Royale Credit Card Application Form (For NRI Applicants only)

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Charlene Wilkerson
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3 Royale Credit Card Application Form (For NRI Applicants only) Kotak Mahindra Bank Ltd. NR FORM NUMBER ABOUT ME Kotak NRI Royale Signature Credit Cardholders will only receive E-statements ADD-ON CARD DETAILS Name of the Add-On Card Applicant CRN of Add-On Card Applicant (incase the Add-On Card applicant has a Kotak account) Name as desired on the Card (Maximum 19 characters): Date of Birth Gender: Male Female Relationship with Primary Cardmember: Spouse Parent Brother / Sister Child Photograph of the Add On Card Applicant to be affixed here I would like to restrict the spending limit on the Add-On Card to: Rs. 10,000 Rs. 20,000 Same as my primary card I would like to aquire the Add-On card at a one time fees of Rs. 599 I accept that the use of the Add-On card is governed by the acceptance of the card member agreement. I accept to pay the appropriate fee for the Add-On card. Service tax & education cess, would be charged as per the rates approved in the Finance Act each year on all interest & fees and other charges levied on you Credit Card. Please note that it is made mandatory for the Add-On Card applicant to submit complete KYC documents for theissuance of the Add-On Card. The Add-On Card will not be issued unless the KYC documents received are found to be to the satisfaction of the Bank. Applicant Signature MY CREDIT CARD DETAILS Name of Bank Card Number Member Since M M Y Y Credit Limit I WANT THE AUTO DEBIT FACILITY (MANDATORY) I authorise Kotak Mahindra Bank to debit my Kotak Mahindra Bank Account No. Minimum Amount Due (Please ensure your signature is the same as the specimen signature with the Bank) Total Amount Due every month for Applicant Signature Filling up this section is mandatory. You are required to make the monthly payment on the Kotak NRI Credit Card through Auto Debit from your Kotak NRE / NRO Bank Account. Please fill up the Auto Debit section else form will not be processed.

