to the pre-defined
limits set on your card.

OPTION IF ADD-ON CREDIT CARDHOLDER IS AN ACCOUNTHOLDER WITH HSBC

In addition to the emergency cash advance facility through the ATM network of HSBC, the credit card from HSBC can also be used as an ATM card to access Savings/Current
account(s) with HSBC. To use this unique facility, please mention the account to be linked for usage with this Add-on credit card.
For the Add-on credit card:
First Add-on credit Cardholder’s
Savings/Current A.c no. *____________________________________________________________
#
(Signature of joint accountholder, if any)
Others *____________________________________________________________

(Signature of joint accountholder, if any)

#

Second Add-on credit Cardholder’s

Savings/Current A.c no. *____________________________________________________________
#
(Signature of joint accountholder, if any)
Others *____________________________________________________________
#
(Signature of joint accountholder, if any)
*Please note: The account nominated for access through an ATM must be a sole account or a joint account with 'either' signing Mandate.
#
In case of a joint account, only an account with two signatories is permitted. The joint accountholder must sign in the space provided.

DECLARATION
I hereby declare that the above information is complete and true and HSBC is entitled to verify this directly or through any third party agency(ies). I further state that HSBC may
at its sole discretion sanction or decline this application for primary and/or Add-on applicant(s). I confirm that the Add-on applicant(s) and I will jointly and severally be bound
by the terms and conditions of usage of the credit cards, copy of which are available on the HSBC website and would be made available on approval of the card. I authorise
HSBC to debit my credit card account for any fees, charges, interest, etc. I irrevocably confirm that all dues in respect of the HSBC Credit Card utilised for services availed of and
goods purchased from eligible service establishments/merchants, by me and any Add-on Cardholder(s), will be payable by me and I guarantee the payment towards the same in
my capacity as the principal Cardholder. I undertake and declare that usage of the credit card by me and any Add-on applicant(s) will be strictly in accordance with the Foreign
Exchange Management Act, ('FEMA') 1999 and the applicable rules, regulations, notifications, directions or orders made thereunder and I confirm that I have (on behalf of HSBC)
obtained undertaking(s) from the Add-on applicant(s) to this effect. In the event of failure by me or any Add-on applicant(s) to comply with the provisions of FEMA, as aforesaid, I
and such Add-on applicant(s) will be liable for action under FEMA. I authorise HSBC to, without notice, combine or consolidate the outstanding balance on the card account with
any other account(s) which I maintain with HSBC, and set off or transfer any money outstanding to the credit of such other account(s), in or towards the satisfaction of my liability
to HSBC under this Agreement.
I acknowledge that the existence of this account and details thereof (including details of credit card transactions and any defaults committed by me), will be recorded with credit
reference agencies and such information (including processed information) may be shared with banks/financial institutions and other credit grantors for the purposes of assessing
further applications for credit by you and/or members of your household, and for occasional debt tracing and fraud prevention. I accordingly authorise HSBC to share information
relating to my credit card account/application, including information relating to any Add-on applicant(s). I understand that as a precondition, relating to grant of loans/advances/
other non-fund-based credit facilities to me, HSBC requires consent for the disclosure by HSBC, of information and data relating to me/Add-on applicant(s), of the credit facility
availed of/to be availed of by me, obligations assumed/to be assumed by me, in relation thereto and default, if any, committed by me in discharge thereof.
1. Accordingly, I hereby agree and give consent and confirm that I have obtained consent from the Add-on applicant(s) for the disclosure by HSBC of all or any such; (a)
information and data relating to me/Add-on applicant(s) (b) the information or data relating to any credit facility availed of/to be availed of by me and (c) default, if any,
committed by me in discharge of my such obligation, as HSBC may deem appropriate and necessary, to disclose and furnish to Credit Information Bureau (India) Ltd. and any
other agency authorised in this behalf by RBI.
2. I undertake on my behalf and on behalf of the Add-on applicant(s) that (a) the Credit Information Bureau (India) Ltd. and any other agency so authorised may use, process
the said information and data disclosed by HSBC; and (b) the Credit Information Bureau (India) Ltd. and any other agency so authorised may furnish for consideration,
the processed information and data or products thereof prepared by them, to banks/financial institutions and other credit grantors, as may be specified by the Reserve Bank
in this behalf.
3. I agree that credit limits are subject to periodic review and will vary based on the bank’s credit assessment of my card account. Accordingly, I expressly grant consent and
authorise HSBC to decrease my credit limit, if required.
4. I hereby declare that I am not a near relation to any senior officer of the Bank or any directors of any HSBC Group Companies (please strike off if this is not the case and
