BANK OF BARODA CREDIT CARD APPLICATION FORM

I/We wish to apply for#

Credit Card EASY SELECT PREMIER PRIME Preferred Mailing

First year*/Annual fee** `500/- `750/- `1,000/- NIL
Address#

*Reversed if spends within 60 days of card issuance : ₹ 6,000 for Easy, ₹ 7,500 for Select and ₹ 10,000 for Premier
**Waived if spends in preceding year : ₹ 35,000 for Easy, ₹ 70,000 for Select and ₹ 120,000 for Premier
The credit card is internationally Valid. In case you wish to deactivate international usage, please tick the box
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Mr./Mrs./Ms./Dr. First Name Middle Name Last Name

Full Name

Name to be printed on Credit Card

Mother’s Maiden Name

Father’s Name

Date of Birth Gender Male Female TG Nationality Resident Indian NRI/PIO Foreign National

Marital Status Single Married Widow(er) AADHAAR No.

PAN No.
Educational Qualification: Graduate Post Graduate Professional Other

Present Residential Address Permanent Residential Address

City Pin City Pin

Landmark Landmark

Tel. (with STD code) Tel. (with STD code

Mobile#

Email ID#

Alternate Mobile No.

Employment Status# Business Professional Self Employed Salaried Others

Employer Type Govt. NGO Private Public

Name of Organisation / Employer

Designation: Employee code (for Bank of Baroda/ its affiliates employees)#

Department No. of Years in Current Org. Months

Present Office Address#

City

Pin Tel. (with STD code Extn.

Gross Annual Income (in Rs.)#

BANK DETAILS

Bank Name

Bank A/c No. Savings A/c Current A/c Other

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Mandatory fields. Do not leave blank as it may lead to delay/ rejection of the application.
 (Photo Idenity Proof Required) (Must be over 18 Years of Age)

I Would like to apply for Add-on Cards for

Date of Birth#

Spouse Parent Sibling Child Mobile Number

Date of Birth#

Spouse Parent Sibling Child Mobile Number

Date of Birth#

Spouse Parent Sibling Child Mobile Number

I___________________________________________________________________(Name in full) do hereby assign the moneys payable by the Insurance Company, in the event of my death due to accident

to my________________ (mention relationship with the insured) Mr./Mrs./Ms.__________________________________and I further declare that his/her receipt shall be sufficient discharge to the Company.

(Name in full) ___________________________________________________________Signature_____________________________ Date__________________ Place _____________________________

DECLARATION
In consideration of BOB Financial Solutions Limited (BFSL) granting facility to use the credit card, I do hereby declare and confirm that I have personally read, understood and interpreted the MITC (Most Important Terms & Conditions)
fully as available on Company’s website www.bobfinancial.com. I will be bound by the terms and 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 and
conditions. I agree to be charged for the first year fee in my first statement. In case of application of add-on card(s), I agree that I will be billed for such add-on card(s) in the monthly statement. I declare and understand that the Credit
Card issued to me, if used overseas, shall be utilized strictly in accordance with the relevant exchange control regulations issued and as amended by the Reserve Bank of India (RBI) from time to time. In the event I exceed my
entitlements as per the exchange control guidelines of RBI, I undertake to bring the same immediately to the notice of BFSL in writing. In the event of any failure to comply with the prevailing exchange control guidelines issued by RBI
by me, I shall be liable for any action under the Foreign Exchange Management Act, 1999, as amended and be debarred from the Credit Card facility either at BFSL instance or RBI. I agree that credit limit on my card account may
be reviewed as per the Company policies specified from time to time and the Company will be entitled to cancel my application/cards or to alter the credit/cash withdrawal limits or update the product at any time without assigning any
reason. I understand that BFSL will provide the credit card as per its internal guidelines and I give consent for issuance of any different credit card in case I am not eligible for the credit card applied for. I am also aware and agree that
in the event of my application getting approved, E-statements 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.
I hereby authorize BFSL to provide and collect information about the applicant and or the card account to the financial credit bureaus/ regulatory authorities. I confirm that the attached photograph presents true identity of me and that
of my additional card applicants, which authorizes the Company to apply it to my credit cards and for which I accept full responsibility and agree to not make any claim against the Company, in respect thereto. And that this condition
applies in addition to the terms of the Card Member Agreement which governs the use of my card. I also confirm that I am not a defaulter of any Credit Institute/ Bank and my repayments are regular. By signing this application, I
understand that all the transactions are effected through my card account. I, including my successors, legal heirs, assignees shall be lawfully responsible for making payments for the same, as per the schedule in force from time to
time. I further understand that mere disputing the transactions shall not absolve my prime liability to defer/ delay the payment of my credit card dues and I along with my successors, legal heirs, assignees will be fully responsible for
making payments of the same, as per the payment schedule in force from time to time.
I further authorize BFSL and/or its associates/subsidiaries/affiliates to verify from, and disclose to, any information pertaining to me /my office/residence and/or contact my family members and/or my Employer/Banker/Credit Bureau/CI-
BIL/RBI and/or any third party including but not limited to Financial credit bureaus/ regulatory authorities etc. as they deem necessary and/or to do any such verification as they deem necessary.
I confirm that I have no insolvency proceedings pending against me nor have I ever been adjudicated insolvent. I agree that my signature on the charge slip will amount to an unconditional undertaking by me to pay BFSL the amount
stated 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.
I understand applicable taxes from time to time will be levied on fees, interest and other charges, as per government guidelines.
I also understand 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 other acceptable modes of communication treating it as a due intimation to the cardholder.
I/we am/are maintaining individual/ joint accounts in Bank of Baroda. I have applied for Bank of Baroda credit card and I/we irrevocably authorize the Company to debit