4 SIGN UP & DECLARATION I want the Kotak NRI Credit Card with annual fee of Rs (Service tax & Education Cess applicable) I here by declare that the particulars contained herein above are complete, true and correct to the best of my knowledge and Kotak Mahindra Bank Ltd. ( Bank ) is entitled to verify the same directly or through any third-party agency. I undertake to notify the Bank immediately of any change in the above details and information given by me. I declare that I am a Non Resident Indian. I understand that the Kotak NRI Credit Card ( Credit Card ) will be issued on the basis of the statements/declarations made by me in this application as well as on the supporting documents to be submitted with the application. I/We hereby undertake to intimate you my/our return to India for permanent residence immediately on arrival. I further understand that the Bank may at its sole discretion accept or reject this application. I further agree to be fully liable and authorise the Bank to debit my Kotak Mahindra Bank Credit Card account for all spends, fees and other charges, interest, etc. on my Card. Service tax and surcharge at applicable rates will be charged on all fees, charges, interest, etc. and I agree to pay the same. In case I have applied for an Add-On Card I will be billed separately for the Add-On Card in the monthly statement. I will be liable for all charges incurred on the Add-On Card. I hereby declare that I have read the Terms and Conditions for the Bank s Credit Card and I agree that I will be bound by these Terms and Conditions including those excluding/limiting the Bank s liability and relating to the Credit Card. I agree to receive my cardholder agreement in the electronic format and I understand that upon my request, printed copy of the same would be couriered to me by the Bank. I further agree and understand that all documents given to the Bank in connection with this application including, but not limited to photocopies of original documents, signatures verification, address verification and bank details shall become the property of the Bank and shall not be returned to me. I state that as security for availing of the Credit Card I have opened a NRE/NRO term deposit ( TD ) with the Bank or I have an existing TD and I am allowing the Bank to mark a lien on the said term deposit in Bank s favour. I also agree that the TD will be auto renewed on maturity. I hereby confirm that I need to make all payments due on the Credit Card through my NRE/NRO account or from remittances from outside India through normal banking channels. I agree and authorize the Bank to debit my NRE/NRO Savings Account held with the Bank for the Minimum Amount Due payable or my Card Account Statement. I agree and hereby authorize the Bank to convert Photograph to be affixed here such remittances to the Indian Rupee equivalent thereof at the then prevailing exchange rate as notified by the RBI from time to time. I hereby confirm that I have read and understood the terms and conditions governing the entire business relationship with the Bank and relating to variour services including but not limited to Cardholder Agreement, ATMS, Phone Banking, Home Banking, Net Banking and Bill Payment. I understand that the Bank may at its absolute discretion, discontinue or modify any of these services completely or partially without any prior notice to me. I state that the TD is subject to the terms and conditions and rules for accounts and service of the Bank. I also understand that the renewal of my Credit Card is subject to the renewal of underlying TD. The validity of the Credit Card is subject to the validity of underlying TD and premature closure of the TD will automatically result in cancellation of the Credit Card. I also understand that if I fail to pay at least the Minimum Amount Due on my Credit Card within 90 days from the Card Account statement or if I wish to withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by me or the Bank, the Bank shall have the unfettered right to liquidate the entire TD amount without prior notice or reference to me and to appropriate and set off from the TD amount, the outstanding amount payable by me to the Bank against the Credit Card and only the balance amount post deduction shall be refunded. I wish to open new term deposit for this purpose I allow the Bank to mark a lien of Rs. Please use my existing deposit no.: on the said term deposit in Bank's favour. Date: Primary Applicant Signature Declaration (in case of jointly held Term Deposits) I /We state that I/We are joint holder/s of the NRE/NRO/term deposit ( TD ) with Kotak Mahindra Bank Ltd. along with the above named Applicant of the Kotak NRI Credit Card. I/We state that we have read and undeerstood the terms relating to the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant. I/We hereby authorize the Bank to mark a lien on the TD in Bank s favour as security for the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant from the Bank. I/We state that the TD will be auto renewed on maturity. I/We state that I/We understand that if the Applicant fails to pay the amount outstanding on the said Credit Card/Add-On Card within 90 days from the Card Account statement or if I/We wish to withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by the Applicant or the Bank, the Bank shall have the unfettered right to liquidate the entire TD amount without prior notice or reference to me/us and to appropriate and set off from the TD, the outstanding amount payable by the Applicant to the Bank against the said Credit Card and any Add-On Card issued by the Bank and only the balance amount post deduction shall be refunded to me/us. I/We allow the Bank to mark a lien on my/our term deposit No. in the Bank s favour. 1st Jointholder's Signature 2nd Jointholder's Signature 3rd Jointholder's Signature I want to apply for Credit Card with Domestic Usage only Domestic & International Usage I agree that if I have selected the Credit Card with Domestic & International usage, the entire credit limit on the card will available for both Domestic and International Transactions. The said credit limit will also be applicable to the Add-On card, subject to the spending limit as agreed by the Primary Applicant if any. Applicant Signature Please note that you can change the credit limit for International usage on the card and the Add-On card (if any) once the card is issued by calling the customer contact centre of the Bank. FOR BRANCH USE CRN: Type of TD: Tenure of TD: TD Amount: Lien Marked Individual Joint days Lien Revocation Authority Marked TD Number: TD Start Date: TD End Date: Lien Amount: Employee ID (Branch Official): SR Number Branch Official Signature FOR BANK USE Channel Code: Card Sales Exclusive: CSM Code: Other Credit Sale Exclusive: Cross-Sell Reference No. Source Code: Promo Code: Fee Code: Cross-Sell Telecaller: Employee Code: Branch Code: TD Promo Code: T D C C 0 9