provide a separate list of relevant related persons).
5. I confirm that as on date of this application, there are no litigations, initiated by other banks/Financial Institutions, being faced by me (please strike off if this is not the case
and provide a separate list of initiated/pending litigations) in addition to any general right to lien/set-off or other right conferred by law or under any other agreement.
6. I hereby declare that all the decisions of HSBC, in respect to the issuance of the credit card to me/the Add-on applicant(s) shall be binding on me and neither me nor any
person claiming through me, shall raise any dispute in this regard.
7. I hereby declare that I have read and understood the most important terms and conditions as mentioned in the application form.
8. I undertake to inform HSBC regarding any change in my residence/employment address and to provide any further information that the bank may require to process my
application. In the event of change in address due to relocation or any other reason, I shall intimate the new address to HSBC within 2(two) weeks of such a change.
9. I understand that the documents and the application form submitted will be treated as a property of HSBC and will not be returned.
10. I understand that as a part of this application process, my credit report may be queried multiple times for verification. I also understand that such multiple queries have a
marginal impact on my Credit score and may affect the assessment of my application for credit facilities from other institutions.
E-mail Statement: I\We agree to receive the card account related information such as statement, details/revision of charges, etc. in an electronic format to my/our e-mail ID
specified on HSBC's records in lieu of physical copies thereof. I/We shall notify HSBC of any change in my/our e-mail ID. HSBC will be deemed to have delivered the same to me
upon it not receiving any delivery failure notification. If I experience any difficulty in accessing the electronically delivered documents/communications, I/we shall promptly advise
HSBC for delivery through alternate means.
Failure to advise HSBC of such difficulty within 30 days after receiving the statement shall serve as an affirmation regarding the acceptance of the statement by me/us. I/We
confirm that I/we am aware of all security risks involved in receiving the electronically delivered statement and undertake not to hold HSBC responsible in any way for the same.
I/We agree that duplicate statements of past transactions are issued against payment of charges as per HSBC’s current Tariff, if applicable. In case of receiving e-statements
through HSBC Internet Banking, I/we agree to be bound by the terms and conditions mentioned on the website www.hsbc.co.in.
I/We hereby agree and undertake to:
a) Indemnify and keep the HSBC and its directors, officers, employees, and agents etc., indemnified from all actions, proceedings, claims, loss, damage, charges, costs and
expenses, which may be made or brought against, or suffered or incurred by them, or may arise or have arisen, either directly or indirectly, out of or as a consequence of or in
connection with:
i. HSBC acting pursuant to, in accordance with, or relying upon, with the consent to this Application Form or instructions, either in writing or through any other medium
including Internet Banking, telephone, facsimile message, registered email, etc. (“Instructions”) given by me/us and/or any person acting through or on my/our behalf,
which HSBC believes, in good faith, to be authentic, and/or any action or step taken by HSBC hereunder (including the costs of enforcing the same), including but
not limited to any variation in Instructions, where I/we gave or may have given contrary instruction to the Relationship Manager or the Bank, for any other reason
whatsoever, and/or
ii. Non receipt of any Instructions claimed to have been sent by me/us to HSBC, non-execution of any Instructions, or delay in receipt of or execution of Instructions due to
any reason,
iii. All claims, costs, losses, damages, charges, expenses and liability of any kind or nature whatsoever and expenses that may be incurred by HSBC by reason of any act or
default on my/our part in respect of the card facility and/or for the recovery of the outstanding dues on account of my/our failure on any of the terms and conditions
herein,
iv. Any tax liability, interest and penalty raised against or suffered by HSBC as a result of either relying upon this declaration or due to my/our delay/default in confirming the
change, if any, of the declarations mentioned above, except where such actions, proceedings, claims, loss, damage, charges, costs or expenses (as the case may be)
have arisen as a consequence of gross negligence or wilful misconduct on part of HSBC.
b) Notwithstanding anything contrary contained herein or elsewhere, HSBC shall have no liability to me/us or to any other person for any consequential, compensatory, special
or other damages, including without limitation for loss of profits.
c) This indemnity is without prejudice to any other rights, privileges, powers and remedies that HSBC may have in law or equity. A failure or delay in exercising any right/power/
privilege by HSBC will not operate as a waiver, and a single/partial exercise of any right/power/privilege will not preclude any subsequent or further exercise of the same or the
exercise of any other such right/power/privilege.
This indemnity shall survive the termination of relationships held by me/us with HSBC.

