Add-on Credit Card App Form~07.09.2023.indd

HSBC ADD-ON CREDIT CARD APPLICATION FORM

Please complete all sections. Tick  boxes as appropriate. Please ﬁ ll in the form in block (CAPITAL) letters only.

REQUEST FOR ADD-ON CREDIT CARD

Please complete all the sections. Tick  boxes as appropriate and specify (NA) where not applicable. The Add-on credit card issued will be the same as the primary credit card.

PRIMARY CREDIT CARDHOLDER DETAILS

Your name (as it appears on your credit card) (In the order of First Name, Middle name, Last name)

Your credit card number

E-mail

Mobile

(ISD code)

ADD-ON CREDIT CARDHOLDER DETAILS

Residential status

g Resident

g Non-Resident

g Foreign national

g Person of Indian Origin

Salutation

g Mr.

g Mrs.

g Ms.

g Mst.

g Others

Full name

(In the order of First Name, Middle name, Last name)

Are you known by any other names

g Yes

g No

Former/Other/Maiden name (If any)

(In the order of First Name, Middle name, Last name)

Name (Same as per ID proof) (provide if di erent from Full name)

Name as desired on the card/How would you like to be addressed in our communication?

Date of birth

Gender

Third Gender Marital status

g Married

g Single

g Others ___________________

Place/City of Birth ______________________________________________________________________

Nationality (country/region/territory)/Citizenship of ___________________________________________________________________________________________________________

Multiple Nationality

g Yes

g No Nationality (country/region/territory)/Citizenship 1 ______________________________________________________________________

Nationality (country/region/territory)/Citizenship 2 ______________________________________________________________________

KYC number

g (number would be given by the Central KYC registry) (If available)

PAN card Number

Father’s name

Spouse’s name (If available)

Mother’s maiden name

Relationship with Primary Cardholder Education

Undergraduate

Graduate

Postgraduate

Professional

g Spouse

g Parent

g Children

g Brother

g Sister

Others __________________________

O cially Valid Documents - Proof of Identity (any one):

UID Aadhaar number

(only last 4 digits) or if applied Enrollment number

or Virtual ID

Passport/NREGA Card

g Expiry Date of Passport

Voters ID/Driving Licence

g Expiry Date of Driving Licence

O cially Valid Documents - Proof of Address (any one):

g Aadhaar card

g Passport

g Voters ID

g NREGA job card

g Driving licence

g Others __________________________

Correspondence Address: Same as Primary Cardholder

CRS - Individual Tax Residency Self-Certiﬁ cation:

Please complete the following table indicating:

i. The country/region where the accountholder is resident for tax purposes.

ii. The accountholder’s TIN (Tax Identiﬁ cation Number) for each country/region indicated.

If the accountholder is tax resident in more than one country/region please use a separate sheet. If a TIN is unavailable please provide the appropriate reason A, B or C,

details of which are mentioned below the table.

Jurisdiction of tax residence/

Country/region of TIN issuance

TIN

If no TIN available enter Reason

A, B or C

If ‘B’ is selected, please explain why

unable to obtain TIN

D D M M Y Y Y Y

Add-on applicant

A  x

self-attested

recent

passport size

photo

D D M M Y Y Y Y

Reason A: The country/region where I am liable to pay tax does not issue TINs to its residents.

Reason B: The accountholder is otherwise unable to obtain a TIN or equivalent number. (Please explain why you are unable to obtain a TIN in the above table if you have

selected this reason)

Reason C: No TIN is required. (Note: Only select this reason if the authorities of the jurisdiction of tax residence entered in the table do not require the TIN to be disclosed)

Even if you have already provided information in relation to the United States Government’s Foreign Account Tax Compliance Act (FATCA), you are still needed to provide

additional information for the CRS as this is a separate requirement under the local regulation.

ADDRESS - RESIDENTIAL AND EMPLOYMENT

Current Address/Valid In-force Address (as per OVD):

Flat number and building name

Road number/name

Area and landmark

City

District

State

Country/region

g Pin code

Telephone number (Res.)

g Mobile number

E-mail

1. Is this address residential and business

g Yes

g No 2. Is your current address same as permanent address

g Yes

g No

(if No then please provide the address details in Additional Details Section)

3. Is this current resident address less than 12 months

g Yes

g No 4. Years at present address

Years

Months

(if Yes, please provide the address details in Additional Details Section)

5. Current Address in the jurisdiction details where applicant is resident for Tax Purposes

Same as Current Resident address

g Same as Permanent address

g Others

g (if others, please provide the address details in the Additional Details Section)

House ownership

g Company residence

g Fully owned private house

g Mortgaged property

g Rented house

Living with parents/relatives

Others

g PG/hostel

O ce address:

Company name

Building name

Road number/name

Area and landmark

City

District

State

Country/region

g Pin code

Telephone (o ce)

(STD code) (Extn

)

E-mail

Permanent address:

Flat number and building name

Road number/name

Area and landmark

City

District

State

Country/region

g Pin code

I would like to opt for statement by e-mail.

g Yes

g No Note: If you opt for statement by e-mail, you will no longer receive a printed copy of your credit card statement.

