HDFC Application Form
HDFC Application Form
Address* ________________________________________________________________________________________________________________
I would like to enable the following facility on the card*: Online Payment Yes No Contactless Yes No
Salaried
Occupation of Cardholder: Salaried/ Self-Employed/ Retired/ Self employed professional/ Housewife/ Politician/ Student/ Other_______________
Pvt Ltd
If salaried, employed with Pvt Ltd/ Partnership/ Proprietorship/ Public Ltd/ Public Sector/ Govt/ MultiNational/ Other _______________________
If Self Employed, since Y Y Yrs Date of Incorporation: DD / MM / YYYY Nature of Business: Manufacturing/ Service Provider/
Agriculture/ Bullion or Gold or Jewellery/ Stock Broker/ Real Estate/ Trader/ Money Lender/ Other_____________________________________
Type of Company Firm: Sole Proprietorship/ Partnership Firm/ Pvt Ltd Company/ Public Ltd Co/ Other___________________________________
Self Employeed Profession: Doctor/ CA/ CS/ Lawyer/ Architect/ I T Professional/ Other________________________________________________
Tick Source of Funds : Salary / Business / Agriculture / Investment Income / Educational Loan / Own Fund / Other Loan or Borrowing
Name of the financial institution from where educational loan is obtained: __________________________________________________________
Residential Status :- Resident Indian - Individual Non Individual / Non-Resident Indian (NRI)
Foreign National – holding PIO/OCI card other than PIO/OCI
Gross Annual Income: < 1L 1L – 5L 5L – 10L 10L – 50L >50L Resident Type: Owned/ Rented/ Ancestral/ Company funded
Type of Card (Select any): Regalia ForexPlus Card/ ForexPlus Card/ MultiCurrency Card/ Hajj Umrah Card/ ISIC Student ForexPlus Card
Forex Card Reference Number Country/ies of Travel : ________________ Date of Travel: DD/MM/YYYY
No of Days of Travel: ____ Purpose of Travel: ____________________Name of Country providing ultimate Service:________________________
Details of Currencies to be loaded/ Reloaded Funded by: Individual/ Corporate
Currency FCY Value Exchange Rate INR Value* Currency FCY Value Exchange Rate INR Value*
Total
*INR Amount excludes GST amount
Acknowledgement
Acknowledgement
Forex Card Reference no Date ____/ _____/ 20___. Branch Code ______________
Details of Currencies loaded
Currency FCY Value Exchange Rate INR Value* Currency FCY Value Exchange Rate INR Value*
Total
*INR Amount excludes GST
Total Amount loaded (in INR) ____________________________________________________________________________________________
Signature of Branch Staff with Stamp: ___________________________________
(Please consult your professional Tax Advisor for further guidance on your tax residency, if required)
Identification type and identification number (Documents’ submitted as proof of identity of an individual) Name of the document
submitted______________________________________ Identification number _____________________________
Please tick the applicable tax resident declaration: (Any One) *
Country # Tax Identification Number% Identification Type (TIN or other%, please specify)
# To also include USA, where the individual is a citizen/ green cardholder of USA
% In case Tax Identification No is not available, kindly provide functional equivalent $
I permissible documents are Passport, Election ID Card, PAN Card, ID Card, Driving License, UIDAI, NREGA job card and Others.
The Central Board of Direct Taxes has notified on August 7, 2015, Rules 1114F to 114H, as part of the Income Tax Rules, 1962, which Rules require Indian Financial
Institutions such as the Bank to seek additional personal tax and beneficial owner information and certain certification and documentation form all our account
holders. In relevant cases, Information will have to be reported to tax authorities/ appointed agencies/ withholding agents for the purpose of ensuring appropriate
withholding from the account or any proceeds in relation thereto.
Should there be any change in any information provided by you, please ensure you advise us promptly i.e. within 30 days
If you have any question about tax residency, please contact your Tax Advisor. If you are a US citizen or resident or green cardholder, please include United Stated in
the foreign country information field along with your US Tax Identification Number. It is mandatory to supply a TIN or functional equivalent of the country in which
you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this to the Form.