DISCLOSURES
• The applicant acknowledges the right of HSBC to provide details of his/her credit card account to third party agencies for the purpose of availing of support services
of any nature by HSBC, without any specific consent or authorisation from him/her
• The applicant further acknowledges that HSBC is authorised to share information relating to the applicant, including information relating to any default committed by the
applicant in discharge of his/her obligation, as HSBC may deem appropriate and necessary, with any existing or future credit bureaus/credit reference agencies as
determined by the Bank from time to time.
Accordingly, the applicant herein expressly gives consent to disclose information to such credit bureaus/credit reference agencies. Such entities may further make available
processed information or data or products thereof to banks/financial institutions and other credit grantors
• HSBC also provides information relating to credit history/repayment record of the applicant to a Credit Information Company (specifically authorised by the RBI), in terms
of the Credit Information Companies (Regulation) Act, 2005
• For credit card accounts where correspondence from HSBC is currently withheld due to non-delivery of earlier correspondence, then HSBC will make attempts to
contact the customer to update the correct address details.
If HSBC is unable to establish contact with the customer, the operation of the account will be restricted by providing a prior notice of 30 days until the correct address is
updated on the Bank’s records with address proof, or until the customer confirms the current address on the Bank’s records to be correct
TAX REPRESENTATION
• Individual accounts: The applicant is responsible for fulfilling any obligation that you may have with respect to the filing of returns or other required documentation in respect
of and the payment of all relevant taxes, including, without limitation, all income, capital gains, wealth and estate duties, stamp duties, Service Tax, Value Added Tax and any
other applicable taxes. The creation and continued operation of he/she account and/or the acquisition, holding or disposal of investments or assets in such account, as
well as any income, distributions or losses realised in relation to the operation of the account may expose you to tax consequences depending on a number of factors
including, but not limited to, your applicable domicile, he/she place of residence, he/she citizenship or the type of assets he/she hold. Certain countries may have tax legislation
with extraterritorial effect regardless of he/she place of domicile, residence or citizenship. HSBC does not provide any legal or tax advice and you should seek legal and/
or tax advice from an independent legal and/or tax adviser. You acknowledge and agree that HSBC has no liability in respect of any of your tax obligations and/or
any legal and/or tax advice provided to you by third parties
SANCTION CLAUSE
• The Bank and other members of the HSBC Group are required to and may take any action to meet Compliance Obligations relating to or in connection with the detection,
investigation and prevention of Financial Crime (Financial Crime Risk Management Activity) and act in accordance with the laws, regulations and requests of public and
regulatory authorities operating in various jurisdictions which relate to Financial Crime. The Bank may take, and may instruct (or be instructed by) any other member of the
HSBC Group to take, any action which it or such other member, in its sole and absolute discretion, considers appropriate to take in accordance with all such laws, regulations
and requests
• Such action may include but is not limited to (a) screening, intercepting and investigating any instruction, communication, drawdown request, application for services, or any
payment sent to or by you, or on your behalf, (b) investigating the source of or intended recipient of funds (c) combining customer information with other related information in
the possession of the HSBC Group, and/or (d) making further enquiries as to the status of a person or entity, whether they are subject to a sanctions regime, or confirming
your identity and status and (e) share information on a confidential basis with such HSBC Group offices, whether located in India or overseas in relation to prevention
of Financial Crime
• Exceptionally, our Financial Crime Risk Management Activity may lead to us delaying, blocking or refusing the making or clearing of any payment, the processing of your
instructions or application for services or the provision of all or part of the services. To the extent permissible by law, neither we nor any other member of HSBC Group
shall be liable to you or any third party in respect of any loss (whether direct or consequential and including, without limitation, loss of profit or interest, however it arose) that