EMPLOYMENT DETAILS

Employment status

g Employed (Salaried)

g Self-employed

g Retired

g Housewife

g Student*

If you are a student please provide

Course start date ________________________ Course end date ________________________

*Please provide a self attested photo copy of your student ID card.

Salaried

Nature of organisation Occupation details

MNC

Government

PSU

Public Limited

Private Limited

Proprietorship

Partnership

HUF

Others (please specify) _______________________

g Senior Management

g Teacher

g Salaried

g Manager/Executive

g Police

Seafarer

Non-Executive

Armed forces

Self-employed

Your ﬁ rm is

Proprietorship

Partnership

Private Limited

Employment Role

Business Owner

__________________________________________________ Employee __________________________________________________

Key Controller

__________________________________________________

Sole Trader

__________________________________________________

(STD code)

To be ﬁ lled by both salaried and self-employed customers:

Your business type Category __________________________________________________ Sub-category __________________________________________________

If salaried:

Designation ___________________________________________________________________ Department ________________________________________________________________

Annual Salary _______________________________________ Total no. of years in employment/business

No. of years in present employment/business

ADDITIONAL SECTION FOR ADDRESS DETAILS

Other residential address

Previous Address:

(if resident at current address for less than 12 months)

Flat number and building name

Road number/name

Area and landmark

City

District

State

Country/region

g Pin code

Years at previous address

Months

Years

Current Address in the jurisdiction details where applicant is resident for Tax Purposes:

If Same as Current Resident/Permanent address/Overseas address

g Yes

g No

If di erent, Address Type:

g Residential/Business

g Residential

g Business

g Registered o ce

Flat number and building name

Road number/name

Area and landmark

City

District

State

Country/region

g Pin code

KEY THINGS YOU SHOULD KNOW

. Credit cards from HSBC have been designed to complement your lifestyle. We currently off er VISA Platinum and HSBC Cashback Credit Cards. The cards extend a host of

off ers ranging from travel privileges to dining, shopping and more.

2. Please visit the credit cards section of our website www.hsbc.co.in for more details on:

- Lost card liability and how to reduce the chances of your credit card being subject to misuse

- Transaction fee and applicable interest for cash advances against your credit card, fi nance charge (interest) in case the credit card outstanding is not repaid

in full by the due date

3. You need to pay the minimum payment due (you may choose to pay higher) by the payment due date specifi ed on your monthly card statement to avoid transactions getting

declined and levy of late payment fee. Non-payment would impact:

- Your credit rating (reporting to Credit InformationCompanies)

- Other credit facilities availed fromHSBC

- In addition to the above, the Bank can cancel the credit limit and initiate recovery proceedings to recover the dues

4. Making only the minimum payment every month would result in the repayment stretching over time with consequent interest payment added to the outstanding balance.

Please refer to Most Important Terms and Conditions (MITC) on www.hsbc.co.in

5. The Bank will notify you of any changes in the terms and conditions of this product with prior notice of one month.

6. All Cards will now allow contactless payments wherein PIN is not required at the Point Of Sale (POS) terminals and supports contactless payments up to the pre-defi ned limits

set on your card.

OPTION IF ADD-ON CREDIT CARDHOLDER IS AN ACCOUNTHOLDER WITH HSBC

In addition to the emergency cash advance facility through the ATM network of HSBC, the credit card from HSBC can also be used as an ATM card to access Savings/Current

account(s) with HSBC. To use this unique facility, please mention the account to be linked for usage with this Add-on credit card.

For the Add-on credit card:

First Add-on credit Cardholder’s

Savings/Current A.c no.

*____________________________________________________________

(Signature of joint accountholder, if any)

Others

*____________________________________________________________

(Signature of joint accountholder, if any)

Second Add-on credit Cardholder’s

Savings/Current A/c no.

*____________________________________________________________

(Signature of joint accountholder, if any)

Others

*____________________________________________________________

(Signature of joint accountholder, if any)

*Please note: The account nominated for access through an ATM must be a sole account or a joint account with 'either' signing Mandate.

In case of a joint account, only an account with two signatories is permitted. The joint accountholder must sign in the space provided.

