Branch: _______________________ Date: D D M M Y Y Y Y

VISA DEBIT CARD APPLICATION FORM

The Branch Manager

.................................................... Branch

I, the applicant, hereby request the Bank of Bhutan Limited to issue BoBL VISA DEBIT CARD to me to be operated
through my account given below:

CARD REQUEST: New Card Old ATM (Proprietary Card) Upgrade

CARD TYPE: INR (Domestic) USD (International)

PERSONAL INFORMATION
Cardholder Name

Account Number

Citizenship ID Number

Present Address

Mobile Number

Email ID

Passport No. Validity

Collection Branch

DECLARATION
I hereby declare that the information provided above are correct to the best of my knowledge. I agree that BOBL
reserves that right to accept or reject my application without assigning any reason whatsoever. I hereby irrevocably
authorize BOBL to debit from my above-mentioned account for the settlement of transaction amount by utilization of
BOBL Visa Debit Card issued in the above name(s) including any reissued card(s) and agree to undertake full liabilities
for all the charges/service fees applicable due to the utilization of the card to which you may be entitled in respect
of the transactions. I acknowledge that I have received, read and understood the Terms & Conditions governing the
use of BOBL Visa Debit Card and its consequences printed on the back of this form and agree to abide by these
unconditionally. In the event I fail to abide by such rules terms conditions, I shall bear the damage and/or penalties as
a consequence thereof. I understand that my old ATM Card will be deactivated upon issuance of my Visa Debit Card
(Domestic) by BOBL. I hereby undertake that use of my Visa Debit Card shall be in compliance with the Rules and
Regulations set therein the Foreign Exchange Regulations of Bhutan.

Further, I also hereby Authorize Bank of Bhutan Ltd. to deduct applicable card charges from my above mentioned
account.

(1) (2)
PLEASE SIGN
INSIDE THE BOX
(1) & (2)

(Signature of Applicant) (Signature of Applicant)

Please collect your card within three months from date of card issuance, otherwise Bank shall cancel the card and fee
is non-refundable

Date: D D M M Y Y Y Y (DD/MM/YYYY - Application Submitted On)

