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

Application for Canara Bank Debit Card (Non-personalised)

(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 – NON PERSONALISED

Name:

Account Number:

Date of Birth:

PAN/GIR No.

Mobile Number:

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)

I/We am/are aware that the rules for the issuance & usage of Canara Bank Debit Card 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 Debit Card/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 aware that I/We am/are liable for action under FEMA 1999. I/We also understand that upon issue of Debit Card (Non-personalised) to me, the existing ATM card if availed will be deactivated.

I am given an option to get CANARA BANK DEBIT CARD – NON PERSONALISED CARD or regular CANARA BANK DEBIT CARD, which is a personalized card. I understand that the non-personalised Debit Card does not bear my name on the card.

I undertake that I do not hold the Bank responsible for any inconvenience that I may face with the use of non- personalised debit card.

Further, I am also aware that I will be provided with a personalized Canara Bank Debit Card, where my name is printed, upon the expiry of the CANARA BANK DEBIT CARD – NON PERSONALISED, now provided. I am also aware that if I do need a personalised CANARA BANK DEBIT CARD before expiry of the non-personalised card

now provided, I can get the same on payment of a nominal sum of Rs.100/- as service fee + applicable service tax and destruction of the non-personalised debit card beyond usage.

I request you to please issue a Non-personalised Debit Card to me.

Thanking you,

Yours faithfully

SIGNATURE OF ACCOUNT HOLDER/S

*Strike if not applicable

FOR BRANCH USE

Inward No: ………………………………………………………

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

DEBIT CARD (Non –personalised) NUMBER:

Checked/verified by

Date:

Authorised Signatory