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
D D gg
Date of birth gg M M gggg
Y Y Y Y Gender g M g F g Third Gender Marital status g Married g Single g Others ______________________

Place/City of Birth ________________________ Country of birth ____________________________ Nationality/Citizenship of _____________________________________

Multiple Nationality g Yes g No Nationality/Citizenship 1 _________________________________ Nationality/Citizenship 2 _____________________________________

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

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)

PAN card Number UID Aadhaar number Passport/NREGA Card
gggggggggg gggg gggg gggg gggggggggggggg
or g ‘Form 60 attached’ or if applied Enrollment number Expiry Date of Passport
gggggggggggggggg D D gg
gg M M gggg
Y Y Y Y

or Virtual ID Voters ID/Driving Licence

gggg gggg gggg gggg gggggggggggggg
Expiry Date of Driving Licence
D D gg
gg M M gggg
Y Y Y 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 where the accountholder is resident for tax purposes.
ii. The accountholder’s TIN (Tax Identification Number) for each country indicated.
If the accountholder is tax resident in more than one country 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.
 Country of tax residence/ If no TIN available enter Reason If ‘B’ is selected, please explain why
TIN
Country of TIN issuance A, B or C unable to obtain TIN
1.

2.

3.

Reason A The country 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 country 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 Residential address
ggggggggggggggggggggggggggggggggggggg
Flat number and building name

Road number/name gggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country ggggggggg Pin code gggggg Telephone number (Res.) ggggg gggggggggg
(STD code)
Mobile number gggggggggg

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 3 years 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
Preferred Day of Delivery g Week Day g Weekend Preferred Time of Delivery g Morning g Afternoon g Evening
Office address
Company name: ggggggggggggggggggggggggggggggggggggggggg
Building name: ggggggggggggggggggggggggggggggggggggggggg

Road number/name ggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country ggggggggg Pin code gggggg Telephone (office) gggg gggggggg ggggg
(STD code) (Extn#)

E-mail ggggggggggggggggggggggggggggggggg
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 g Business Owner g Key Controller g Sole Trader
To be filled by both salaried and self-employed customers:

Nature of business g Software g IT g Hardware g Finance g Insurance g FMCG g Engineering g Infrastructure g Textile g Leather
g Others (please specify) ________________________
If salaried/self-employed
Company Name _______________________________________________________________ Office Address ________________________________________________________________
Designation ___________________________________________________________________ ______________________________________________________________________________
Department ___________________________________________________________________ Annual Gross Income __________________________________________________________

Annual Gross 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 3 years)
ggggggggggggggggggggggggggggggggggggg
Flat number and building name

Road number/name gggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country ggggggggg Pin code gggggg

Years at previous address gg Months gg Years

Permanent address:
ggggggggggggggggggggggggggggggggggggg
Flat number and building name

Road number/name gggggggggggggggggggggggggggggggggggggggg

Area and landmark gggggggggggggggggggggggggggggggggggggggg

City ggggggggggggg District ggggggggggg State ggggggggggggggg

Country ggggggggg Pin code gggggg

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 ggggggggg 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, Advance 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.
4. Making only the minimum payment every month would result in the repayment stretching over years with consequent interest payment on your outstanding balance. Please
refer to Most Important Terms and Conditions (MITC) on www.hsbc.co.in
5. You need to pay at least your minimum due amount by the due date. Non-payment would impact:
- Your credit rating (reporting to Credit Information Companies)
- Other credit facilities availed from HSBC
- In addition to the above, the Bank can cancel the credit limit and initiate recovery proceedings to recover the dues
6. The Bank will notify you of any changes in the terms and conditions of this product with prior notice of one month.
7. 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 India is entitled to verify this directly or through any third party agent. I further state that HSBC India
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 India) 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 India 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/We acknowledge that the Bank may assign 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/We also acknowledge
the right of the Bank to provide details of my/our account/application to such service providers for the purpose of availing outsourced services of any nature by HSBC India,
without any specific consent.
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 India 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 India; 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 expressly authorise HSBC India to decrease the credit limit on my credit card, based on its credit assessment, without prior notice to me.
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.
I hereby declare that all the decisions of HSBC India, 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.
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 India to decrease my credit limit, if required.
I hereby declare that I have read and understood the most important terms and conditions as mentioned in the application form.
I undertake to inform the Bank regarding any change in my residence/employment address and to provide any further information that the bank may require to process my
application.
I understand that the documents and the application form submitted will be treated as a property of HSBC India and will not be returned.
I/We consent and authorise HSBC India to generate subsequently an additional report through Credit Information Companies across this document or authorised agency/bureau
to process my credit card application, in the event the necessary documentation and processes are not completed as per HSBC’s policies. In the event of change in address due to
relocation or any other reason, I shall intimate the new address to HSBC within two weeks of such a change.
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.