Note: The Custodian should maintain the Form for Record Page 1 of 4
 TERMS & CONDITIONS ON THE USAGE OF THE CARD BY THE CARDHOLDER
The Terms and Conditions under which the Card is issued are mentioned below for his/ for mBoB facility. Any transactions incurred prior to proper report of the loss, theft or
her guidance related to the usage of the Card by the Cardholder on his/her designated disclosure shall be for the Cardholder’s account.
Account No.: f. The Cardholder shall remain fully liable to the Bank for any and all debits to the
Card Account arising from any Card Transactions, Cash Advances or ATM transactions
1. The abbreviations used in these terms and conditions shall be construed as: effected through the use of the Card by any person whether the same be with or
a. “Card” means Bank Visa or Proprietary Debit Card issued to the customer. without the knowledge of or authority from the Cardholder.
b. “Bank” means Bank of Bhutan Limited. g. The Bank may in its absolute discretion issue a replacement for any lost or stolen
c. “Cardholder” means customer of Bank who has been issued the Card. Card, subject to an applicable card fee for each Card replaced, or a new PIN for the
d. “ATM” means Automated Teller Machine. relevant Card, all on such terms and conditions as the Bank may deem fit.
e. “Merchant” means shops/outlets that are authorized to accept cards as a mode of h. In the event that the Cardholder recovers the lost or stolen Card, he shall immediately
payment. return it to the Bank without using it. The Cardholder shall not use the same PIN after
f. “POS” means Point of Sale Terminal at Merchant outlets, where the cardholder the Cardholder has reported to the Bank such PIN’s disclosure to another person.
swipes the cards, which are authorized to accept the cards as payment mode.
g. “Account” means the account nominated by the cardholder that is to be debited 6. Debits to Cardholder’s Account
for use of Card. a. The Bank has the express authority to debit the designated account of the
h. “PIN” means Personal Identification Number, specific to each Cardholder. Cardholder for all transactions effected using the Card as evidenced by Bank’s records
i. ‘‘Skimming’’ means illegal copying of information from the magnetic strip of a credit which shall be conclusive and binding on the Cardholder. The Cardholder expressly
Card authorizes the Bank to debit the designated account.
b. The Bank shall debit the account designated by the cardholder for all transactions
2. Card initiated including cash withdrawals by using the card. For this purpose, the cardholder
a. The Card is a property of the Bank at all times. irrevocably authorizes the Bank to debit his/her nominated account(s) with the
b. The Bank reserves the complete rights to seize/cancel the Card so issued to the amount of transaction(s) plus charges if any by use of his/her card.
Cardholder, if found at later date, the information submitted by the Cardholder is false c. The Bank shall debit the Nominated Account for all fees and charges as determined
and/or the Card has been misused. by the Bank relating to the Card and service thereby provided.
c. The card is non-transferable and shall be used exclusively by the cardholder only.
d. The Bank reserves the right to terminate membership, withdraw the privileges 7. Daily Limit
attached to the Card or not to renew the expired Card at any time and to call upon the a. The Bank reserves the complete right to limit daily cash withdrawal by the
Cardholder to surrender the Card. Cardholder and decide on denomination that would be dispensed.
e. Upon termination of membership or withdrawal of privileges of the Card for any
reason whatsoever, the Card shall be returned to the Card Division within 7 days, form 8. Transactions
the date of receipt of notice. The Cardholder shall be liable for payment of the bills or a. The transaction record generated by the ATM/POS shall be conclusive and binding
unsettled amount arising out of use of the Card till Card is not surrendered to the Bank. unless verified otherwise and corrected by the Bank. The verified and corrected
f. Use of the Card after notice of withdrawal of the privileges or the termination of amount will be binding on the Cardholder.
the membership is fraudulent and may be subject to legal action by the Bank in b. Any sales slip signed by the Cardholder shall be the conclusive proof of the charges
accordance with the prevailing law. recorded therein any incurred by the cardholder himself/herself and shall be charged
g. The Cardholder shall provide written instructions to the Bank for the cancellation by the Bank to the Cardholder.
or nonrenewal of the Card one month prior to the expiry date specified in the Card. c. The Transaction Log of ATM transactions shall be the conclusive proof of the charges
recorded therein as incurred by the cardholder himself/herself. The verification of PIN
3. Validity of Card confirms the authenticity of the cardholder and the transaction.
a. The Validity of the card remains by the end of the month mentioned in the card in
MM/YY format 9. Dispute
a. It shall be the sole responsibility of the Cardholder to reconcile the transactions with
4. PIN the account statement every month and be vigilant of any unauthorized transaction