was suffered or incurred by you or a third party, caused in whole or in part in connection with the undertaking of Financial Crime Risk Management Activity for the purpose of
the present clause
• ‘Compliance Obligations’ means obligations of the HSBC Group to comply with: (a) laws or international guidance and internal policies or procedures, (b) any demand or
request from authorities or reporting, disclosure or other obligations under laws, and (c) laws requiring us to verify the identity of our customers
• ‘Financial Crime’ includes money laundering, terrorist financing, bribery, corruption, tax evasion, fraud, evasion of economic or trade sanctions, and/or any acts or attempts to
circumvent or violate any laws relating to these matters
CRS and CKYCR Declaration and Consent clause
I have read and understood the information requirements and the terms and conditions mentioned in this form (and hereby confirm that the information provided by me on this
form is true, correct and complete. I hereby agree and confirm to inform The Hongkong and Shanghai Banking Corporation Limited, India (HSBC) for any modification to this
information promptly. I further agree to abide by the provisions relating to ‘Foreign Account Tax Compliance Act' (FATCA) and Common Reporting Standards (CRS) on Automatic
Exchange of Information (AEOI) provided in Rules 114F to 114H of the Income Tax Rules, 1962’.
I authorise you to update your records basis the above information. I also authorise you to share the given information provided by me with any statutory/regulatory authorities, as
appropriate or HSBC group entities.
I understand that the details provided in the form will be reconciled with your existing records and any discrepancy thereof will be duly highlighted to me for further rectification/
updation of records.
I acknowledge that the information contained in this form and information regarding the accountholder and any Reportable Account(s) may be provided to the tax authorities of
the country/region in which this account(s) is/are maintained and exchanged with tax authorities of another country/region or countries in which the accountholder may be tax
resident pursuant to intergovernmental agreements to exchange financial account information.
I certify that I am the accountholder (or am authorised to sign for the accountholder) of all the account(s) to which this form relates.
In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.
I hereby consent for receiving information from Central KYC Registry through SMS/E-mail on the above mentioned registered number/e-mail address.
I certify that where I have provided information regarding any other person (such as a Controlling Person or other Reportable Person to which this form relates) that I will, within
30 days of signing this form, notify those persons that I have provided such information to HSBC and that such information may be provided to the tax authorities of the country/
region in which the account(s) is/are maintained and exchanged with tax authorities of another country/region or countries in which the person may be tax resident pursuant to
intergovernmental agreements to exchange financial account information.
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I under take to inform you of any changes therein immediately. I
also undertake to provide HSBC with a suitably updated self-certification and declaration within 90 days of such change in circumstances which affects my tax residency status.
KNOW YOUR CUSTOMER/DUE DILIGENCE REQUIREMENT
• In line with the requirements of the Bank's policy, the Know Your Customer (KYC) documents along with other documentation need to be submitted at the time of availing a
new card/account or as and when requested by the Bank. If we collect any information from you other than KYC requirement, we will collect it separately and not as part of
account opening form. In case we collect any additional information we will explain the purpose for which we are collecting this information and take your specific consent for
the same.
HSBC reserves a right to allow/restrict operations in a newly opened/existing credit card accounts maintained with the Bank, if the customer is not able to satisfy the due
diligence requirements in line with the Internal Policy.
ACCOUNT RULES AND TERMS AND CONDITIONS
• HSBC reserves a right to block transactions/allow operations in a newly opened/existing credit card accounts maintained with HSBC, if the account deliverables/
welcome letter/welcome pack/bank correspondences not limited to account statements, etc., are returned undelivered and HSBC is unable to contact the accountholder
at the address/contact number provided by them at the time of account opening/updated in bank records