DISCLOSURES
• The applicant acknowledges the right of HSBC India 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 India, without any specific consent or authorisation from him/her
• The applicant further acknowledges that HSBC India 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 India 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 India 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 India is currently withheld due to non-delivery of earlier correspondence, then HSBC India will make attempts to
contact the customer to update the correct address details.
If HSBC India 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 India 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 India 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 India) 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 in which this account(s) is/are maintained and exchanged with tax authorities of another country 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 in which the account(s) is/are maintained and exchanged with tax authorities of another country 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 India 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 India 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 India reserves a right to block transactions/allow operations in a newly opened/existing credit card accounts maintained with HSBC India, if the account deliverables/
welcome letter/welcome pack/bank correspondences not limited to account statements, etc., are returned undelivered and HSBC India 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
From time to time, HSBC India communicates various features/products/promotional offers which offer significant benefits to its customers and may use the service of third
party agencies to do so. Do you wish to be informed about such benefits?
g I expressly authorise HSBC India to use information or data relating to me/us, for communicating marketing offers as outlined above.
g I do not wish to receive offers as outlined above.
For customers who wish to receive such marketing offers but do not wish to be communicated the same by way of telephone calls/ SMSs from HSBC, we offer a ‘Do
not call’ service. To register for this, please visit our website www.hsbc.co.in
g Sharing of information and Assignment of Activities to Third Party Agencies
I acknowledge that HSBC India remains entitled to assign any activities to any third party agencies/service providers at its sole discretion. I further acknowledge the
right of HSBC India to provide details of my/our account and sharing or transfer of information which will be on a 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 by the Bank, and also may
disclose 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.

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 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 country 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 or 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 or territory outside India (except the United States of America) under the tax laws of such country or territory or an estate of a descendent who
was a resident of any country or territory outside India (except the United States of America) under the tax laws of such country or 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

Does the customer have or are they applying for one lower risk product? (excluding credit cards) g Yes g No

Is the customer applying for or already has a credit card only product? g Yes g No

State the number of HSBC Credit Cards held by the customer: _________________________________

Note: If customer has 5 or more cards, complete full CDD.

Is a manual EDD trigger required for the customer? g Yes g No

Is the customer applying for or already has Minimum Risk Insurance products only? g Yes g No

Walk-in g Yes g No

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

Does the Jurisdiction of Tax Residency appear inconsistent with the customers residential address(es), correspondence address(es) and nationality/citizenship or TIN
provided? g Yes g No

Has the customer’s identity been verified in line with the required standards and have true copies of the original documents been obtained? g Yes g No

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

Specify category of special circumstances:

g Benefit or Social Welfare claimants g Individual who lack the capacity to manage their own affairs
g Individual in care homes/sheltered accommodations/refuge g Economic Migrants
g Individuals on probation g Refugees
g Prisoners g Asylum seekers
g Students g Other _______________________
g Minors

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

Was the CDD Risk Acceptance request approved by Business Risk/FCC? g Yes g No

Why is the customer applying for an account in a country/territory which is not their country of residence? _______________________

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

Note: If applicant is an undergraduate student please collect a self attested photo copy of student ID card.

Will the customer be premier Top Tier (to identify HNWI)? 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

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

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

Connected party details: g Individual

Existing Customer g Yes g No

Customer ID (if existing customer):

Account number (if existing customer):

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 India 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_11/19

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