DECLARATION

I hereby declare that the above information is complete and true and HSBC is entitled to verify this directly or through any third party agency(ies). I further state that HSBC may

at its sole discretion sanction or decline this application for primary and/or Add-on applicant(s). I conﬁ rm that the Add-on applicant(s) and I will jointly and severally be bound

by the terms and conditions of usage of the credit cards, copy of which are available on the HSBC website and would be made available on approval of the card. I authorise

HSBC to debit my credit card account for any fees, charges, interest, etc. I irrevocably conﬁ rm that all dues in respect of the HSBC Credit Card utilised for services availed of and

goods purchased from eligible service establishments/merchants, by me and any Add-on Cardholder(s), will be payable by me and I guarantee the payment towards the same in

my capacity as the principal Cardholder. I undertake and declare that usage of the credit card by me and any Add-on applicant(s) will be strictly in accordance with the Foreign

Exchange Management Act, ('FEMA') 1999 and the applicable rules, regulations, notiﬁ cations, directions or orders made thereunder and I conﬁ rm that I have (on behalf of HSBC)

obtained undertaking(s) from the Add-on applicant(s) to this e ect. In the event of failure by me or any Add-on applicant(s) to comply with the provisions of FEMA, as aforesaid, I

and such Add-on applicant(s) will be liable for action under FEMA. I authorise HSBC to, without notice, combine or consolidate the outstanding balance on the card account with

any other account(s) which I maintain with HSBC, and set o or transfer any money outstanding to the credit of such other account(s), in or towards the satisfaction of my liability

to HSBC under this Agreement.

I acknowledge that the existence of this account and details thereof (including details of credit card transactions and any defaults committed by me), will be recorded with credit

reference agencies and such information (including processed information) may be shared with banks/ﬁ nancial institutions and other credit grantors for the purposes of assessing

further applications for credit by you and/or members of your household, and for occasional debt tracing and fraud prevention. I accordingly authorise HSBC to share information

relating to my credit card account/application, including information relating to any Add-on applicant(s). I understand that as a precondition, relating to grant of loans/advances/

other non-fund-based credit facilities to me, HSBC requires consent for the disclosure by HSBC, of information and data relating to me/Add-on applicant(s), of the credit facility

availed of/to be availed of by me, obligations assumed/to be assumed by me, in relation thereto and default, if any, committed by me in discharge thereof.

1. Accordingly, I hereby agree and give consent and conﬁ rm that I have obtained consent from the Add-on applicant(s) for the disclosure by HSBC of all or any such; (a)

information and data relating to me/Add-on applicant(s) (b) the information or data relating to any credit facility availed of/to be availed of by me and (c) default, if any,

committed by me in discharge of my such obligation, as HSBC may deem appropriate and necessary, to disclose and furnish to Credit Information Bureau (India) Ltd. and any

other agency authorised in this behalf by RBI.

2. I undertake on my behalf and on behalf of the Add-on applicant(s) that (a) the Credit Information Bureau (India) Ltd. and any other agency so authorised may use, process

the said information and data disclosed by HSBC; and (b) the Credit Information Bureau (India) Ltd. and any other agency so authorised may furnish for consideration,

the processed information and data or products thereof prepared by them, to banks/ﬁ nancial institutions and other credit grantors, as may be speciﬁ ed by the Reserve Bank

in this behalf.

3. I agree that credit limits are subject to periodic review and will vary based on the bank’s credit assessment of my card account. Accordingly, I expressly grant consent and

authorise HSBC to decrease my credit limit, if required.

4. I hereby declare that I am not a near relation to any senior o cer of the Bank or any directors of any HSBC Group Companies (please strike o if this is not the case and

provide a separate list of relevant related persons).

5. I conﬁ rm that as on date of this application, there are no litigations, initiated by other banks/Financial Institutions, being faced by me (please strike o if this is not the case

and provide a separate list of initiated/pending litigations) in addition to any general right to lien/set-o or other right conferred by law or under any other agreement.

6. I hereby declare that all the decisions of HSBC, in respect to the issuance of the credit card to me/the Add-on applicant(s) shall be binding on me and neither me nor any

person claiming through me, shall raise any dispute in this regard.

7. I hereby declare that I have read and understood the most important terms and conditions as mentioned in the application form.

8. I undertake to inform HSBC regarding any change in my residence/employment address and to provide any further information that the bank may require to process my

application. In the event of change in address due to relocation or any other reason, I shall intimate the new address to HSBC within 2(two) weeks of such a change.

9. I understand that the documents and the application form submitted will be treated as a property of HSBC and will not be returned.

10. I understand that as a part of this application process, my credit report may be queried multiple times for veriﬁ cation. I also understand that such multiple queries have a

marginal impact on my Credit score and may a ect the assessment of my application for credit facilities from other institutions.

E-mail Statement: I\We agree to receive the card account related information such as statement, details/revision of charges, etc. in an electronic format to my/our e-mail ID

speciﬁ ed on HSBC's records in lieu of physical copies thereof. I/We shall notify HSBC of any change in my/our e-mail ID. HSBC will be deemed to have delivered the same to me

upon it not receiving any delivery failure notiﬁ cation. If I experience any di culty in accessing the electronically delivered documents/communications, I/we shall promptly advise

HSBC for delivery through alternate means.

Failure to advise HSBC of such di culty within 30 days after receiving the statement shall serve as an a rmation regarding the acceptance of the statement by me/us. I/We

conﬁ rm that I/we am aware of all security risks involved in receiving the electronically delivered statement and undertake not to hold HSBC responsible in any way for the same.

