Multicurrency Card Application Form

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FOREXCARD-RELOAD FORM
Full Name*Mr/Ms/Dr ____________________________________________________________________________________.
Type of Card:
Multicurrency Platinum ForexPlus card
ForexPlus Chip Card
Hajj &Umrah Card
ForexPlus Platinum Card
ForexPlus Card
DETAILS OF FOREX ISSUED
Card Number
Details of Currencies Reloaded
Currency
USD
GBP
SGD
AUD
CHF
HKD
SAR
NZD
NOK
MYR
TRL
FCY Value
Exchange Rate
Purpose of Travel : _____________________________
INR Value*
Currency
Euro
AED
JPY
CAD
SEK
THB
ZAR
DKK
OMR
LKR
FCY Value
Exchange Rate
INR Value*
Multicurrency Card
Application Form
Total
*INR Amount includes service tax amount
PLEASE SIGN BELOW AUTHORISATION ON REVERSE
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I hereby apply for the reload of an HDFC Bank Forex Card and declare that the information included in the application is true and correct and that I am
eligible to apply for an internationally valid card. If this application is accepted, I will be bound by the Terms & Conditions governing the HDFC Bank Forex
Card, as may be in force time to time and use of the card shall be deemed to be acceptance of those Terms and Conditions. I authorize HDFC Bank and / or
its associates to verify any information or otherwise at my office/ residence or to contact me, my employer/ banker/ credit bureau/ RBI or any other source to
obtain or provide any information that may be required for confirming membership requirement or maintaining any account in good standing. I understand
and acknowledge that local laws and Reserve Bank of India’s rules and regulations, lay down norms and limits for the purchase and use of foreign exchange.
I undertake that the usage of the HDFC Bank Forex Card by me will be in accordance with the Exchange Control Regulations of the Reserve Bank of India
and the applicable laws in force from time to time, in particular and without limitation, the Foreign Exchange Management Act, 1999.In the event of any failure
on my part to do so, or any information supplied by me being incorrect or inaccurate, I agree that I will be solely liable for any / all penalties and / or action
under local laws and / or regulations as may be in force, governing the purchase and use of the HDFC Bank Forex Card.
I agree and acknowledge that HDFC Bank will act on requests made by any person authorized by me for reload of the HDFC Bank Forex Card issued to me.
In case of HDFC Bank Forex Card issued to me at the request of my employer, I hereby authorize HDFC Bank to act on the requests made by my employer
for reload, cancellation and refund of the HDFC Bank Forex Card.
Details under FATCA/Foreign Tax Laws: Tax Regulations require the bank to collect information about each individual’s tax residency. In certain
circumstances (including if the bank does not receive a valid self-certification from you) we may be obliged to share information on your account with relevant
tax authorities. If you have any questions about your tax residency, please contact your tax advisor. Should there be any change in the information provided
to the bank, please ensure you advise us promptly within 30 days
I understand and take responsibility to surrender any unutilized balances of value greater than $ 2,000 (or equivalent) on the card within 180 days from
completion of my travel as per the FEMA guidelines
I understand that there can be scenarios when a Forex Card can get over-utilized, resulting in the Bank paying on behalf of the cardholder, and the card
getting into a negative balance. I understand and take responsibility to make good this negative card balance to the bank, as the Bank has paid this sum for
the goods/ services utilized by me. I also accept that the bank reserves the right to regularize negative card balance by debiting my account held with the
bank.
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Forex card reload acknowledgement
Primary Card no
Date ____/ _____/ 20___.
Type of Card:
Multicurrency Platinum ForexPlus card
ForexPlus Chip Card
Hajj &Umrah Card
ForexPlus Platinum Card
Branch Code ______________
ForexPlus Card
Details of Currencies loaded
Currency
FCY Value
Exchange Rate
USD
GBP
SGD
AUD
CHF
HKD
SAR
NZD
NOK
MYR
TRL
*INRAmount includes service tax amount
INR Value*
Currency
Euro
AED
JPY
CAD
SEK
THB
ZAR
DKK
OMR
LKR
FCY Value
Exchange Rate
INR Value*
Total
Total Amount loaded (in INR) ________________________________________________________________________________
Signature of Branch Staff with Stamp: _________________________________
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I acknowledge that I carry the risks of reloading a wrong Card number by communicating a wrong Card number to the Bank. I understand that the Bank
cannot be held responsible for the same.
I agree and acknowledge that the fees are non-refundable.
I authorize HDFC Bank to act on such requests believed by HDFC Bank to be made by me or on my behalf. HDFC Bank shall be entitled to treat any such
requests for reload of the HDFC Bank Forex Card as to have been personally made by me. HDFC Bank shall not be obliged / required in any manner
whatsoever to confirm with me whether orally or in writing or otherwise the giving of such requests.
I understand that ATMs / EDC terminals are machines and errors could occur while in operation. I agree to indemnify the Bank for any such machine /
mechanical errors / failures.
PAYMENT MODE (any one of the below allowed)
Dr to HDFC Bank A/c No ________________________
Encl HDFC Bank Cheque No _____________________
#
Other bank Cheque No ________________________
(Card activation subject to availability of clear funds after clearing)
Drawn on (Bank Name) : ________________________
Branch Name : ________________________________________
Amount (in words) : ______________________________________________________________________________________
Relationship with Cardholder : Self / Family member(Encl.: Letter of authority from cardholder (in case of third party)
A2 Form Declaration (Under FEMA 1999)
I, declare that1) 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.
X
Date: __________________________
Signature of the Forex Cardholder
Place: _________________________
Name : _______________________________________________
FOR BRANCH USE
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
LG Code ____________
Signature of Inputter
Emp No ____________________
Important Notes - DO’s & DON’Ts on Forex cardholder
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This card cannot be used in India, Nepal and Bhutan
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The card should not be used for temporary charges like paying the hotel deposits / Pre-authorization transactions or deposits towards car
rental deposits etc
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Card can be used for transactions in online mode only. Manual key entered transactions and mail order / telephone order (MOTO) are not
allowed on Forex card.
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In some countries additional charges are levied on non-domestic cards towards use of ATM. Such charges will be debited to your Forex
card by the ATM service provider, over and above the charges levied by HDFC Bank for ATM Transactions
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Please note that certain ATMs or merchant terminals have in built capacity of currency conversion. Please do not opt for currency
selection (INR or any other currency other than local currency offered by the merchant / ATM) while making payments using your Forex
card. This will lead to cross currency transaction more than once and applicable charges will be debited to your Forex card.
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Cash withdrawal are subject to the daily transaction limit set by ATM network acquirer and the balance on your Forex card