Bank of Baroda Credit Card Application
Bank of Baroda Credit Card Application
UNIFORM CHECKLIST
JSTOMER NAME:
IODUCT APPLIED FOR: Fevnande
EASY SELECT PREMIER ETERNA PRIME
ENAISSANCE HPCL ENERGIE IRCTC SNAPDEAL ICAI CMA ONE ICSI UNNATI
INDIAN ARMY PRAGATI OTHERS
VARUNAH VIKRAM RAKSHAMAH THE SENTINEL EMPOWER
YODDHA
INCOME PROOF/SURROGATE
BRANCH HOME
BOB NON-BOB AUTO LOAN
ITR RELATIONSHIP STAFF CARD ON CARD
SALARIED SALARIED LOAN
VALUE
REQUALIFIED FIXED REGISTRATION OTHERS
RADIANCE CIBIL
CERTIFICATE
SALES DEPOSIT/
SELF OTHERS
MPLOYEMENT STATUS: SALARIED AETIRED
EMPLOYED C
AME OF ORGNISATION: TENURE(YEARS):
ESIDENCE: OWNED RENTED PARENTAL HOW LONG(YEARS):
FFICE: OWNED RENTED RESI. CUM OFFICE HOWLONG(YEARS):
SUER/BANK NAME:
REDIT LIMIT:
NTAGE OF CARD(YEARS):
Re yOO9 four La bhg andy
1CASE CUSTOMER HAVE ANY BOB HL/AL/PL/EL ETC: YES NÞ IF YES, PLS SPECIFY DETAILS:
RE OVERALL COMMENTS:
ROMOBILE NUMBER:
8769689S2 RRO SIGNATURE:
Bank of Baroda
Credit Card 3ETERNA APPLICATION FORM
ForquickK processing of your application, please complete all sections in BLOCK LETTERS in boxes where appropriate and write N. A. if not applicable.
Please fill in CLEAR BLOCK Letters, without touching the
boxes e.g. AB
IWe wish to apply for Bank of Baroda ETERNACredit Card
For BFSL Use
For Branch Use
Source Code
Campalgn Code Promo Code Branch SOL ID Employee Code (ECNo.) Branch Head EC No.
Father's Name
GRAAERaDo
Date of Birth DD MM YY
L61 29 Gender MaleFemale TG Nationality Resident Indian NRUPIO Foreign National
Marital Status Single Married Widow(er)
CKYC [Link] ldentifier Number (KIN)
ADHAAR NO. Rb SS 93S
PAN [Link]
Educational Qualification: WGraduate Post Graduate Professional Other
VialavoreT
Cy 7hoth kudi in 2 oo
Landmark
NEARVANAN|4STORE
Tel. (with STD code)
Landmark
OCCUPATION
Office Address
City
Pin
Tel. (with STD code)| Extn.
Bank Name
Bank A/c No. Savings Alc, CurrentAlc Other
Mandatory fields. Do not leave blank as it may lead to delaylrejection of the aplication.
ADD-ON CARDS (Photo ldentity Proof Required) (Must be ovor 18 Yoars of Ago)
IWould like to apply for Add-on Cards for MM
DD
MFTG Date of Birth
PAN No.