I/We agree that duplicate statements of past transactions are issued against payment of charges as per HSBC’s current Tari , if applicable. In case of receiving e-statements

through HSBC Internet Banking, I/we agree to be bound by the terms and conditions mentioned on the website www.hsbc.co.in

I/We hereby agree and undertake to:

a) Indemnify and keep the HSBC and its directors, o cers, employees, and agents etc., indemniﬁ ed from all actions, proceedings, claims, loss, damage, charges, costs and

expenses, which may be made or brought against, or su ered or incurred by them, or may arise or have arisen, either directly or indirectly, out of or as a consequence of or in

connection with:

i. HSBC acting pursuant to, in accordance with, or relying upon, with the consent to this Application Form or instructions, either in writing or through any other medium

including Internet Banking, telephone, facsimile message, registered email, etc. (“Instructions”) given by me/us and/or any person acting through or on my/our behalf,

which HSBC believes, in good faith, to be authentic, and/or any action or step taken by HSBC hereunder (including the costs of enforcing the same), including but

not limited to any variation in Instructions, where I/we gave or may have given contrary instruction to the Relationship Manager or the Bank, for any other reason

whatsoever, and/or

ii. Non receipt of any Instructions claimed to have been sent by me/us to HSBC, non-execution of any Instructions, or delay in receipt of or execution of Instructions due to

any reason,

iii. All claims, costs, losses, damages, charges, expenses and liability of any kind or nature whatsoever and expenses that may be incurred by HSBC by reason of any act or

default on my/our part in respect of the card facility and/or for the recovery of the outstanding dues on account of my/our failure on any of the terms and conditions

herein,

iv. Any tax liability, interest and penalty raised against or su ered by HSBC as a result of either relying upon this declaration or due to my/our delay/default in conﬁ rming the

change, if any, of the declarations mentioned above, except where such actions, proceedings, claims, loss, damage, charges, costs or expenses (as the case may be)

have arisen as a consequence of gross negligence or wilful misconduct on part of HSBC.

b) Notwithstanding anything contrary contained herein or elsewhere, HSBC shall have no liability to me/us or to any other person for any consequential, compensatory, special

or other damages, including without limitation for loss of proﬁ ts.

c) This indemnity is without prejudice to any other rights, privileges, powers and remedies that HSBC may have in law or equity. A failure or delay in exercising any right/power/

privilege by HSBC will not operate as a waiver, and a single/partial exercise of any right/power/privilege will not preclude any subsequent or further exercise of the same or the

exercise of any other such right/power/privilege.

This indemnity shall survive the termination of relationships held by me/us with HSBC.

DISCLOSURES

• The applicant acknowledges the right of HSBC to provide details of his/her credit card account to third party agencies for the purpose of availing of support services

of any nature by HSBC, without any speciﬁ c consent or authorisation from him/her

• The applicant further acknowledges that HSBC is authorised to share information relating to the applicant, including information relating to any default committed by the

applicant in discharge of his/her obligation, as HSBC may deem appropriate and necessary, with any existing or future credit bureaus/credit reference agencies as

determined by the Bank from time to time.

Accordingly, the applicant herein expressly gives consent to disclose information to such credit bureaus/credit reference agencies. Such entities may further make available

processed information or data or products thereof to banks/ﬁ nancial institutions and other credit grantors

• HSBC also provides information relating to credit history/repayment record of the applicant to a Credit Information Company (speciﬁ cally authorised by the RBI), in terms

of the Credit Information Companies (Regulation) Act, 2005

• For credit card accounts where correspondence from HSBC is currently withheld due to non-delivery of earlier correspondence, then HSBC will make attempts to

contact the customer to update the correct address details

If HSBC is unable to establish contact with the customer, the operation of the account will be restricted by providing a prior notice of 30 days until the correct address is

updated on the Bank’s records with address proof, or until the customer conﬁ rms the current address on the Bank’s records to be correct.

TAX REPRESENTATION

• Individual accounts: The applicant is responsible for fulﬁ lling any obligation that you may have with respect to the ﬁ ling of returns or other required documentation in respect

of and the payment of all relevant taxes, including, without limitation, all income, capital gains, wealth and estate duties, stamp duties, Service Tax, Value Added Tax and any

other applicable taxes. The creation and continued operation of he/she account and/or the acquisition, holding or disposal of investments or assets in such account, as

well as any income, distributions or losses realised in relation to the operation of the account may expose you to tax consequences depending on a number of factors

including, but not limited to, your applicable domicile, he/she place of residence, he/she citizenship or the type of assets he/she hold. Certain countries may have tax legislation

with extraterritorial e ect regardless of he/she place of domicile, residence or citizenship. HSBC does not provide any legal or tax advice and you should seek legal and/

or tax advice from an independent legal and/or tax adviser. You acknowledge and agree that HSBC has no liability in respect of any of your tax obligations and/or

any legal and/or tax advice provided to you by third parties

SANCTION CLAUSE

• The Bank and other members of the HSBC Group are required to and may take any action to meet Compliance Obligations relating to or in connection with the detection,

investigation and prevention of Financial Crime (Financial Crime Risk Management Activity) and act in accordance with the laws, regulations and requests of public and

regulatory authorities operating in various jurisdictions which relate to Financial Crime. The Bank may take, and may instruct (or be instructed by) any other member of the