a. The Card and the PIN issued to the Cardholder are entirely at the Cardholder’s risk alert. Any dispute of the card transactions shall be lodged on the date of incidence or
and responsibility. The Cardholder shall not disclose the PIN or permit possession of finding to Cards Division or Bank’s Contact Center to avoid rejection due to delay in
the Card to any other person. The Cardholder undertakes full responsibility for any or lodging the claim with Visa International Payment Scheme.
all transactions made by the use of the Card with proper identification marked at the b. In case of any dispute arising out of these Terms and Conditions, the same shall be
time of transaction. mutually resolved to the extent possible.
b. The Cardholder is advised in his own interest to change his/her PIN choice. For this c. In the event that disputes cannot be resolved mutually between the Bank and
purpose, he/she may use the PIN change option available at BANK ATMs. Cardholder, the matter shall be referred to the Court for adjudication in accordance
c. Usage of a wrong PIN three times would invalidate your Card till activated by Bank with the relevant laws of the Kingdom. The Cardholder shall return this form after being
with proper verification. signed as a token of having read and understood the above Terms and Conditions.
d. The Card should remain in Cardholder’s possession and shall not be handed over
to anyone else. 10. Others
e. The Card is issued on the condition that the Bank bears no liability for the a. The Bank shall not be responsible in any way for non-availability of ATM services or
unauthorized use of the Card. This responsibility is fully that of the Cardholder. The POS terminals at Merchant outlets for any reason whatsoever and howsoever arising
cardholder undertakes not to carry Card and PIN in his/her Wallet/Purse and leave as a result of malfunctioning of the Card or ATM or POS, insufficiency of funds in such
card unattended in any places. machines, mechanical or power supply failure or otherwise.
f. The Cardholder shall change the PIN immediately if it is accidentally divulged. b. When the ATM is not running online or some technical snags are there, the
g. The Cardholder undertakes not to pass the card or disclose the PIN to any other transactions in the ATM transactions shall be accounted for on the same/next working
persons or to a Third Party. Any such disclosure or inadequate protection of the day or with some delay.
confidentiality of the PIN is entirely at the Cardholder’s risk. c. The Bank reserves the right to introduce new facilities/curtail facilities as and when
h. The Cardholder agrees to inform the Bank in writing regarding lost/stolen, damage warranted without assigning any reasons for the same. Delays in Card/PIN delivery
of card and disclosure of PIN. The Cardholder will be liable for all the transactions may take place due to circumstances beyond our control.
received prior to the receipt and record of such notification by the Bank. d. The Cardholder undertakes to indemnify the Bank and to keep the Bank indemnified
against all losses, damages, cost or expenses incurred and sustained by the Bank
5. Loss of Card and PIN / Skimming of Card data arising out of Cardholder’s failure to observe any of the terms and conditions herein
a. Any financial loss arising out of unauthorized use of the lost /skimmed card till mentioned.
such time the Bank records the notice of loss/skimming of the Card shall be to the
Cardholder’s account and the Cardholder shall be fully be responsible and liable. 11. Receipt of Funds in Excess of the Funds
b. The Cardholder undertakes to indemnify the Bank from and against all losses, 11.1. In all cases where the Cardholder receives excess funds, the Cardholder agrees
damages, cost or expenses incurred /to be incurred by the Bank arising out of to repay to the Bank the said excess funds as may be specified by Bank, or may be
Cardholder’s failure to observe any of the terms and conditions mentioned herein. deducted from the funds available on the Card upon such terms and conditions as the
c. The Cardholder shall be fully liable for all Card Transactions affected via the Bank shall specify or from any account of the Cardholder with Bank or by payment
corresponding PIN as such Card Transactions are deemed effected by or in behalf of to Bank.
the Cardholder. 11.2. Bank reserves the right to debit any excess funds credited to Customer’s Card
d. The Cardholder shall use all reasonable precautions to prevent the loss or theft of Account by mistake or oversight or otherwise, with prior intimation/approval by the
the Card and shall not disclose any PIN to any person. Cardholder
e. In the event that the Card is lost or stolen or card data is compromised, the
Cardholder shall immediately notify the Bank of the loss, theft or compromised data 12. Amendments
together with particulars thereof at [email protected] /+975-02-334333 or contact a. The Bank reserves the right to amend these Terms and Conditions at any time with
center at 1095 (toll free)/+975-02-349903. The Cardholder shall also notify the Police prior notice to the Cardholder and such amended Terms and Conditions shall be
or equivalent authority of the country or jurisdiction where such loss or theft or binding on the Cardholder.
disclosure occurred. Cardholder can also block via mBoB, those who have registered