X X
Signature of Primary Cardholder Signature of Add-on Cardholder

Date: ___________________________________

CUSTOMER CONSENT
Marketing Offers
I hereby agree to receive marketing communications through telephone call/E-mail/SMS on various products/features/promotion offers provided by the Bank. I understand
that in case I DO NOT wish to receive marketing offers or the marketing communication, I can register for 'Do Not Call and Marketing Opt Out' service through Bank’s
website www.hsbc.co.in. or other channels as may be offered by the Bank.
g Sharing of information and Assignment of Activities to Third Party Agencies
I/We acknowledge and agree to HSBC assigning any activities to any service provider, whether located in India or overseas and whether an HSBC Group entity or a
third party, at its sole discretion, in accordance with the applicable guidelines of the Reserve Bank of India (RBI). I further agree and consent to HSBC providing details
of my/our account and sharing or transfer of information on a strictly confidential basis to HSBC Group offices or other third party agencies/service providers, whether
located in India or overseas for the purpose of availing support services of any nature HSBC may also disclose any information if required or permitted by any law, rule
or regulation or at the request of any public or regulatory authority or if such disclosure is required for the purposes of preventing fraud, without any further specific
consent or authorisation from me/us. I/We understand and consent to HSBC using or sharing information submitted by me/us to conduct employment verification and
other related checks, through third party agency(ies) engaged by it, from public information sources such as Employees' Provident Fund Organisation (EPFO).
I/We am/are voluntarily providing a physical copy of my Aadhaar card/e-Aadhaar card in a masked form to HSBC for the purpose of establishing my/our identity/
address proof to set up a banking relationship and process instructions in relation to the same.
I hereby provide my consent for verification of my Aadhaar to establish its genuineness through such means acceptable as per UIDAI or under any Act or law from
time to time. The consent and purpose of collecting Aadhaar have been explained to me and I confirm having understood the same.
I acknowledge that the Bank will store the said Aadhaar number in a masked form in their records and use the same for such purposes as may be permitted.
I also acknowledge that the Bank has provided me/us with alternate options in terms of identity documents that could be provided in lieu of Aadhaar for setting up a
banking relationship.

X X
Signature of Primary credit card applicant Signature of Add-on Cardholder

ACKNOWLEDGEMENT (To be filled by sales representative)

I hereby confirm that the applicant(s) has/have signed in my presence.
i. The customer’s need for the product has been identified based on the reason for availing of the product as indicated by the customer in the form.
ii. The suitability of the product has been understood based on the financial standing and income details provided by the customer in the form.
iii. I confirm that the details provided by the customer are correct. I have personally verified this and have performed the due diligence on other declarations submitted by customer
(if any)

X X
Signature of Bank Executive Signature of Agent
Date: ___________________________________

OTHER DECLARATIONS
1. g I declare that my signature/signature flow on __________________________________________ document is my old signature and the signature done on the application
form and self-attestation done on documents is my new signature. Please consider my new signature for processing the Credit Card application
2. g I declare that my name on _________________________ document is mentioned g shortly g incorrect g has a spelling error g Order mismatch g is a
mismatch. Hence request to please consider my name as mentioned in the credit card application
3. g I declare that my Date of Birth mentioned on _____________________________ document is wrong. Please consider my Date of Birth as mentioned in the credit card
application
For Point 1 For Point 2 For Point 3