HSBC Group to take, any action which it or such other member, in its sole and absolute discretion, considers appropriate to take in accordance with all such laws, regulations

and requests

• Such action may include but is not limited to (a) screening, intercepting and investigating any instruction, communication, drawdown request, application for services, or any

payment sent to or by you, or on your behalf, (b) investigating the source of or intended recipient of funds (c) combining customer information with other related information in

the possession of the HSBC Group, and/or (d) making further enquiries as to the status of a person or entity, whether they are subject to a sanctions regime, or conﬁ rming

your identity and status and (e) share information on a conﬁ dential basis with such HSBC Group o ces, whether located in India or overseas in relation to prevention

of Financial Crime

• Exceptionally, our Financial Crime Risk Management Activity may lead to us delaying, blocking or refusing the making or clearing of any payment, the processing of your

instructions or application for services or the provision of all or part of the services. To the extent permissible by law, neither we nor any other member of HSBC Group

shall be liable to you or any third party in respect of any loss (whether direct or consequential and including, without limitation, loss of proﬁ t or interest, however it arose) that

was su ered or incurred by you or a third party, caused in whole or in part in connection with the undertaking of Financial Crime Risk Management Activity for the purpose of

the present clause

• ‘Compliance Obligations’ means obligations of the HSBC Group to comply with: (a) laws or international guidance and internal policies or procedures, (b) any demand or

request from authorities or reporting, disclosure or other obligations under laws, and (c) laws requiring us to verify the identity of our customers

• ‘Financial Crime’ includes money laundering, terrorist ﬁ nancing, bribery, corruption, tax evasion, fraud, evasion of economic or trade sanctions, and/or any acts or attempts to

circumvent or violate any laws relating to these matters

CRS and CKYCR Declaration and Consent clause

I have read and understood the information requirements and the terms and conditions mentioned in this form (and hereby conﬁ rm that the information provided by me on this

form is true, correct and complete. I hereby agree and conﬁ rm to inform The Hongkong and Shanghai Banking Corporation Limited, India (HSBC) for any modiﬁ cation to this

information promptly. I further agree to abide by the provisions relating to ‘Foreign Account Tax Compliance Act' (FATCA) and Common Reporting Standards (CRS) on Automatic

Exchange of Information (AEOI) provided in Rules 114F to 114H of the Income Tax Rules, 1962’.

I authorise you to update your records basis the above information. I also authorise you to share the given information provided by me with any statutory/regulatory authorities, as

appropriate or HSBC group entities.

I understand that the details provided in the form will be reconciled with your existing records and any discrepancy thereof will be duly highlighted to me for further rectiﬁ cation/

updation of records.

I acknowledge that the information contained in this form and information regarding the accountholder and any Reportable Account(s) may be provided to the tax authorities of

the country/region in which this account(s) is/are maintained and exchanged with tax authorities of another country/region or countries in which the accountholder may be tax

resident pursuant to intergovernmental agreements to exchange ﬁ nancial account information.

I certify that I am the accountholder (or am authorised to sign for the accountholder) of all the account(s) to which this form relates.

In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

I/We hereby acknowledge and agree as follows:

(a) The Government of India vide their Notiﬁ cation dated 26 November, 2015 authorised the Central Registry of Securitisation Asset Reconstruction and Security Interest of India

(CERSAI) to act as and to perform the functions of the Central KYC Records Registry under the said rules, including receiving, storing, safeguarding and retrieving the KYC

records under the Prevention of Money Laundering Act, 2002.

(b) In compliance with the Master Direction on KYC issued by The Reserve Bank of India (RBI), HSBC shall capture the KYC data/records of its individual customers and shall

update/upload the same onto CKYCR. A KYC identiﬁ er, as generated by CKYCR, shall be communicated to me/us by HSBC.

(c) HSBC shall also be entitled to download KYC information of the individual customers as and when required for KYC compliance, as per the applicable laws/regulations.

(d) All KYC related information provided by me/us to HSBC are true and correct and I/we undertake to inform HSBC of any changes thereto, immediately. In case any of the

information provided are found to be false, misleading, or misrepresenting, I/we are aware that I/we shall be held liable for the same.

(e) I/We hereby consent for receiving information from CKYCR through SMS/E-mail on the above mentioned registered number/e-mail address.