my/our A/c No. _________________________________________ maintained with Bank of Baroda _________________________________________________ branch,

against monthly/ any dues in Credit Card issued to me on the basis of this application form.
Signature of Joint account Holder if applicable
Yes No

Total Amount Due Minimum Amount Due Customer specific % (if not specified total amount due will be debited)
I undertake that all the documents submitted by me with this application are self-attested true copies of the original documents and are deemed to be submitted by me to BFSL. I further understand that in case application is not
considered favourably, the Company reserves the right to retain the documents submitted with this application.
I agree to abide by terms and conditions as may be amended by the Company from time to time, without 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 to abide by them.
I undertake not to use the Credit Card on Internet or otherwise for purchase of prohibited items like lottery tickets, banned or proscribed magazines, participation in sweepstakes, payment for callback services, remittance in any form
towards overseas forex trading, margin calls to overseas exchanges/overseas counter party, trading in foreign exchange in domestic/overseas markets etc.
I understand that the Company reserves the right to withdraw any of the existing features/ conditions including Personal Accidental Death Cover, in which case the nomination details obtained would stand null and void. I further
understand that in the event of settlement of claim by the Insurance Company against Personal Accidental Death Cover, BFSL dues, if any shall be appropriated first and balance shall be paid to the nominee. In case of default in
payment of the card outstanding, Company may refer the matter to the sole arbitrator to be appointed by the Company. The arbitration shall take place in Mumbai and/or Delhi and I undertake to abide by terms and conditions whatsoev-
er of the award, if any passed by such arbitrator. I confirm and authorize BFSL to (a) Use my Aadhaar details to authenticate me from Unique Identification Authority of India (UIDAI) (b) UIDAI to release my demographic details to
BFSL through biometric authentication which BFSL may use for KYC verification (identity/address proof) for the purpose of Credit Card.
I hereby authorize BFSL to share cardholder information/transaction details with parent, subsidiaries, affiliates, business partners and/or associates of BFSL for the purposes of marketing and offering various products and services
of BFSL or its group companies, subsidiaries, affiliates, business partners and/or associates. (Yes____No____)
I am interested to know more about the various other product(s)/service(s) of BFSL and/or affiliates/subsidiary/holding company of BFSL or agents authorized by BFSL and hereby provide my consent to and/or affiliates/subsidiary/hold-
ing company of BFSL or agents authorized by BFSL to contact me for the same and this consent shall have an overriding effect on any National Do Not Call (NDNC) registry made/opted by me.

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For Office Source Campaign Promo Branch Employee
use only Code Code Code SOL ID Code (EC No.)

__________________ __________________ __________________ __________________ __________________

BOB Financial Solutions Limited (formerly known as Bobcards Limited)

Date__________________
Regd. Office: “BARODAHOUSE”, 2nd floor,Behind Dewan Shopping Centre,
Place__________________ S.V. Road, Jogeshwari (W.) Mumbai - 400 102. INDIA. Phone: 91 22 4206 8502;
Fax: 91 22 2677 7560, CIN: U65990MH1994GOI081616 www.bobfinancial.com