CREDIT CARD APPLICATION FORM
Token No: Promo Code: C4
Otp Date: 02/04/2026
Application Ref No.: PCB3469864
13:10:06
Which YES BANK Credit Card would you like to apply for? You can also refer to
[Link] for more details
YESBANKPOPCLUBCARD
PERSONAL INFORMATION
Name: MR SOUMYADIP BHATTACHARJEE
Maiden Name (if any):
Name desired on the card: SOUMYADIP
Name of Association/Company: INDIGO FACILITY SRVCS PVT LTD
Father/Spouse Name: DIPAK KUMAR BHATTACHARJEE
Mother Name:
Marital Status: MARRIED Gender: M Date of Birth: 19870703 No of Dependents
What are your identification numbers?
PAN Card: AQDPB7801K Passport Number
Driving License Passport Expiry Date
Driving License Expiry Date UID (Aadhaar): 8210
NREGA Job Card Voter ID
What is your Educational Qualification?:
What is your Nationality?: INDIAN
What is your Country of Citizenship?: INDIAN
What is your Current Residential Address?
Address Line 1: HOUSE NO 251
Address Line 2: BARASAT BADU PANCHANAN TALA
Address Line 3: KOLKATA
Landmark:
City: KOLKATA Pincode: 700128
State: WEST BENGAL Country: INDIA
How long have you lived in your current residence?:
Your residence is
What are your Personal Contact Details?
Mobile: 9836218256 Residence Landline:
Alternate Mobile: Relationship with Alternate contact person:
Personal Email ID:
SOUMYADIPINDIGO14@[Link]
What is your Permanent Address? (Leave blank if same as current residential address)
Address Line 1: BADU PANCHANANTALA ROAD
NORTH 24 PA
Address Line 2: RGANAS BARASAT I BADU
BARASAT I
Address Line 3:
Landmark:
City: NORTH 24 PARGANAS Pincode: 700128
State: WEST BENGAL Country: INDIA
What are your Permanent Address Contact Details?
Mobile: Residence Landline:
Your vehicle is
Your 4 Wheeler vehicle is Your 2 Wheeler vehicle is
RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA
ADDITIONAL DETAILS REQUIRED
Country of Residence Tax Identification Number or
equivalent
Place / City of Birth Country of Birth
What is the address in the jurisdiction details where
outside India for tax you are resident purposes?
Same as
Address Line 1:
Address Line 2:
Address Line 3:
City Pincode:
State Country:
OCCUPATIONAL INFORMATION
a. What is your occupation?: SALARIED
If salaried, Nature of Profession: SERVICES
If self-employed, Nature of Business:
If self-employed, Type of Industry:
Total period in Employment/ Business: Period in Current Employment/ Business:
What is your Office Address?
Company Name: INDIGO FACILITY SRVCS PVT
LTD
Department:
Employee Number: Designation: MANAGER
Address Line 1: KOLKATA INTERNATIONAL
AIRPORT
Address Line 2: JESSORE DUM DUM ROAD
KOLKATA
Address Line 3:
City: KOLKATA Pincode: 700052
State: WEST BENGAL Country: INDIA
What are your Official Contact Details?
Office Landline:
What is your work shift?
Office Email ID:
FINANCIAL INFORMATION
For YES BANK Customers
Account No. Customer ID
Account Type Duration of the account held
Loan Account(if any):
For Other Banks
Name of your Bank
No. of years account held
Account No.:
Account Type:
Other Bank Credit Card/ Loan Details
Bank Type of Facility (Credit Card / Member Since/Loan Open Credit Limit/Loan
Name Loan) Date Amount
Income Details
Gross Monthly Income from all sources Average Monthly Expenses (in
Additional Monthly Income:
(in INR): INR):
RELATIONSHIP- IMPORTANT
Do you have any relationship with any Director or Senior Officer of Any BANK?: NO
Name of Director / Senior Officer: Relationship with the Director / Senior Officer:
NOMINATION DETAILS (applicable for certain products with insurance feature only)
Name of the Nominee:
Relationship with the Nominee: Nominee's Date of Birth:
AUTO PAY OPTION
I accept the auto pay facility and authorise YES BANK to debit my Bank account, aforementioned in the
primary bank details section, towards Credit Card payments as indicated on payment due date as per my Credit
Card statement.