SpouseParentSibling Child Mobile Number
DO MM YY
Date of Birth
DECLARATION
ing facility to use the credit card, Ido hereby declarg and confirm that Ihave personally read, understood and Interpreted the MITC (Most Important Terms &
In cor [Link]. Iconfim that I have received the MITC along with the application form and have read all details In it The MITC provided is in English language and I am
Condr guest BOB Financial Solutions Limited to provide anv information with regard to Bank of Baroda Credit Card In English language.I will be bound by the terms and
fully o he card shall be deemed to be acceptance of those tems and conditlons. I agree to be charged for Ihe first year fee in my first stalement. In case of application of
Condit in the monthly statement. I declare and understand that the Credit Card issued to me, lIf used overseas, shall be utilized stricly in accordance with the relevant
add-o dmy entlements as per the exchange control guldelirnes of RBI, Iundertake to bring the same
bnue Rank of Indla (RBI) from time lo ime. In he even
excha ure to comply with the prevalng exchange control guldelinesexveeu" dby RBI by me, Ishal be liable for any acion under the Foreign Exchange Management Ac.,
immed ylther at BFSL instance or RBI. I agree thal credit limit on my card account may be reviewed as per the Company policles specifed from time to ime and the
1999. will be entilled to cancel my application/cards or to alter the credi/cash withdrawal limits or updale the product at any time without assigning any reason. I understand that BFSL will provide the credit card as per its
Company
internal auidelines and I give Consent for issuance of any diferent credit card in case I am not eligible for the credit card applied for, I am also aware and agree that in the event off my
a00ngetting approved, E-stalements
would be sent every month to the email id as updated in BFSL records. Also, all SMS related to the card account will be sent to the registered mobile number provided in the application. Iwould like partner with BFSL on The Go
Green' initiative. Please mail my credit card billing statement on the email ID provided in his form. [Please note that no hard copy of monthly statement shall be provided. In case you require hard copy of monthiy billing statement,
please login to your online card account and raise request for a hard copy bill]. Ihereby give my consent lo BFSL for oblaining my KYC details from CERSAI CKYC portal and to receive information from Central KYC Registry
through SMS/Email on the above regislered numberlemail address
Ihereby authorize BFSL to provide aand collect infomation about the applicant and/or the card account to the financial credit bureaus/regulalory authorities. Iconfim that the attached photograph presents true ldentity of me and that
dim
appliesaduional
in additioncad
to z0picais.
the terms ofwhich authotzes
the Card MemberheAgreement
Company which
lo applgovems
y i to mythecedituSe cards
of my and
[Link] l acceplthatul responsilly
also confim and agreof anyto notCredit
Iam not a defaulter makeInstitule/Bank
any dam against
and mytherepayments
Company arenrespect
[Link],And that
By signing his candlionI
this application,
understand that all he transactions are effected through my card account. I, including my sUCcessors, lega! heirs, assignees shall be lawtulty responsible for making payments for the same, as per the schedule in force from time to
ima Ionther undersand thal mere dsputng the transacliensshall nel absolve my pime liabiny todeferldelay the pajment ol my credt card dues and Ialong with my successors, legal bers, assignees wil ba tuly responsbie lar
making payments of the same, as per the payment schedule in force from time to time.
Ifurther authorize BFSL and/or its associates/subsidiaries/affliates to verify from, and disclose to, any information pertaining to me Imy officelresidence and/or contact my family members and/or my Employer/Banker/Credit
Bureau/ClBILRBI and/or any (hird party including but nol limited to Financial credit bureaus/regulatory authoritles etc. as they deem necessary and/or to do any such verification as they deemmnnecessary. I confim that Ihave no
insolvency proceedings pending against me nor have lever been adjudicaled insolvent. I agree that my slgnature on the charge sllp wll amount to an unconditional undertaking by me to pay BFSL the amount slated therein and
agree that a copy of my periodic statement of accounts will be a conclusive evidence of my liability for the charges stated therein. Iunderstand appllcable taxes from time to time will be levied on fees, interest and other charges, as
per government guidelines.
Ialso undersland that the BFSL reserves the right to vary any or all of the Terms &Conditions of the Schedule of Charges from time to time. Changed Terms &Conditions shall be communicated through the BFSL'S website and/or by
against monthlyl any dues in Credit Card issued lo me on the basis of this applcaion fom. Yes No Slgnature of Johtaccount Holder ißapplcl
Tolal Amount Due Minimum Amount Due Customer specific | % ( fnot spacifed total amount due wil be debited)
Ihave an active Bank of Baroda Credit Card Ihave an existing Merchant relationship (POS) with BFSL: VesNo (fyes, provide MID number
Iundertake thal all the documents submitled by me with this application are self-attested true coples of the original documents and are deemed to be submitted by me lo BFSL. I further undersland that in case applicaion is not
considered favourably,
lagree to abide by termstheand
Company reserves
conditions as maytheberight lo relainby Uhe
amended the documents submited
Company from time towilh
tlme,thiswithout
applicalon.