5 CUSTOMER CHECKLIST Sr. No. Signature Checklist Check Box 1. Primary Applicant Signature 1 - Annual Fee of Rs. 1,000 p.a. 2. Primary Applicant Signature 2 - Add-on Card Fee of Rs. 599 (if applied) 3. Primary Applicant Signature 3 - Auto Debit Section - Total Amount Due / Minimum Amount Due 4. Primary Applicant Signature 4 - Sign up and Declaration (Two places) 5. Primary Applicant Signature 5 - Sign up and Declaration (in case of Joint TD) 6. Photograph of the applicant at the top left of the application form needs to be affixed Sr. No. Personal Information Checklist of Information Registered with the Bank Check Box 1. Applicant - Name, Middle Name, Last Name 2. Applicant - Name as desired on the card 3. Applicant - Date of Birth 4. Applicant - PAN number or Form 60 (Mandatory) 5. Applicant - Mother s Maiden Name 6. Applicant - Mobile Number (Mandatory) 7. Applicant - ISD / Area Code should be mentioned, before the mobile number 8. Applicant - ID (all statements sent will be e-statements) (Mandatory) 9. Applicant - Tick the relevant option for Occupation as applicable 10. Applicant - Annual Income / Business Turnover in Rs. Lacs 11. Applicant - Preferred Mailing Address 12. Applicant - If pin code in the overseas address is alpha-numeric or only alphabetic, then mention it in the Address Line Applicant - Country name should be mentioned in the Address line 3 (Mandatory) 14. Add-on Card Applicant - CRN number of the add-on card applicant should be mentioned in the add-on card details, if the add-on card holder has an existing relationship with the Bank. In case the add-on card applicant does not have a relationship with the Bank, KYC will be required 15. Applicant - NRE/NRO Account Number for Auto Debit (Mandatory) SIGN UP & DECLARATION (To be retained by the applicant) I want the Kotak NRI Credit Card with annual fee of Rs (Service tax & Education Cess applicable) I hereby declare that the particulars contained herein above are complete, true and correct to the best of my knowledge and Kotak Mahindra Bank Ltd. ("Bank") is entitled to verify the same directly or through any third party agency. I undertake to notify the Bank immediately of any change in the above details and information given by me. I declare that I am a Non Resident Indian. I understand that the Kotak NRI Credit Card ("Credit Card") will be issued on the basis of the statements/declarations made by me in this application as well as on the supporting documents to be submitted with the application. I/We hereby undertake to intimate you my/our return to India for permanent residence immediately on arrival. I further understand that the Bank may at its sole discretion accept or reject this application. I further agree to be fully liable and authorise the Bank to debit my Kotak Mahindra Bank Credit Card account for all spends, fees and other charges, interest, etc. on my Card. Service tax and surcharge at applicable rates will be charged on all fees, charges, interest, etc. and I agree to pay the same. In case I have applied for an Add-On Card I will be billed separately for the Add-On Card in the monthly statement. I will be liable for all charges incurred on the Add-On Card. I hereby declare that I have read the Terms and Conditions for the Bank's Credit Card and I agree that I will be bound by these Terms and Conditions including those excluding/limiting the Bank's liability and relating to the Credit Card. I agree to receive my cardholder agreement in the electronic format and I understand that upon my request, printed copy of the same would be couriered to me by the Bank. I further agree and understand that all documents given to the Bank in connection with this application including, but not limited to photocopies of original documents, signatures verification, address verification and bank details shall become the property of the Bank and shall not be returned to me. I state that as security for availing of the Credit Card I have opened a NRE / NRO term deposit ("TD") with the Bank or I have an existing TD and I am allowing the Bank to mark a lien on the said term deposit in Bank's favour. I also agree that the TD will be auto renewed on maturity. I hereby confirm that I need to make all payments due on the Credit Card through my NRE / NRO account or from remittances from outside India through normal banking channels. I agree and authorize the Bank to debit my NRE/NRO Savings Account held with the Bank for the Minimum Amount Due payable on my Card Account Statement. I agree and hereby authorize the Bank to convert such remittances to the Indian Rupee equivalent thereof at the then prevailing exchange rate as notified by the RBI from time to time. I hereby confirm that I have read and understood the terms and conditions governing the entire business relationship with the Bank and relating to various services including but not limited to Cardholder Agreement, ATMs, Phone Banking, Home Banking, Net Banking and Bill Payment. I understand that the Bank may at its absolute discretion, discontinue or modify any of these services completely or partially without any prior notice to me. I state that the TD is subject to the terms and conditions and rules for accounts and service of the Bank. I also understand that the renewal of my Credit Card is subject to the renewal of underlying TD. The validity of Photograph to be affixed here the Credit Card is subject to the validity of underlying TD and premature closure of the TD will automatically result in cancellation of the Credit Card. I also understand that if I fail to pay at least the Minimum Amount Due on my Credit Card within 90 days from the Card Account statement or if I wish to withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by me or the Bank, the Bank shall have the unfettered right to liquidate the entire TD amount without prior notice or reference to me and to appropriate and set off from the TD amount, the outstanding amount payable by me to the Bank against the Credit Card and only the balance amount post deduction shall be refunded. I wish to open new term deposit for this purpose I allow the Bank to mark a lien of Rs. Please use my existing deposit no.: on the said term deposit in Bank's favour. Date: Declaration (in case of jointly held Term Deposits) Primary Applicant Signature I / We state that I / We are joint holder/s of the NRE / NRO / term deposit ("TD") with Kotak Mahindra Bank Ltd. along with the above named Applicant of the Kotak NRI Credit Card. I / We state that we have read and understood the terms relating to the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant. I / We hereby authorize the Bank to mark a lien on the TD in Bank's favour as security for the said Credit Card being availed by the Applicant and/or Add-On Card issued at the request of the Applicant from the Bank. I / We state that the TD will be auto renewed on maturity. I / We state that I / we understand that if the Applicant fails to pay the amount outstanding on the said Credit Card / Add-On Card within 90 days from the Card Account statement or if I / We wish to withdraw the TD amount or if the TD is terminated for any reason or in case the Credit Card is cancelled by the Applicant or the Bank, the Bank shall have the unfettered right to liquidate the entire TD amount without prior notice or reference to me / us and to appropriate and set off from the TD, the outstanding amount payable by the Applicant to the Bank against the said Credit Card and any Add-On Card issued by the Bank and only the balance amount post deduction shall be refunded to me/us. I / We allow the Bank to mark a lien on my / our term deposit No. in the Bank s favour. 1st Jointholder's Signature 2nd Jointholder's Signature 3rd Jointholder's Signature

TD number - The correct TD number on which the lien has to be marked should be entered in the TD number space 5. Type of TD - 'For Branch Use' Section 6. TD Start Date - 'For Branch Use' Section 7.

