Debit Card Application Form

Debit Card Application Form
º°üîdG ábÉ£H Ö∏W IQɪà`°SG
DEBIT CARD REQUEST
º°üîdG ábÉ£H Ö∏W
ÜÉ°ù◊G ÖMÉ°üd πeɵdG º°S’G
Full Name of the Account Holder
ÜÉ°ùëdG ºbQ
Account No.
ábÉ£ÑdG ≈∏Y ¬©ÑW ܃∏£ŸG º°S’G
Name to be printed on Card
ÜÉ°ù◊G ¬«a óLGƒàj …òdG ´ôØdG
Branch where Account is Maintained
Telephone: Office :
Ö൪dG ∞JÉg Residence:
∫õæªdG Mobile:
∑ôëàªdG
(∞∏ÿG ‘ ô¶fG) »H á°UÉîdG º°üîdG ábÉ£ÑH á≤∏©àªdG •hô°ûdG áaɵH ΩGõàdE’G ≈∏Y Éæ≤aGh/â≤aGh »dÉàdÉHh É檡a/⪡ah Éæ©∏WG/â©∏WG ób ÉæfCÉH/»æfCÉH ócDƒf/ócDhCG
I / We confirm that I/we have read, understood and agreed to abide by the Terms and Conditions covering
my Debit Card. (see overleaf)
Signature dfdfdfd
™```«bƒàdG
ácôà°ûªdG äÉHÉ°ùëdG »a ±GôWC’G ™«ªL ™«bƒJ
(All Parties to sign if Joint A/c)
DEBIT CARD LINKING TO ACCOUNT
ÜÉ°ùëdÉH º°üîdG ábÉ£H §HQ
Please link my debit card
»H á°UÉîdG º°üîdG ábÉ£H §HQ ≈Lôj
debit card number
º°üîdG ábÉ£H ºbQ
»HÉ°ùM ≈dEG
AED
to my account
Account Type
ÜÉ°ùëdG ´ƒf
Currency
»JGQÉeEG ºgQO
á∏ª©dG
Account Number
™«bƒàdÉH (ø«°VƒØªdG) ¢VƒØªdG
™«bƒàdÉH (ø«°VƒØªdG) ¢VƒØªdG
Authorised Signature(s)
Authorised Signature(s)
For Bank use only
DATE ïjQÉàdG
Card received
ábÉ£ÑdG ∫ƒ°Uh
Card encoded
ábÉ£ÑdG õ«eôJ
Card collected
ábÉ£ÑdG ΩÓà°SG
C/A ™«bƒJ øe ≥≤ëàdG ºJ
C/A Signature
Verified
S/A ™«bƒJ øe ≥≤ëàdG ºJ
S/A Signature
Verified
ÜÉ°ùëdG ºbQ
§≤a ∂æÑdG ΩGóîà°S’
áédÉ©ªdG
AóH
INIT
F/A ™«bƒJ øe ≥≤ëàdG ºJ
F/A Signature
Verified
»eƒ«dG Ö°ùëdG óM
Card Valid from
øe ájQÉ°S ábÉ£ÑdG
Card Serial No.
ábÉ£ÑdG π°ù∏°ùJ ºbQ
Application approved
Ö∏£dG ≈∏Y áØbGƒªdG
04/12
Daily Withdrawal Limit
Debit Card Service Terms and Conditions
In consideration of Standard Chartered Bank (the Bank)
pursuant to my / our request, making available to me / us,
Automated Teller Machine (ATM) facilities and issuing to me /
us a DEBIT CARD (the Card), I / we agree to be bound by the
following Terms & Conditions:
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(10)
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(16)
At all times to regard the Card as the property of the
Bank and to surrender it unconditionally and without
reservation upon demand by the Bank.
At no time to use or attempt to use the Card unless there
are sufficient funds in my / our account to cover the
withdrawal or transfer.
To restrict use of the Card exclusively to me / us as it is
not transferable.
Not to use or attempt to use the Card after any
notification of its cancellation or withdrawal has been
given to me / us by the Bank or by any person acting on
behalf of the Bank.
At no time and under no circumstances to disclose to
any person the Personal Identification Number (PIN)
allotted to me / us to facilitate the use of the Card in the
Bank’s ATM.
To Immediately notify the Bank of the loss or theft of the
Card.
To accept full responsibility for all transactions processed
from the use of the Card except any transactions
occurring after the Bank shall have confirmed to me / us
that it has received notice of loss or theft of the Card or
of unauthorised acquisition of the PIN.
Subject to (7) above, to accept the Bank’s record of
withdrawals and / or transfers as conclusive and binding
for all purposes and to authorise the Bank to debit my /
our account with all amounts withdrawn or transferred
with or without my / our knowledge or authority.
To acknowledge that the amount stated on the ATM
screen or a printed enquiry slip or receipt advice shall not
for any purpose whatsoever be taken as conclusive of
the state of my / our account with the Bank.
Not to hold the Bank liable, responsible or accountable
in any way whatsoever for any loss, injury or damage
howsoever arising caused by any mechanical defect in or
insufficiency of funds in or malfunction of the ATM.
Notwithstanding and without prejudice to the generality
of the provisions of (10) above, the use of the Card shall
be at my / our sole risk and I / we assume any and all
risks incidental to or arising out of the use of the Card.
That the Bank will not be responsible for the Card for any
reason not being honoured.
To return the Card for cancellation should it be no longer
required or should my / our account with the Bank for
any reason be closed.
That the Bank shall be at liberty to terminate the facility at
any time without notice to me / us by cancelling or
refusing to renew the Card.
The Bank reserves the right to vary these Terms and
Conditions by prior notice in writing to me / us.
Cash withdrawal and purchase limits are subject to
change.
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