giving notice to me. The MITC (Most Important Terms &Conditions) as available on the Company's website has been read by
me and I agree
Tunderlake nol toto use
abide
thebyCredil
[Link] on Internet or otherwise for purchase of prohibited items lke lottery tickels, banned or proscribed magazines, participalion In sweepslakes, payment for callback services, remittance in any fom
lOwards overseas forex trading, margin calls to overseas exchanges/overseas counter party, trading in forelgn exchange in domesticloverseas markets etc.
Tundersland that the Company reserves the right to withdraw any of the existing features/conditions including Personal Accldental Death Cover, in which case he nomination details oblained would stand null and void. Ifurther
undersland hat in the event of settlerment of claim by the Insurance Company against Personal Accidenlal Death Cover, BFSL dues, if any shall be approprlated first and balance shll be paid to the nomlnee. In case of delault in
payment of the card outslanding, Company may refer he malter to the sole arbltralor to be appolnted by the Company. The arbitraton shall take place in Mumbal and/or Delhi and Iundertake to abide by terms and conditions whalsoev
er of the award, if any passed by such arbilralor. Iconfirm and authonize BFSL to (a) Use my Aadhaar details to authenticale me from Unique ldentification Aulhority of India (UIDAI) (b) UIDAI lo release my demographic details lo
BFSL through biometnc
authorize BFSL authenicaion which informalion/transactlon
to share cardholder BFSL may use lor KYC details
verificaion
with (idenily/address proo)aliates,
parent, subsidiaries, lor thebusiness
purpose partners
of Credit and/or
Card. associates of BFSLfor the purposes of markeing and ofering various products and services
of BFSL or its group companles, subsidiaries, afiliates, business partners and/or assoclales.
am nterested okhowmore aboul tlevanous other productyseice)ol BFSL andor aflialessubsidlaryholdingcompany of BFSL or agenis authartzad by BFSL. nd hareby provide my cansenl lo andor aflialosisubsidaryhlid
ng company ofBFSLor agents aulhonued by BFSL (0 comlacd me lor the sameand Ihis consent shal havean overtding aféct on any Naional Do Nol Cal (NDNC)Tglaty madelopled by me.
laonm nat the atadred a0ressprools are presendy alid and tuevenlficalon documents ol mysell wl nouiy BFSLImmediataly when thero is achange in my current ieaidenilal addres, by ghing arequest along with requred
KYC documenis.
Thereby agree andIn undersland
case any of that
the inabove inlomaion
the absence (s found
of me to be lalse
submitting OVD ,oflam
my aware
CurrentUhat imay wilhin
Address be heldaliable
periodforoft3 months trom he dale of his appllcation, BFSL shall be free to proceed wilh appropriale remedies, which may
include bul shall not be limited to cancellation of the Card issued to me.
/we hereby Dsubmit my Aadhaar numberlAadhaar Card/Asdhaar Detalls ("Aadhaar Deails") as lssued byby UIDAl B3 proof of identily and Address (or KYC purpose. Futher, Uve valunarily provide mylour independent consent for
submitting mylour Aadhaar Delails to BOB Financial Solutions Limiled (BFSL), as per regulaions ol Aadhaar ar Act. 2016 (or procassing my credilt card application. I conhim and agree that BFSL $hall nol be liable in any manner
whalsoever due to my submiting Aadhaar Detalls with BFSL. I further stale and declare that while sourcing the appllcation of Bank of Baroda Credit Card: No Cash has ncallecled trom me, No credit limits l addiional gifts etc.
have been promised lo me. Ishall contact the BoB Credit Card Cuetomer Helplina in se I have any doubls/clariflcations.