I, Mr./Mrs./Ms ___________________________________ have read, understood and agree to comply with the above Terms and Conditions and the rules of Bank in force from
time to time governing the conduct of the Card/Account.

Signature: ___________________________ Date: ___________________________

Page 2 of 4
 FOR BANK USE ONLY
Application Received On (DD/MM/YYYY)

Card Reissued Date (DD/MM/YYYY)

Signature/Document
verified by*:
(Name) (Signature)

DOCUMENTS REQUIRED

Copy of Citizenship Identity Card

Letter of Undertaking (for Domestic Cards)

Some Important Points to Card safety and help protect against fraud

1. Card safety
• Sign the signature panel on the back of your card as soon as you get it
• Never keep your PIN code in the same place as your card
• Never write your personal identification number (PIN) on your card.

2. Keep your account number private

• Keep your card safe — don’t let anyone see
• Never allow anyone else to use your card. It is yours and yours alone.
• Don’t give the number over the phone unless you initiated the call and you’re talking to your bank or a merchant
you trust
• Never allow your card to be taken out of site
• Never answer an email that asks for your account number or personal information — even if it looks like it’s from
your bank or a reputable company or organization
• Consider paperless statements to remove your sensitive information from the postal system
• Store paper statements and other documents with sensitive information securely and shred prior to disposal

3. Be careful with your receipts

• Extra spaces on the receipt? Draw a line through them before you sign, so nothing can be added later
• Keep your receipts and check them against your Account Statements
• Don’t just toss receipts and duplicates — shred the ones you don’t need and securely file the rest

4. Make sure your devices and networks are secure

• Make sure your computer is equipped with a firewall, which prevents unauthorized users from gaining access to
your computer or monitoring transfers of information to and from the computer
• Be sure to download and install any operating system and software updates (sometimes called patches or
service packs) in a timely manner
• Make sure your browser software is up to date
• Equip your computer with virus-protection software. Avoid downloading software or programs from unknown
sources

5. Keep your passwords secret

• Choose effective passwords that use both letters and numbers
• Avoid using names, birthdays or anniversaries
• Never share your passwords, and never keep them near your card
• Consider changing your passwords periodically and don’t use the same password for all your accounts

6. Report lost cards and suspected fraud right away

• If you lose your credit card or suspect fraudulent activity, contact us immediately @1095(toll free). We can block
your card and account number so no one else can use them, and give you a new card and account number.

Page 3 of 4
LETTER OF UNDERTAKING FOR USE OF BOBL VISA DOMESTIC DEBIT/CREDIT CARDS IN INDIA & NEPAL

In the event I avail the services of the Visa Domestic Debit/Credit Card from Bank of Bhutan Limited, I unconditionally
and irrevocably hereby undertake and agree to the following terms and conditions stipulated hereunder:

1. That I fully understand that the use of card to withdraw Indian or Nepal currency shall be restricted for my general
travel related and personal expenses during my travel to India or to Nepal.
2. That I shall not use the card for taking cash advances from POS at the Merchant establishment.
3. That I shall not allow any fund from other sources/persons to be credited into my account and use my debit card
to withdraw cash for other people at ATMs in India or in Nepal.
4. That the card shall not be used for paying for importing goods and services for merchandise requiring import
license and capital transactions.
5. If I intentionally or unintentionally breach any of the above terms and conditions, that Bank is given my consent
to disclose all my card details to the RMA for taking an appropriate administrative action/s or any legal action/s
against me. In such an eventuality, the Bank shall have the right to de-activate my card with immediate effect
without any prior information/notice to me.
6. I shall not hold the Bank liable for any of the omissions or commissions on my part or loss arisen due to the use of
the said card.

LETTER OF UNDERTAKING ON THE USE OF BANK VISA INTERNATIONAL DEBIT CARD BY

BHUTANESE IN THIRDCOUNTRIES OTHER THAN BHUTAN, INDIA AND NEPAL

In the event I avail the services of the Visa International Debit Card from Bank of Bhutan Limited (Bank), I unconditionally
and irrevocably hereby undertake and agree to the following terms and conditions stipulated hereunder:

1. That I fully understand that the use of the card shall be restricted for general travel related expenses or towards
miscellaneous purchases during my travel to third country/countries, except for Bhutan, India and Nepal.
2. That I as the cardholder traveling to third country/countries can travel without producing necessary documents for
release of the Annual Travel Scheme/Quota. The amount spent on the card during a calendar year shall be within
the limit of USD 3000/- (US Dollars three thousand only) or equivalent limit for the said period as prescribed
by the Royal Monetary Authority and the facility of Annual Travel Scheme/Quota shall not be entitled to the
cardholder for the period of validity of the card.
3. That the ATM/Debit Card shall not be used for making import payments requiring import license, capital transaction
or any other activities not specified to me in writing by Bank.
4. That if I intentionally or unintentionally breach any of the above terms and conditions, that Bank is given my
consent to disclose all my card details to the RMA for taking an appropriate administrative action/s or any legal
action/s against me. In such an eventuality, the Bank shall have the right to de-activate my card with immediate
effect without any prior information/notice to me. The Bank shall also have the right to take appropriate action
against me in case of breach of any conditions agreed to in this undertaking.
5. That I shall not hold the Bank liable for commission of unpermitted acts or omission of any act from my side.

Affix
Legal
Stamp
Witness:
Signature ...........................................
(Signature)
Name: .................................................
Name of Card/Account Holder(s): ……………………………………………… A/C No:...............................................
Account Number: …………………………………………………………………………… CID No:................................................
CID/Passport Number(s): ……………………………………………………………... Contact No:.......................................

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