Nomination Form
Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule 2(1) of Banking Companies (Nomination) Rules, 1985 in respect of Bank Deposits
I/ We (Name) ____________________________________________________ (Address) _______________________________________________________________
________________________________________________________________Nominated the following person to whom in the event of my/ our/ minor’s
death the amount of deposit in the above account may be returned by HDFC Bank (Nominee Name) _____________________________________________________
(Nominee Address) _______________________________________________________________________________________________________________________
Relationship with depositors, if any______________________ Age ___________ Yrs.’ If nominee is minor Date of Birth: DD / MM / YYYY
Sign on the signature panel of your card as soon as you receive it to protect it from unauthorized usage
Use the card only at merchant outlets& make sure to collect the sales slip every time a transaction is made with the card at a merchant outlet
To activate NetBanking facility for your card, use the IPIN provided along with the Card Kit.
Please retain a record of transactions generated by the ATM / EDC terminal at Merchant Establishments with you. Make sure to log out of your
NetBanking account after use, to prevent self-locking of the NetBanking ID
If you lose your card, please report the loss immediately by calling Phone Banking or block your card through Prepaid Card NetBanking facility
The card should not be used for temporary charges like paying hotel deposits, car rental deposits, etc.
Never reveal your ATM Personal Identification Number (PIN) or your NetBanking IPIN to anyone.The card should not be swiped more than once
for the same transaction at a merchant outlet
Please do not use your card on merchant outlets that opt for DCC (Dynamic Currency Conversion) option at the time of authorization or
settlement of your bills while swiping the card.Never surrender the card to anyone except designated bank officers at HDFC Bank branches, and
that too only after cutting it into several pieces through the magnetic strip. Do not use the card for mail order and telephone order
transactions. The card cannot be used to make payments in India, Nepal and Bhutan. The card does not support Address Verification (AVS)
facility by merchants and may not be accepted at merchant outlets where AVS is mandatory
Page 3
PAYMENT MODE
Declaration for Purchase of Foreign Exchange under Liberalised Remittance (LRS) Scheme of $ 250,000
Details of remittances made/ transactions effected under the scheme in the current financial year (Apr 20___ to March 20____)
Sr Date Amount Name & address of AD Branch/ FFMC through which the transaction has been effected.
No
1. I voluntarily opt for Aadhaar OVD KYC or e-KYC or offline verification, and submit to the Bank my Aadhaar number, Virtual ID, e-Aadhaar, XML, Masked Aadhaar,
Aadhaar details, demographic information, identity information, Aadhaar registered mobile number, face authentication details and/or biometric information
(collectively, “Information”).
2. I am informed by the Bank, that:
(i) submission of Aadhaar is not mandatory, and there are alternative options for KYC and establishing identity including by way of physical KYC with officially valid
documents other than Aadhaar. All options were given to me.
(ii) for e-KYC/authentication/offline verification, Bank will share Aadhaar number and/or biometrics with CIDR/UIDAI, and CIDR/UIDAI will share with Bank,
authentication data, Aadhaar data, demographic details, registered mobile number, identity information, which shall be used for the informed purposes mentioned
below.
3. I authorise and give my consent to the Bank (and its service providers), for following informed purposes:
(i) KYC and periodic KYC process as per the PML Act, 2002 and rules thereunder and RBI guidelines, or for establishing my identity, carrying out my identification,
offline verification or e-KYC or Yes/No authentication, demographic or other authentication/verification/identification as may be permitted as per applicable law, for
all accounts, facilities, services and relationships of/through the Bank, existing and future.
(ii) collecting, sharing, storing, preserving Information, maintaining records and using the Information and authentication/verification/identification records: (a) for
the informed purposes above, (b) as well as for regulatory and legal reporting and filings and/or (c) where required under applicable law;
(iii) enabling my account for Aadhaar enabled Payment Services (AEPS);
(iv) producing records and logs of the consent, Information or of authentication, identification, verification etc. for evidentiary purposes including before a court of
law, any authority or in arbitration.
4. I understand that the Aadhaar number and core biometrics will not be stored/ shared except as per law and for CIDR submission. I have downloaded the e-Aadhaar
myself using the OTP received on my Aadhaar registered mobile number. I will not hold the Bank or its officials responsible in the event this document is not found to
be in order or in case of any incorrect information provided by me.