Customer Signature Customer Signature Customer Signature

 ANNEXURE
Instructions/Check list/Guidelines for filling Individual Application Form
Self-Certification of documents is mandatory.
The generation of KYC number/identifier will be performed by the Bank subject to availability of necessary technology.
Clarification/Guidelines on filling details for CRS purposes.
Reason A: The country/region where I am liable to pay tax does not issue TINs to its residents.
Reason B: The accountholder is otherwise unable to obtain a TIN or equivalent number. (Please explain why you are unable to obtain a TIN in the below table if you have
selected this reason.)
Reason C: No TIN is required.
(Note: Only select this reason if the authorities of the jurisdiction of tax residence entered in the table do not require the TIN to be disclosed.)

Appendix – Definitions

Note: These are selected definitions provided to assist you with the completion of this form. Further details can be found within the Income Tax Rules, 1961 and OECD
Common Reporting Standard for Automatic Exchange of Financial Account Information (the CRS), the associated commentary to the CRS, and domestic guidance. This
can be found at the following link www.oecd.org/tax/automatic-exchange/
If you have any questions then please contact your tax adviser or domestic tax authority.

Tax Identification Number (TIN): TIN (including functional equivalent) – The term TIN means Taxpayer Identification Number assigned to a person in the country/territory in
which he is resident for tax purposes and includes a functional equivalent in case no such number is assigned. A TIN is a unique combination of letters or numbers assigned
by a jurisdiction to an individual or an Entity and used to identify the individual or Entity for the purposes of administering the tax laws of such jurisdiction. Further details of
acceptable TINs can be found at the following link www.oecd.org/tax/automatic-exchange/
Some jurisdictions do not issue a TIN. However, these jurisdictions often utilise some other high integrity number with an equivalent level of identification (a functional
equivalent). Examples of that type of number include, for individuals, a social security/insurance number, citizen/personal identification/service code/number, and resident
registration number, PAN (Permanent Account number) and resident registration number.)
Accountholder – The term ‘accountholder’ means the person listed or identified as the holder of a Financial Account by the financial institution that maintains the account.

CKYCR – Central KYC Registry.

Controlling Person – This is a natural person who exercises control over an Entity and includes a beneficial owner as determined under sub-rule (3) of rule 9 of the Prevention
of Money-Laundering (Maintenance of Records) Rules, 2005.
In determining the beneficial owner, the procedure specified in the following circular as amended from time to time shall be applied, namely:
i. DBOD.AML.BC. No.71/14.01.001/2012-13, issued on 18 January 2013 by the Reserve Bank of India; or
ii. CIR/MIRSD/2/2013, issued on 24 January 2013 by the Securities and Exchange Board of India; or
iii. IRDA/SDD/GDL/CIR/019/02/2013, issued on 4 February 2013 by the Insurance Regulatory and Development Authority.
In the case of a trust, the Controlling Person means the settlor, the trustees, the protector (if any), the beneficiaries or class of beneficiaries, and any other natural person
exercising ultimate effective control over the trust, and in the case of a legal arrangement other than a trust, the said expression means the person in equivalent or similar
position.
Where an Entity accountholder is treated as a Passive Non-Financial Entity (NFE) then a Financial Institution must determine whether such Controlling Persons are Reportable
Persons. If the account is maintained for an Entity of which the individual is a Controlling Person, then the ‘Controlling Person tax residency self-certification’ form should be
completed instead of this form.

Entity – The term ‘Entity’ means a legal person or a legal arrangement, such as a corporation, organisation, partnership, trust or foundation.