I certify that where I have provided information regarding any other person (such as a Controlling Person or other Reportable Person to which this form relates) that I will, within

30 days of signing this form, notify those persons that I have provided such information to HSBC and that such information may be provided to the tax authorities of the country/

region in which the account(s) is/are maintained and exchanged with tax authorities of another country/region or countries in which the person may be tax resident pursuant to

intergovernmental agreements to exchange ﬁ nancial account information.

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I under take to inform you of any changes therein immediately.

I also undertake to provide HSBC with a suitably updated self-certiﬁ cation and declaration within 90 days of such change in circumstances which a ects my tax residency status.

As per the RBI Master Direction DBR. AML. BC. No. 81/14.01.001/2015-16, updated on 28 April 2023, in line with the requirements of Prevention of Money Laundering Rules,

HSBC would like to inform that in case of any update in the documents submitted by the customer at the time of establishment of business relationship / account-based

relationship and thereafter, as necessary, customers shall submit to the HSBC the update of such documents. This shall be done within 30 days of the update to the documents

for the purpose of updating the records at HSBC’s end.

KNOW YOUR CUSTOMER/DUE DILIGENCE REQUIREMENT

• In line with the requirements of the Bank's policy, the Know Your Customer (KYC) documents along with other documentation need to be submitted at the time of availing a

new card/account or as and when requested by the Bank. If we collect any information from you other than KYC requirement, we will collect it separately and not as part of

account opening form. In case we collect any additional information we will explain the purpose for which we are collecting this information and take your speciﬁ c consent for

the same

HSBC reserves a right to allow/restrict operations in a newly opened/existing credit card accounts maintained with the Bank, if the customer is not able to satisfy the due

diligence requirements in line with the Internal Policy.

ACCOUNT RULES AND TERMS AND CONDITIONS

• HSBC reserves a right to block transactions/allow operations in a newly opened/existing credit card accounts maintained with HSBC, if the account deliverables/

welcome letter/welcome pack/bank correspondences not limited to account statements, etc., are returned undelivered and HSBC is unable to contact the accountholder

at the address/contact number provided by them at the time of account opening/updated in bank records

X X

Signature of Primary Cardholder Signature of Add-on Cardholder

Date: ___________________________________

CUSTOMER CONSENT

Marketing O ers

I hereby agree to receive marketing communications through telephone call/E-mail/SMS on various products/features/promotion o ers provided by the Bank. I understand

that in case I DO NOT wish to receive marketing o ers or the marketing communication, I can register for 'Do Not Call and Marketing Opt Out' service through Bank’s

website www.hsbc.co.in. or other channels as may be o ered by the Bank.

g Sharing of information and Assignment of Activities to Third Party Agencies

I/We acknowledge and agree to HSBC assigning any activities to any service provider, whether located in India or overseas and whether an HSBC Group entity or a

third party, at its sole discretion, in accordance with the applicable guidelines of the Reserve Bank of India (RBI). I further agree and consent to HSBC providing details

of my/our account and sharing or transfer of information on a strictly conﬁ dential basis to HSBC Group o ces or other third party agencies/service providers, whether

located in India or overseas for the purpose of availing support services of any nature HSBC may also disclose any information if required or permitted by any law, rule

or regulation or at the request of any public or regulatory authority or if such disclosure is required for the purposes of preventing fraud, without any further speciﬁ c

consent or authorisation from me/us. I/We understand and consent to HSBC using or sharing information submitted by me/us to conduct employment veriﬁ cation and

other related checks, through third party agency(ies) engaged by it, from public information sources such as Employees' Provident Fund Organisation (EPFO).

I/We am/are voluntarily providing a physical copy of my Aadhaar card/e-Aadhaar card in a masked form to HSBC for the purpose of establishing my/our identity/

address proof to set up a banking relationship and process instructions in relation to the same.

I hereby provide my consent for veriﬁ cation of my Aadhaar to establish its genuineness through such means acceptable as per UIDAI or under any Act or law from

time to time. The consent and purpose of collecting Aadhaar have been explained to me and I conﬁ rm having understood the same.

I acknowledge that the Bank will store the said Aadhaar number in a masked form in their records and use the same for such purposes as may be permitted.

I also acknowledge that the Bank has provided me/us with alternate options in terms of identity documents that could be provided in lieu of Aadhaar for setting up a

banking relationship.

X X

Signature of Primary credit card applicant Signature of Add-on Cardholder

ACKNOWLEDGEMENT (To be ﬁ lled by sales representative)

I hereby conﬁ rm that the applicant(s) has/have signed in my presence.

i. The customer’s need for the product has been identiﬁ ed based on the reason for availing of the product as indicated by the customer in the form.

ii. The suitability of the product has been understood based on the ﬁ nancial standing and income details provided by the customer in the form.

iii. I conﬁ rm that the details provided by the customer are correct. I have personally veriﬁ ed this and have performed the due diligence on other declarations submitted by customer

(if any)

X X

Signature of Bank Executive Signature of Agent

Date: ___________________________________

OTHER DECLARATIONS

g I declare that my signature/signature ﬂ ow on __________________________________________ document is my old signature and the signature done on the application

form and self-attestation done on documents is my new signature. Please consider my new signature for processing the Credit Card application.

g I declare that my name on _________________________ document is mentioned

g shortly

g incorrect

g has a spelling error

g Order mismatch

g is a

mismatch. Hence request to please consider my name as mentioned in the credit card application.

g I declare that my Date of Birth mentioned on _____________________________ document is wrong. Please consider my Date of Birth as mentioned in the credit card

application.

g I agree that for certain transactions on my credit card, the account will be allowed to transact higher than the credit limit , considering the bank’s internal policy and risk

assessment. These additional limits maybe revised from time-to-time.

