PUNJAB & SIND BANK Branch Code Branch Office ATMAEPLICATION FORM Application St. No... 21, Bank House, Rajendra Place, Ground Floor, The Branch Manager, New Delhi-110008, Ph, : 25825784, 25711896 Punjab & Sind Bank Dear Sir, - we wish to apply for PSB /ATM Card. My/Our details are as under :~ (a IMR DrAcae fa New ote Cater? Fist Nane [tifa pame sera ease fans ese ie ieee fee eee) 2. Card Display Name (As to be embossed on the card) fees i tt ei tn ted ee tte st te eet | ee |e eae | ee) | eae cea 3, Date of Birth City Pin, Code Mobile Be City ‘Pin CLT TT [TT TT tT tT tt tT tt I ‘Telephone No. (with STD Code) |S SEE EES RE EE EEE ae SC RG RE EE LE FEET RE CT TT TTT rrr rrr tt tt tt 7, Primary Account Type SB/CD 6, Branch Nam 8, Primary Aecount No. | |S (SEED esi een ene ‘9, Secondary Account Type : SBICDICC = 10. Secondary Account No. [enya] a [se rae ets] aa] IT PAN] GIR No. = I I I I I I ] 12, Declaration liwe declare thatthe above information is correct. /We authorize Bank to Debit my Primany Account forall withdrawls using the card and also to recover the Bank’s Charges /fees as applicable from time to time without any prejudice to above, 1/ We acceptthe Bank’ lien on my/ourall deposits, present and future, held inthe above mentioned Primary Account. U'We undertake to ‘maintain sufficient funds, exeluding the minimum balance stipulated in Primary Account. We accept fall responsibility for my/our PSB ATM Card and agree not to make any claims against Punjab & Sind Bank inrespeet thereto s (Incase of Joint ae, all holders should sign.) (Signature ofthe Customer) (10 BE FILLED BY THE ISSUING BRANCH) “The Details mentioned in the application form including signatures ofthe applicant and mode of operation ofthe Primary and ‘Secondary accounts are verified and correct, (Authorised Official) (Branch Manager) Date PSB ATM Card No. Issued Date of issuePUNJAB & SIND BANK : ATM CARD TERMS & CONDITIONS for issuing ATM's card 48) The Card willbe valid only for the transaction options as permitted by the bank from time to time at PSB ATMs, ') The cards and wil be the property of the bank at all times and shal be retuned tothe bank unconditionally and immediately on the Bank demand. The card holder isto ensure the denty ofthe Bank's official before handling over the card : 0) The card isnot transferable or assignable bythe card holder under any circumstances. 1) The card holder must sign the card immediately on receipt €) The card holder must net permit any other person to use his card and should safe guard the card from misuse by retaining and preserving the card carefuly under hie personal custody and contro ll tes. £) The PIN i srcty confidential, non transferable and for personal use ofthe card holder only. 9) The PIN should not be disclosed to any third paty, either to the Banke staf orto any body else under any circumstances or by any means ‘Sthenwise the card holder shall be lable for any damages caused tothe bank arising fom the card holder’ falure todo so or fom erroneous 1us9 of the card hh. The card holde’s primary account will be debited immediately wih the amount of any withdraw, transfer, oF any other transactions effected byuse ofthe card. The card holder must maintain suficiont balance in the accounts to meet any debi 1} The cardi vail up to th last day of tre manth ofthe year indicated on the card. The card holder hereby undertakes to destroy the card, When it expires. j} The bank may fom time to time, tits discretion tie-up with various agencies to offer various features on the ATM card. Allthese features ‘shal be on best efforts basis only. and the bank does not guarantee the efficiency, usefulness of any ofthe products. ik) When requested by the Bank, the card holder shall provide any information relating tothe matars that PSB deems necessary card holder will also authorize PSB to verify the authenticity of the information furnished by whatever means or ftom whichever source deemed necessary, ifthe data isnot provided or is found incorrect, PSB may atts discretion reuse renewal ofthe card or cancel the card forth I) Bank reserve the right to disclose customer's information to any court of compotont jurisdiction, law enforcement agencies and other institution such information concerning the card holder's account as may be necessary or appropriate in connection tits participation in any Electronic fund transfer network 'm) The card holder will be responsible for transaction effected by the use of the card, whether authorized by the card holder or not and shall indemnify the Bank against any oss/damage caused by the unauthorized use ofthe card or related PIN, including any penal action atising therefrom on aocount of any violation of RBI guidelines or rules framed under any law being in force in India or any ather country. 1) The card holder not enftied to over draw the account. In case of mistake or ue to any reason whatever cash is withdrawn without providing funds as stated above, to meet such with drawis the card holder shall reimburse the bank such with draws in excess with interest @ applicable to ODs as per bank rues. ‘O} The ATM's record for with drawis through card rom ATMTS by use ofthe card by the card holder shall be conclusive and bincing on them for all purposes. 'p) The bank is entitled to obtain a photocopy of ATM card signed the card holder. {Tha eard halder must net perms any other person to use his card and should safe guard the card from misuse by retaining and preserving the card carefully under his personal custody and conto al the times, £) The card nolder wal be cesponsile for transaction effected by the use ofthe card, whether authorized by the card holder or not and shall ‘indemnify the bank against any loss/damage caused by unauthorized use of card or related PIN, including any penal action arising therefrom ‘on account of any violation of RI guidelines or rules framed under any law being in force in india or any other county. General Rules : ‘) The primary account of the card holder cannot be loseditransferred to other branches ofthe bank during the currency ofthe card 'b) The bank wil not be lable to for failure to provide any services orto perform any obligation hereunder where such failure is _attibutabletwhether directly o indirect) to any malfunction of ATMS or the card, insufficiency of cash, failure of power ete. 6) The bank shal be enitied to terminate the ATM facility with immeciate effect and card shal be returned upon the occurrence of any ofthe following events: | faitue o adhere to or comply with the terms and conditions herein setforth or i Inthe event of default under any agreement ar commitment (contingent or ctherwise) entered into with PSB relating to transactions other than ATM or li Card holder being adjudged as insolvent or on the cardholder filing insolvency petition or Iv Closure of the cara holder's account or failure to maintain the minimum average balance: PSB reserve the right to add. to delete 0 vary any ofthe terms & concitons, police, features and benefts without prior notice to the card holder. ¥.On demise ofthe card holder. 4) The bank may atts ciscretion slow overdrawing the account not wth standing inadequacy of funds. The card holder agrees thet in the event ofthe account being overdrawn or showing debit balance, the Bank reserves the right to set off his amount against any ereit balance lying in any of card holder's account without notice. {2} The bank wil nat be responsible for any cash loss after cash withdrawl is completed bythe card holder at ATM. {) The issue and use of the caré shall be subject fo the rules regulation in forca from time fo time as issued by RBIIGO! and by PSB. ‘Signature of Customer