Canara Bank Debit Card Application Form – Fill Out and Use This PDF

Application for Canara Platinum Debit Card

(Please fill this form in Capital letters and tick appropriate boxes)

From	Date:
____________________________	Ph:
____________________________
____________________________
____________________________

To
The Manager, Canara Bank,	(DP )
Dear Sir,

Subject: Request for issue of CANARA BANK DEBIT CARD GLOBAL – PLATINUM in association with

Account Number:

New

Additional

Replacement

Date of Birth:

PAN/GIR No.

Name as required in the Debit Card (Not to exceed 19 characters including spaces)

PRIMARY ACCOUNT NUMBER TO WHICH DEBIT CARD IS TO BE LINKED

1 Branch

SB

CA

OD

2 Other accounts to be linked

SB

CA

OD

(in the same branch)

SB

CA

OD

Operation Severally

SB

CA

OD

(in case of joint A/cs)

*ISSUE OF CANARA BANK DEBIT CARD GLOBAL – PLATINUM:

*I/We am/are aware that the rules for the issuance & usage of Canara Bank Debit Card Global – Platinum are governed by the terms and conditions set out therein. I/We accept to be bound by such terms and conditions unconditionally and to any changes made therein from time to time, by accepting/signing on the reverse of the Canara Bank Debit Card Global – Platinum /using the card.

I/We undertake that the usage of card is strictly in accordance with the exchange control Regulations/other RBI guidelines issued from time to time and in the event of any failure to do so I/We am/are liable for action under FEMA 1999. I/We also understand that upon issue of a Debit Card Regular/Non-personalised to me, the existing ATM card if availed will be deactivated.

I also understand that the privileges offered for the Canara Bank Debit Card – Platinum are sponsored by Visa/MasterCard and the privileges may be discontinued at the will of the respective Card Associations (Visa/MasterCard). I do not hold Canara Bank responsible for any deficiency in service attributable to the said Card Associations in the matter of extending the privileges.

I request you to please issue CANARA BANK DEBIT CARD GLOBAL – PLATINUM to me.

Thanking you,

Yours faithfully

ACCOUNT HOLDER

*Strike if not applicable

FOR OFFICE USE

Signature of customer and mode of operation of the account(s) verified. Authorised to issue the Debit Card.

A CANARA BANK DEBIT CARD GLOBAL – PLATINUM with Number ______________________________________________issued

to Sri /Smt _______________________________ against his acknowledgement.

Date:

Authorised Signatory