For Point 1 For Point 2 For Point 3 For Point 4

Customer Signature Customer Signature Customer Signature Customer Signature

ANNEXURE

Instructions/Check list/Guidelines for ﬁlling Individual Application Form

Self-Certiﬁcation of documents is mandatory.

The generation of KYC number/identiﬁer will be performed by the Bank subject to availability of necessary technology.

Clariﬁcation/Guidelines on ﬁlling details for CRS purposes.

Reason A: The country/region where I am liable to pay tax does not issue TINs to its residents.

Reason B: The accountholder is otherwise unable to obtain a TIN or equivalent number. (Please explain why you are unable to obtain a TIN in the below table if you have

selected this reason.)

Reason C: No TIN is required.

(Note: Only select this reason if the authorities of the jurisdiction of tax residence entered in the table do not require the TIN to be disclosed.)

Appendix – Deﬁnitions

Note: These are selected deﬁnitions provided to assist you with the completion of this form. Further details can be found within the Income Tax Rules, 1961 and OECD

Common Reporting Standard for Automatic Exchange of Financial Account Information (the CRS), the associated commentary to the CRS, and domestic guidance. This

can be found at the following link www.oecd.org/tax/automatic-exchange/

If you have any questions then please contact your tax adviser or domestic tax authority.

Tax Identiﬁcation Number (TIN): TIN (including functional equivalent) – The term TIN means Taxpayer Identiﬁcation Number assigned to a person in the country/territory in

which he is resident for tax purposes and includes a functional equivalent in case no such number is assigned. A TIN is a unique combination of letters or numbers assigned

by a jurisdiction to an individual or an Entity and used to identify the individual or Entity for the purposes of administering the tax laws of such jurisdiction. Further details of

acceptable TINs can be found at the following link www.oecd.org/tax/automatic-exchange/

Some jurisdictions do not issue a TIN. However, these jurisdictions often utilise some other high integrity number with an equivalent level of identiﬁcation (a functional

equivalent). Examples of that type of number include, for individuals, a social security/insurance number, citizen/personal identiﬁcation/service code/number, and resident

registration number, PAN (Permanent Account number) and resident registration number.)

Accountholder – The term ‘accountholder’ means the person listed or identiﬁed as the holder of a Financial Account by the ﬁnancial institution that maintains the account.

CKYCR – Central KYC Registry.

Controlling Person – This is a natural person who exercises control over an Entity and includes a beneﬁcial owner as determined under sub-rule (3) of rule 9 of the Prevention

of Money-Laundering (Maintenance of Records) Rules, 2005.

In determining the beneﬁcial owner, the procedure speciﬁed in the following circular as amended from time to time shall be applied, namely:

i. DBOD.AML.BC. No.71/14.01.001/2012-13, issued on 18 January 2013 by the Reserve Bank of India; or

ii. CIR/MIRSD/2/2013, issued on 24 January 2013 by the Securities and Exchange Board of India; or

iii. IRDA/SDD/GDL/CIR/019/02/2013, issued on 4 February 2013 by the Insurance Regulatory and Development Authority.

In the case of a trust, the Controlling Person means the settlor, the trustees, the protector (if any), the beneﬁciaries or class of beneﬁciaries, and any other natural person

exercising ultimate eective control over the trust, and in the case of a legal arrangement other than a trust, the said expression means the person in equivalent or similar

position.

Where an Entity accountholder is treated as a Passive Non-Financial Entity (NFE) then a Financial Institution must determine whether such Controlling Persons are Reportable

Persons. If the account is maintained for an Entity of which the individual is a Controlling Person, then the ‘Controlling Person tax residency self-certiﬁcation’ form should be

completed instead of this form.

Entity – The term ‘Entity’ means a legal person or a legal arrangement, such as a corporation, organisation, partnership, trust or foundation.

FATCA – Foreign Account Tax Compliance Act.

Financial Account – A ‘Financial Account’ is an account maintained by a Financial Institution and includes: Depository Accounts; Custodial Accounts; Equity and Debt

interest in certain Investment Entities; Cash Value Insurance Contracts; and Annuity Contracts.

Reportable Account – The term ‘Reportable Account’ means an account held by one or more Reportable Persons or by a Passive NFE with one or more Controlling Persons

that is a Reportable Person (relevant extract for CRS).