CORRESPONDENCE & STATEMENT
Where would you like your card statement and other correspondence to be sent? : RESIDENCE
Where would you like your card e-statement and other email correspondence to be sent ? :
SOUMYADIPINDIGO14@[Link]
Would you like to receive your Credit Card monthly statement only by Email ? : YES
FORM ACKNOWLEDGEMENT Application Form No: PCB3469864
We acknowledge receipt of your application for a Credit Card from YES BANK. In case of any queries kindly write to us at yestouchcc@[Link]
YES BANK Rep Name Mobile No. of YES BANK Rep
To track the status of your Credit Card application please call our 24x7 YES TOUCH Customer Care at 1800 103 1212 quoting your 13 digit unique
application reference number which you will receive on your mobile number
Credit Card issuance is at the sole discretion of YES BANK Limited. Credit Card will be delivered within 15 working days from the date of application
subject to approval.
DECLARATION
I hereby apply for YES BANK Credit Card and declare that the information included in this application is true & correct and that I am eligible to apply
for an internationally valid card. I accept that YES BANK is entitled in its absolute discretion to accept or reject this application. It is my responsibility to
obtain the Terms & Conditions applicable to the YES BANK Credit Card separately and read the same. I will be bound by the Terms & Conditions as
may be in force from time to time and receipt /use of the card shall be deemed to be acceptance of those Terms & Conditions. I authorise YES BANK
and/or its associates to verify relevant information at my office/ residence or to contact me/my employer/banker/credit bureau/RBI/ Telecom service
provider or any other source to obtain or provide any information that may be required for confirming membership requirements or maintaining my
account in good credit standing. I agree to be charged my card fee in my first statement. In case I have applied for Add-on Card(s) I will be billed for such
an Add-on Card in the normal monthly statement. I, the primary applicant, will be liable for all charges incurred on Primary or on the Add-on Card(s)
issued on the account and each Add-on applicant will be liable for all charges incurred with Add-on Card jointly and severally with the holder of the
primary card. The facility of Add-on Card(s) being special facility at a concessional fee/rate, continuation of the Add-on Cardmember will be dependent
on the continuation of my membership. I understand and undertake that the usage of YES BANK Credit Card(s) shall be strictly in accordance with
exchange control regulations, of the Regulatory Authorities as applicable from time to time which I undertake as my responsibilities to keep myself
updated of, and in the event of any failure to do so, I will be liable to action under the Foreign Exchange Management Act, 1999 or its statutory
modification or reenactment thereof. I confirm that I have no insolvency proceedings pending against me nor have I ever adjudicated insolvent. The Bank
will be entitled to cancel my Cards(s) at any time without assigning any reasons. I understand Goods & Services Tax will be levied on fees, interest and
other charges, as per government guidelines. I am aware that the Bank reserves right not to return the supporting financial documents given by me along
with the application. I have received and read the detailed Terms & Conditions and agree to abide by them once I am allotted the Credit Card. I hereby
confirm that I have also read and understood the contents of the schedule of Charges and disclosure details, and agree to be levied various charges
mention therein as and when applicable to me. I confirm that basis my eligibility YES BANK shall at its sole discretion reserves the right to issue any
existing card product in their portfolio. Credit limit on any card account may be reviewed as per the Bank policy specified from time to time. The Bank
reserves the right to decrease and/or unconditionally cancel the limit assigned to the card and intimate the Cardmember about the same. In such a stand
the Bank will inform immediately including the reason thereof, by SMS/ e-mail followed by confirmation in writing. I also understand and agree to the
fact that the Bank is authorised to change any or all of the Terms & Conditions of the Schedule of Charges with due intimation to the Customer. Changed
Terms & Conditions shall be communicated through the Bank website and by other acceptable modes of communication. I authorise the Bank to record
specific conversations between me/my representative and the Bank representative, in case of grievance-related conversations or payment-recovery related