I, declare that-
1) I, hereby declare that the total amount of foreign exchange purchased from or remitted through all sources in India during the financial year, is within the overall
limit of USD 250,000/- (US Dollar Two hundred and Fifty Thousand only), which is the limit prescribed by the Reserve Bank of India for the purpose and certify that
the sources of funds for making the said remittance belong to me and the foreign exchange will not be used for prohibited purposes.
2) Foreign exchange purchased from you is for the purpose indicated in the form.
Declaration cum undertaking under sec 10(5), Chapter III of FEMA, 1999
1. I/ We, hereby, declare that the transaction details of which are mentioned above does not involve, and is not designed for the purpose of any contravention or
evasion of the provision of the aforesaid Act, or of any rule, regulation, notification, direction or order made there under.
2. I/ We, also understand that if I/ We refuse to comply with any such requirement or make only unsatisfactory compliance therewith, the Bank shall refuse, in
writing, to understand the transaction and shall, if it has reason to believe that any contravention. Evasion is contemplated by me/ us, report the matter to RBI.
3. I/We also hereby and undertake to give such information/ documents as will reasonably satisfy you about this transaction, in terms of the above declaration
Declaration under Liberalised Remittance Scheme for Resident Individuals:
1. I/ We, hereby, declare that the total amount of foreign exchange purchased from or remitted through, all sources in India during the financial year including this
application is within the overall limit of the Liberalised Remittance Scheme prescribed by the Reserve Bank of India and certify that the source of funds for
making the said remittance belongs to me and the foreign exchange will not be used for prohibited purpose.
2. I am a person resident in India. I am not a Foreign National/ NRI/ PIO.
3. The remittance would be utilised for permitted Capital & Current Account transaction only
4. I have not availed any loan/ credit/ borrowings for remitting under Liberalised Remittance Scheme for Capital Account transactions
5. The remittance is not being requested for any transaction not permitted under FEMA and those in the nature of remittance for margins or margin calls to
overseas exchanges/ overseas counterparty are not allowed under the scheme
6. The Scheme is not available for capital account remittances to countries identified by Financial Action Task Force (FATF) as non-co-operative countries and
terrorists as available on FATF website www. Fatf-gafi.org or as notified by the Reserve Bank
7. The remittance is not being sent for purchase of FCCBs issued by Indian companies in the overseas secondary market
8. The remittance is not being sent for trading or speculations in Foreign exchange abroad
9. I/We undertake to make all Capital A/c transactions under LRS from HDFC Bank Only
Page 4
General Declaration
1. The purpose and transaction details as mentioned above are true to the best of my knowledge
2. I/ We shall be responsible and liable for any incorrect details provided by me/ us.
3. The remittance is not being requested for any purpose specifically prohibited under Schedule I or any item restricted under Schedule II of Foreign Exchange
Management (Current Account Transaction) Rules, 2000.
4. The remittance is not being sent directly or indirectly to Nepal & Bhutan
5. The remittance is not being sent directly or indirectly to those individuals and entities identified as posing significant risk of committing acts of terrorism as
advised separately by the RBI to the banks.
6. The transaction mentioned above does not involve, and is not designed for any purpose for which the drawal of foreign exchange is prohibited under Rule 3 of
the Foreign Exchange Management (Current Account Transaction) Rules, 2000 read with Schedule I thereof viz:
a. Remittance out of lottery winning
b. Remittance of income from racing/ riding, etc. or any other hobby
c. Remittance for purchase of lottery tickets, banned/ prescribed magazines, football pools, sweepstakes, schemes involving money circulation, securing prize
money/ awards etc.