Signature
VERIFIED WITHORIGINAL
Ban of [Link] Branch
CHRISTINAV
Asst. Manager
EC No: 163906
Government of lncia Unlgue ldentiicaion ADINOty ohdia
VERIFIEDWITHORIGINAL
Branch
Tuticorin
Bagoda
Ba of
Manager
Manager/ Sr
Officer /ChiefManager
Aspin
CHRISTINAV
[Link]
EÇNo:163906
Annexure - 1
Place :Atcoin
Date
The Chief/Sr. Br./Br. Manager,
Bank of Baroda
Tuticomin branch
Dear Sir/Madam,
Subject: In relation to Credit Card issuedto be issucd/ Credit Card Application Ref No. [.] made
to BoB Financial Solutions Limited (BFSL") for issuance of Credit Card.
With reference to the application issuance pf a Çredit Card to be issued by BoB Financial
Solutions Limited to fo nono eqCardffoider,UWe hereby authorize Bank of Baroda
(the "Bank") to mark a lien to the extent of Rs. o000 (amount in figures) , Rupces
five lakhs (amount in word5 on the Fixcd Deposit Account Number
o2o3206L330, including renewals thereof (FD"), as security for the Credit Card
being issued to melus by BFSL.
FDR3)082200
UWe, hereby intends to deposit the original Fixed Deposit Receipt No. dated [.]z|·&.2os
issued in connection with the FD ("FDR"), with Bank of Baroda for creation of security interest
by way of marking lien in favor of Bank of Baroda for securing the due repayment of any and/or
all outstanding amount, including without limitation, any or all outstanding dues/ interest/pcnal
charges/ late payment charges or fees/any other charges or fees/cost ("Outstanding Amount") in
relation to the Credit Card.
I/We, also confirm that the above FD is currently free from lien and/or any kind of
encumbrance and the said FDR shall be treated as continuing security even if the Credit
Card account runs intocredit or is reduced or extinguished at any time or from time to
time.
UWe,agree that the Bank at its sole discretion is hereby fully authorizod to liquidate the
FD without any cause or notice to melus and appropriate the proceeds towards any
Outstanding Dues on the Credit Card and remit such amount to BFSI. In such event,
UWe expressly agree that the Bank shall not be responsible for any loss arising duc to
pre-mature encashment of the FD. I/We shall, not apply for premature withdrawal
of the FD and authorize the Bank to automatically rollover the FD for such further similar
periods on each maturity date as long as the Credit Card is active and/or is in use and/or
any Outstanding Amount is due towards the Credit Card and is not fully paid to BFSI.
VWe,furthcr acknowledge, confirm and agree that in an event the BFSL decides in its sole and
independent discretion to recalls the Credit Card limit granted to mehus, the Bank in such
an event shall be entitled to adjust the
BFSL's Credit Card account or any Outstanding
Amount due to BFSL by liquidating the FD and IWe shall not
raise any
action taken by Bank of liquidation and adjustment of the FD dispute any such
amount towards
Outstanding Amount of the Credit Card being paid to BFSL.
UWe. further agree to arrange for further FDs from time to
may be required by the Bank/BFSL, with lien in favor of thetime of requisite amounts as
Bank shall be entitled to proceed against the Card Holder forBank. I/We agree that the
after adjusting the FD towards the dues.
the balance outstanding
Note: [Link] to be same as that used for banking transactions 2. To be signed by all the Joint
Account Holders
Annexure 2
Ref No.:
Dear Sir/Madam,
All capitalized Terms used herein but not defined, shall have the
Customer Declaration (Annexure - 1). meaning ascribed to them in
We refer tothe Fixed Deposit Receipt bearing no. [.] dated [] for an amount of
name of the Card
Rs., ("FDR") 0ssued in the
Holder and We write to confirm that:
1. We have noted lien for bO00 on his/her fixed deposit bearing no.0708030ol330
and A/c No. Ofo Polbo00 G217 (copy enclosed) for R 00000 for
securing the due repayment of Outstanding Amount against the Credit Card.