6 RM CHECKLIST Sr. No. All Fields are Mandatory to be filled Check Box 1. RM Signature - RM should sign in the 'For Branch Use' Section 2. Stamp - RM should put a stamp in the 'For Branch Use' Section 3. CRN - The CRN of the customer should be entered in the 'For Branch Use' Section 4. TD number - The correct TD number on which the lien has to be marked should be entered in the TD number space 5. Type of TD - 'For Branch Use' Section 6. TD Start Date - 'For Branch Use' Section 7. Tenure of TD - 'For Branch Use' Section 8. TD End Date - 'For Branch Use' Section 9. TD Amount - The total amount for which TD is booked in the 'For Branch Use' Section 10. Lien Amount - The amount for which the customer has asked to mark a lien on in the 'For Branch Use' Section 11. SR Number - SR number should be mentioned in the 'For Branch Use' Section for marking a lien on Term Deposit in case of existing Term Deposit 12. Channel Code - LRBN is the channel code that should be entered in the 'For Bank Use' Section 13. Source Code - Input the source code as shared with the team in the 'For Bank Use' Section 14. Promo Code - AQNR is the promo code which should be entered in the 'For Bank Use' Section 15. Fee Code should be entered in the 'For Bank Use' Section 16. CSM Code - If the preferred mailing address of the customer is an Indian Residential Address, then the CSM code will be INDI If the preferred mailing address of the customer is an Overseas Address, then the CSM code will be INTL 17. DSE Code - DSE code should be entered in the 'Other Cards Sales Executive Column' in the 'For Bank Use' Section 18. Employee Code - To be entered in the 'For Bank Use' Section 19. Copy of sign up and declaration to be handed over to the customer Signature of the RM 2X REWARDS ON INTERNATIONAL SPENDS Earn 2X rewards on international spends; i.e. earn 2 rewards points for every Rs. 200 spent internationally Earn 1X reward for every Rs. 200 spent within India 1 Reward point = Re 1 CHOICE ON REWARDS Accumulate your reward points and redeem it online at against a host of redemption options like movie tickets, air tickets, air miles, cash and more. Instead of redeeming your reward points online you can also choose to activate the auto redemption feature by calling the Customer Care Centre In the auto redemption feature your accumulated reward points will get automatically encashed for Re. 1/ reward point to your statement every 3 months. ATTRACTIVE EMI OPTIONS Call us to convert any transaction above Rs into an EMI. For more details, please visit Service Tax and education Cess would be charged as per statutory regulations on the interest and fees and other charges charged on your Credit Card. FREEDOM TO PURCHASE AND PAY IN INR When travelling to India, save the mark up fee charged on your credit card issued outside India or the hassles of currency exchange. Enjoy the benefit of paying for your purchases, travel and dining in Indian rupees. FUEL SURCHARGE WAIVER While travelling in India enjoy 2.5% fuel surcharge waiver across all petrol pumps. Applicable on all transactions done between ` 500 and ` 3000 Maximum fuel surcharge waiver allowed in a calendar year is ` 3500.

7 CROSS-SELL CONSENT FORM NR I, the undersigned have applied for a Kotak Credit Card from Kotak Mahindra Bank Limited (hereinafter referred to as the Bank ) and in connection with my Application, I have submitted various documents and information to the Bank. I am aware that the Bank and its group companies / associates offer various other products and services and I would like to be informed about the various products / services offered by the Bank and its group companies / associates. For this purpose, the Bank may need to share my documents / information across group companies / associates. I hereby expressly authorise the Bank to exchange, share, disclose, or use in any manner whatsoever, any and / or all information / document provided by me to the Bank with its group companies / associates and to make telephone calls and / or send SMS s and / or s and / or use any other form of communication to offer and / or market and / or sell to me any of the products or services or any enhancements / upgradation / revisions thereof offered from time to time, by the Bank or its group companies / associates.

Relationship Form (DCB PayLess Card / Account / Term Deposit)

Customer ID: Account No.: FIELDS WITH * (STAR) ARE MANDATORY *Segment Code Application No.: RM / CSE / RO (Code): Account Sourced By (Code): Branch: (A) Applicant Details Relationship Form (DCB PayLess