d. Payment of commission on exports made towards equity investment in Joint Ventures/ Wholly Owned Subsidiaries abroad of Indian Companies
e. Remittance of dividends by any company, to which the requirement of dividend balancing is applicable
f. Payment of commission on exports under Rupee State Credit Route, except commission up to 10% of invoice value of export of tea & tobacco
g. Payment related to ‘Call-back Services’ of telephones
h. Remittance of Interest income on funds held in the Non-Resident Special Rupee Account Scheme
i. Travel to Nepal and/ or Bhutan
j. A transaction with a person residing in Nepal & Bhutan
7. I/ We agree that submission of request does not necessarily imply processing of the transaction. HDFC Bank has full rights to reject the transaction based on
regulatory and internal guidelines
8. I/ We agree that the event the transactions could not be executed / debited to my/ our account, after submitting the request for processing the bank on account
of insufficient/ unclear balance at the time of execution of the transactions in my/ our account, HDFC Bank shall not be responsible for not being able to process
the transaction. Any exchange loss incurred in this connection, due to reversal of the forex deal, can be charged to my/ our HDFC Bank Account.
9. I/ We agree that in the event the transaction is cancelled or revoked by me/ us after submitting the request for processing to the bank, any exchange losses
incurred in this connection, can be charged to my/ our HDFC Bank Account
10. I/ We further agree that once the funds remitted by me/ us have been transmitted by HDFC Bank to the correspondent and/ or beneficiary banks, HDFC Bank
shall not be responsible for any delays in the disbursement of such funds, including the withholding of such funds by the correspondent and/ or beneficiary
banks.
11. I/ We agree that once the funds remitted by me/ us have been transmitted by HDFC Bank. Intermediary Service charges may be levied by correspondent and/ or
beneficiary banks, which may vary from bank to bank
12. I/ We agree that in the event the transaction being rejected by the beneficiary bank, because of incorrect information submitted by me, any Service charges
levied by the beneficiary bank or exchange losses incurred in this connection can be charged to my HDFC Bank Account
13. I/ We further declare that the undersigned has the authority to give the application, declaration and undertaking on behalf of the firm/ company. (Applicable
when the application/ declaration/ undertaking is signed on behalf of the firm/ company)
14. I/We hereby declare on the date of signing/ filling of this application form, which declaration shall be deemed to be repeated by me on each day during my
continued availing of the ForexPlus Cards facility and/ or the Approved Currency facility, that:
(a) I do not have any administrative, civil and/or criminal case/proceeding/investigation pending against me before any court, judicial or quasi-judicial
authority or any governmental or administrative agency/ authority;
(b) I have never been accused/ found guilty/convicted of any offence and/or crime and no charges have been framed against me in such connection.
I understand that in the event of any misrepresentation as to the truth or veracity of the foregoing, the Bank shall be entitled to:
(a) immediately discontinue/block the ForexPlus Cards facility and/or the Approved Currency facility;
(b) initiate or file an administrative, civil and/or criminal proceeding/case against me before any court, tribunal, governmental and/or administrative
authority in India or otherwise and report any such matter to the Reserve Bank of India and/or any other governmental authority/agency as the Bank may
deem fit in its sole discretion.
X Date: __________________________
Confirmed that de-duping is done for the purchaser against banned list. This is to certify that the remittance is not being made by/ to
ineligible entities and that the remittance is in conformity with the instruction issued by the Reserve Bank from time to time under the
Scheme.
Branch Name ________________ Branch Code _________ Date of Issuance ____/____/ 20____
LC Code ____________ x
Emp ID ____________________
For Payment mode: HDFC Bank Account / HDFC Bank Debit Card or Credit Card / HDFC Net Banking / HDFC EMI
Address proof (if address is different from the one as mentioned in Passport / Account)
Self-attested copy of Appointment letter / Admission letter / University Identity Card (Required for ISIC card only)
Hajj receipt and manifest (Required for Hajj card only if Passport is not provided)
For Payment mode: Other Bank Cheque / Other Bank Net Banking / UPI
Address proof (if address is different from the one as mentioned in Passport)
Self-attested copy of Appointment letter / Admission letter / University Identity Card (Required for ISIC card only)
Hajj receipt and manifest (Required for Hajj card only if Passport is not provided)
Self-attested copy of Other Bank Statement (1 year) / Passbook or Cancelled Cheque confirming/stating Type of Account
* Branch to validate the funding Account type (to be Savings A/c only) basis Other Bank Statement/Passbook/Cancelled Cheque