2. We have obtained the duly executed Customer Declaration and letter of
Authority as per
prescribed format and the same are enclosed.
3. The aforesaid FDis duly discharged on the reverse with our
endorsement.
4. There is no lock in period for encashment of the said FDR.
5. The amount under the said FDR Would be paid to you on demand, at any time, upon maturity of the
said FDR or before maturity of the sald FDR without reference to Card Holder.
6. Encashment whether premature or otherwise would not reguire any reference/clearance from Card
Holder/any other authority / person.
7. We agree that on encashment of FDR, the interest accrued will also be released to you.
8. We agree that the FDR will be renewed for such periods as per you instructions from time to time until
all Outstanding Amount is paid in full or the Card Holder is discharged by You in writing.
9. We confirm having retained the original FDR copy in our safe custody and shall not release the
same without obtaining No Objection Certificate (NOC) from BOB Financial Solutions Limited.
Yours faithfully,
Name:
B CHRISTINA V
Designation: Asst. Manager
EC No: 163906
EC No.:
t o l Scheme BARODA TIRANGA PLUS DEPOSI HY¢A YRG / Joint Holder (s)
ArAIGH INomination Y
3108202302
Nominee Registration No.
Deposit Amount Date of Issue Rate of Interest Tenure of Deposit Maturity Date Maturity Value*
500000 31-08-2023 7.25 OMonths 399 Days 03-10-2024 540759
"utvaI Ay rstun HhT (atAlA HTUH fruad * HqrR)/ Maturity Value is subject to TDS (as per current Incume Tax rulcs)
AuA rrTerms &Conditions:
Rate of Interest is in percerlage per annum.
I For Deposils issued for a parod of 1yar and above Deposits wil ba renewed for 1
,ear at thÇ prevai ingrate of intergst on the due cata if not instructed otherise
i)For DepTsits issued for a pariod of lass than 1 year. Deposits vil be reved for the
same period at the prevailing rate of interest on the due date not instructed atnenvise
3. Form 15G and 15H is applicable to Resident accounts anly.
4. Afresh 15G/ 15H 15AA (d applicabla) has to be submitted by Resident individuals
for each Financial Year pribr to crossing the threshold limit, failing vhich TDS wi! ba
deducted
5 Form 15H can be accepted onhv fronn senior clzens (age of 60 ;ears or nore)
i Premalure withdrawal of deposit lor Rs 1crore and above vall atract 153% penat.
ie. 15% less than card rale as on (ha dale of deposit for the perlod for which dopozt
has remainad wth Bank For prenvature withdraval of depasit Rs 1crere end aour a
withdrawal nolica of minimunn 31 s prior to wihdravval ef deposts to be given :0
Dank:
Please note, this is a syslom generated advico and doos not require ary signature
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LR167843
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Request
User
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2023 ID
Module
September,
Requested
By
AB
O ANFK RODA
FERNANDO. ADURA
https:/
[Link]
07
Denomin
ation
J
ROBERT
CD Reason
No.
0708
Lien
INRDefined EffectiveExpiry
Lien OTH
Infosys 07080300014330
User Date 2099
-
from InquiryULIEN
FromDate04-09
2023
Solution
Old
Lien
Amt. 5,00,000.00
IFinacle
Alc.
Lien
Maintenance
Banking
Module
Type Amt.
Lien
New 5,00,000.00
Universal
Function
Add
ID
Alc.
OK
Page 1of 1
07-09-2023
ROBERT JFERNANDO
Account Details
Address 8EAST STREET Addres8
Line 1 CHIDAMBARANAGAR ST
Line 2
Address
Line 3 City TUTICORIN
State TAMIL NADU
PIN No.
Country MAURITIUS
628008
Phone No. +02(304)547751 / +09(442)323630
1/ Phone
No. 2
Mobile No. +919150512843 Emall ID
Cust. Status NRI RFERNAND@[Link]
Alc. Status ACTIVE
Go Clear
ARA OF BARO
SADURA)