conversations or any other conversation that the Bank may deem fit, at its own discretion. I agree to abide by any Terms & Conditions as may be
added/amended by the Bank from time to time with due intimation to the Customer, regarding this Credit Card/ any other facility/loan product that I avail
through this Credit Card or any other Credit Card that I may be issued by the Bank in the future. Changed Terms & Conditions shall be communicated
through the Bank Website and by other acceptable modes of communication. I am aware that my new Credit Card would be automatically registered for
YES BANK NetBanking in case I am a NetBanking Customer. I/We confirm that I/We do not have any existing Customer ID apart from the one
mentioned above, and incase found otherwise, Bank reserves the right to consolidate the Customer IDs under a single Customer ID as it may decide,
without any prior notice to me/us. I/We authorise YES BANK to make any enquiries regarding my application & give consent to the Bank to disclose,
without notice to me/us, information furnished by me/us in application form(s)/related documents executed in relation to the facilities availed from the
Bank, other branches/subsidiaries/affiliates, credit bureaus/rating agencies, service providers, as it deems fit. I/We acknowledge that the Bank may assign
any activities related to the Credit Card operations to any service provider appointed by the Bank, whether located in India or overseas and whether a
YES BANK 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/share details of my/our account/application to such service providers for any activities related to the
Credit Card operations without any specific consent. I agree to receive all marketing communication and offers on my YES BANK Credit Card through
telemarketing channels not withstanding my telephone number being registered in any Do not call registry list. I understand that I can withdraw my
consent at any point of time by registering with YES BANK Credit Card Do-Not-Call Registry by calling the Helpline numbers mentioned at the back of
the card. In addition to above, following is applicable for YES Prosperity Business Credit Cardmembers. I am the proprietor/partner of the Firm M/s.
____________.I confirm that I have the required authorizations/consents to use the name of the firm on my credit card along with my name. I confirm
that I have applied for this card in my individual capacity and I shall be liable and responsible for making the repayment of the outstanding dues and all
charges, fees and interest incurred by me under the said credit card and further undertake to keep the Bank harmless against all claims/losses/damages
made by any third party for using the name of the Firm on the card. In the event any of my representations turned out to be false or I cease to be
theproprietor/partner of the Firm and the same is informed to the Bank, the Bank shall be free to cancel the said card at its discretion. I have received
Most Important Terms & Conditions (MITC) for Credit Card. I have also read and understood the same.
I have read the Key Fact Statement (KFS) and Declaration for all credit card variants. I confirm my acceptance of the same for the purpose of YES
BANK Credit Card application : YES
If self-employed, By selecting the same I hereby confirm that I have the required authorizations/consents to use the name of the firm/organization on my
credit card along with my name: NO
Yes, I would like to receive promotional messages and updates via whatsapp, email and sms : YES
I am giving my consent to avail an insurance coverage and to update above nominee details in bank records : NO
I am a Politically exposed person (Politically exposed persons are individuals who are or have been entrusted with prominent public functions in by a
foreign country, including Heads of States/ Governments, senior politicians, senior government or judicial or military officers, senior executives of state-
owned corporations, important political party officials). : NO
Related to Politically exposed person: NO
I give my consent for the virtual RuPay Credit Card under shared credit limit:
DIGITAL APPLICATION:
Place: KOLKATA Date: 02/04/2026
Passcode Verified
FORM NO. 60 (see Third Provision to Rule 114B)
Form of declaration to be mandatorily filled by a person who does not have a Permanent Account Number
1. Full Name & Address
2. Are you a tax assessee?
3. If YES A. Details of ward/circle/range where the last ITR was filed
B. Reason for not having PAN Number
4. Address Proof attached
VERIFICATION
I hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today the day of Place Signature
FOR OFFICE USE ONLY Application Form No. PCB3469864
Branch Code: 786 CRM Lead No
Source Code:
TSE Code AM Code
YPOP
LC1 Code:
LG Code: 6247005 LC2 Code
6755156