FATCA – Foreign Account Tax Compliance Act

Financial Account – A ‘Financial Account’ is an account maintained by a Financial Institution and includes: Depository Accounts; Custodial Accounts; Equity and Debt
interest in certain Investment Entities; Cash Value Insurance Contracts; and Annuity Contracts.

Reportable Account – The term ‘Reportable Account’ means an account held by one or more Reportable Persons or by a Passive NFE with one or more Controlling Persons
that is a Reportable Person (relevant extract for CRS).

Reportable Person
Reportable person means,
(a) one or more persons other than,
i. a corporation, the stock of which is regularly traded on one or more established securities markets;
ii. any corporation that is a related Entity of a corporation mentioned in item (i);
iii. a Governmental Entity;
iv. an International organization;
v. a Central bank; or
vi. a financial institution,
that is a resident of any country/territory outside India (except the United States of America) under the tax laws of such country/territory or an estate of a descendent who was
a resident of any country/territory outside India (except the United States of America) under the tax laws of such country/territory; (relevant extract for CRS).
Dual resident individuals may rely on the tiebreaker rules contained in tax conventions (if applicable) to solve cases of double residence for purposes of determining their
residence for tax purposes.
 BANK USE SECTION

Is the customer using any high risk products? g Yes g No

Is this a new customer applying for a credit card only? g Yes g No

Is this a face-to-face account opening? g Yes g No

Channel Type – g Branch g MSF g MSF - TPSA g Contact Centre g Postal g Digital

Has the Customer’s Identity been verified in line with the required standards? g Yes g No

Is the customer able to provide required ID? g Yes g No

Currency that applies to all intended transactions: INR/USD/Other _______________________

Is a CDD Risk Acceptance request required to be submitted to Business and FCC? g Yes g No

Is the customer a permanent resident in the same country/territory they have or are opening their product? Is the customer
a permanent resident in the same country/territory they have or are opening their product? _______________________

Confirm the customer’s occupation as a student has been validated. g Yes g No

Is the customer a permanent resident in the same country/territory they have or are opening their product?Is the customer
a permanent resident in the same country/territory they have or are opening their product? g Yes g No
Account record checked by (To be checked by the account opening staff):

Employee name: ____________________________________________________

PS ID: ____________________________________________ Signature __________________________________________

g For MSF/Branch Channels - KYC completed and account opening authorised by Account Opening Authority (provide AOA details:
Branch Manager/Regional Head/Designated AOA details)

Opened by g MSF g Branch Date of submission of all documents gg gg gggg

Anticipated account activity aligned to customer profile g Yes g No

I have verified the name of the customer on AOF with the KYC documents provided and confirm that it meets the standards of CDD.

I also hereby confirm that customer’s photo on PI and PA (if photo ID) matches with the photo on AOF g Yes g No

Branch Manager/Regional Head name ________________________________________ Branch Manager/Regional Head staff number gggggg

Branch Manager’s/Regional Head’s signature

CONNECTED PARTY
List the connected/associated parties who will have control or influence over the customer's account without necessarily signing on the account. These parties could be over
and above the Add-on cardholders.

Connected parties g Yes g No : Rationale for connection : Add-on Cardholder

KYC number gggggggggggggg (number would be given by Central KYC registry) (If available)
Connected party details: g Individual

Existing Customer g Yes g No

ggggggggg
Customer ID (if existing customer):

Account number (if existing customer): gggggggggggggggg

What level of influence does the Connected Party have over the account?
g Control g Contribute g Direct g Beneficiary
Is the Connected Party’s customer record in the same system as the main party’s? g Yes g No
Rationale for connection _________________________.

Confirm that the identity of the Connected Party (full name, residential address) has been verified. g Yes g No

Is there a reasonable connection between the Connected Party and the customer? g Yes g No
Is the Connected Party a Politically Exposed Person (PEP)? g Yes g No

Was Connected Party’s Identity verified through the use of Electronic or Documentary sources? g Yes g No

Were any exceptions (to global CDD policy) noted during the Connect Party verification process? g Yes g No
Confirm the purpose of opening the account(s) is consistent with the expected account activity and the customer’s profile, including their Source of Funds and Source of
Wealth (where applicable)? g Yes g No

I confirm that I have met the primary applicant in person and verified the ID and address documents in original.
Employee name: ____________________________________________________

PS ID: ____________________________________________ Signature ____________________________________________

There are no annual fees on the Add-on credit card. However, finance charges applicable on the unpaid due amount as per the applicable rate
from the date of transaction.
 DOCUMENTS REQUIREMENT
Proof of Identity (any one) Proof of Address (any one)
• PAN number • Aadhaar card
• Aadhaar card or Virtual ID • Passport
• Passport • Voters ID
• Voters ID • NREGA job card
• National Rural Employment Guarantee Act • Driving licence
(NREGA) job card
• Driving licence • Others __________________________
#
For information on additional documents acceptable as identity/address proof, please get in touch with the nearest HSBC branch in India or your HSBC Relationship Manager or call
the HSBC Contact Centre.

Documents accepted as a Proof of Address should mention the address details.

Self-attested copy of the latest salary slip or Income tax returns or Form 16 (wherever applicable).

For credit card customers without a bank account, a stenciled copy of the Primary Cardholder’s credit card is required. (To make a stencil copy of the credit card, place a blank paper
on the front of the credit card and then run a pencil across the paper, form an impression of the credit card number on the blank paper.)

If you are not comfortable in providing the stencil copy, please visit the branch with the primary applicant carrying his/her current ID and address document(s).

Kindly submit the documents to HSBC Representative or to nearest HSBC Branch in India with a duly completed and signed card application form, photocopies of the Proof of ID
and Proof of Address documents. You are requested to carry the original documents for verification by the HSBC representative.

Terms and Conditions apply. For further details on the products and services offered by HSBC, please visit www.hsbc.co.in or refer to the credit card services guide.

Issued by The Hongkong and Shanghai Banking Corporation Limited, India. Incorporated in Hong Kong SAR with limited liability.

ACKNOWLEDGEMENT - BANK DO NOT CALL SERVICES

Sr. No. _______________________ From time to time, HSBC, India communicates various features/products/
promotional offers which offer significant benefits to its Cardholders and
Agency Name _____________________________________________________
may use the services of third party agencies to do so. If you do not wish
Sales Executive’s Name ______________________________________________ to be informed about such benefits through telephone calls/SMS, you can
subscribe for the ‘Do not call’ service.
Sales Executive’s Code Please fill up the form given below and mail it to Direct Response Cell,
Received completed application form and relevant documents for credit card HSBC, P. O. Box 631, Mumbai GPO, Mumbai - 400 001. Your request will
from ____________________________________________________________ be implemented within 30 days from the date of receipt.
Customer Name
on D D M M Y Y Y Y
(If approved, your credit card will be despatched within 7 days. Please contact HSBC Name __________________________________________________________
24/7 customer service centre after 7 days to know the status of your application). First Middle Last

X X City ________________________________________
Signature of Sales Executive Signature of Customer
Please enter at least one of the following contact numbers:

Tel. No. gggg ggggggg

(STD Code)
ACKNOWLEDGEMENT - APPLICANT
Sr. No. _______________________ Mobile No. ggggggggggg
Agency Name _____________________________________________________

Sales Executive’s Name ______________________________________________

Sales Executive’s Code

Received completed application form and relevant documents for credit card
from ____________________________________________________________
Customer Name
on D D M M Y Y Y Y
(If approved, your credit card will be despatched within 7 days. Please contact HSBC
24/7 customer service centre after 7 days to know the status of your application).

X X
Signature of Sales Executive Signature of Customer
 SAVE PRINT

CC_ADD-ON FORM_11/2021

Issued by The Hongkong and Shanghai Banking Corporation Limited, India. Incorporated in Hong Kong SAR with limited liability.