Reportable Person

Reportable person means,

(a) one or more persons other than,

i. a corporation, the stock of which is regularly traded on one or more established securities markets;

ii. any corporation that is a related Entity of a corporation mentioned in item (i);

iii. a Governmental Entity;

iv. an International organization;

v. a Central bank; or

vi. a ﬁnancial institution,

that is a resident of any country/territory outside India (except the United States of America) under the tax laws of such country/territory or an estate of a descendent who was

a resident of any country/territory outside India (except the United States of America) under the tax laws of such country/territory; (relevant extract for CRS).

Dual resident individuals may rely on the tiebreaker rules contained in tax conventions (if applicable) to solve cases of double residence for purposes of determining their

residence for tax purposes.

BANK USE SECTION

Is the customer using any high risk products? gg Yes gg No

Is this a new customer applying for a credit card only?

gg Yes gg No

Is this a face-to-face account opening?

gg Yes gg No

Channel Type –

gg Branch gg MSF gg MSF - TPSA gg Contact Centre gg Postal gg Digital

Has the Customer’s Identity been veriﬁed in line with the required standards?

gg Yes gg No

Is the customer able to provide required ID?

gg Yes gg No

Currency that applies to all intended transactions: INR/USD/Other _______________________

Is a CDD Risk Acceptance request required to be submitted to Business and FCC?

gg Yes gg No

Is the customer a permanent resident in the same country/territory they have or are opening their product? Is the customer

a permanent resident in the same country/territory they have or are opening their product? _______________________

Conﬁrm the customer’s occupation as a student has been validated.

gg Yes gg No

Is the customer a permanent resident in the same country/territory they have or are opening their product?Is the customer

a permanent resident in the same country/territory they have or are opening their product?

gg Yes gg No

Account record checked by (To be checked by the account opening sta):

Employee name: ____________________________________________________

PS ID: ____________________________________________ Signature __________________________________________

gg For MSF/Branch Channels - KYC completed and account opening authorised by Account Opening Authority (provide AOA details:

Branch Manager/Regional Head/Designated AOA details)

Opened by

gg MSF gg Branch Date of submission of all documents gg gg gggg

Anticipated account activity aligned to customer proﬁle gg Yes gg No

I have veriﬁed the name of the customer on AOF with the KYC documents provided and conﬁrm that it meets the standards of CDD.

I also hereby conﬁrm that customer’s photo on PI and PA (if photo ID) matches with the photo on AOF

gg Yes gg No

Branch Manager/Regional Head name ________________________________________ Branch Manager/Regional Head sta number

gggggg

Branch Manager’s/Regional Head’s signature

Attestation Mode/Oce Use Only:

Documents Received

gg Certiﬁed Copies gg E-KYC data received from UIDAI gg Data received from Oine veriﬁcation gg Digital KYC Process

g g Equivalent e-document gg Video Based KYC

CKYCR Attestation Flag:

gg 1 – Certiﬁed Copies/OSV copies – Self-Signed physical documents accepted in KYC process

gg 6 – Video Based KYC (VCIP) – Documents through VCIP

gg 2 – E-KYC data received from UIDAI – To receive customer details from UIDAI through AADHAR number or biometric scanner details and Mobile OTP based

authentication

CONNECTED PARTY

List the connected/associated parties who will have control or inﬂuence over the customer's account without necessarily signing on the account. These parties could be over

and above the Add-on Cardholders.

Connected parties

gg Yes gg No : Rationale for connection : Add-on Cardholder

KYC number

gggggggggggggg (number would be given by Central KYC registry) (If available)

Connected party details:

gg Individual

Existing Customer

gg Yes gg No

Customer ID (if existing customer):

ggggggggg

Account number (if existing customer): gggggggggggggggg

What level of inﬂuence does the Connected Party have over the account?

gg Control gg Contribute gg Direct gg Beneﬁciary

Is the Connected Party’s customer record in the same system as the main party’s?

gg Yes gg No

Rationale for connection _________________________.

Conﬁrm that the identity of the Connected Party (full name, residential address) has been veriﬁed.

gg Yes gg No

Is there a reasonable connection between the Connected Party and the customer?

gg Yes gg No

Is the Connected Party a Politically Exposed Person (PEP)?

gg Yes gg No

Was Connected Party’s Identity veriﬁed through the use of Electronic or Documentary sources?

gg Yes gg No

Were any exceptions (to global CDD policy) noted during the Connect Party veriﬁcation process?

gg Yes gg No

Conﬁrm the purpose of opening the account(s) is consistent with the expected account activity and the customer’s proﬁle, including their Source of Funds and Source of

Wealth (where applicable)?

gg Yes gg No

I conﬁrm that I have met the primary applicant in person and veriﬁed the ID and address documents in original.

Employee name: ____________________________________________________

PS ID: ____________________________________________ Signature ____________________________________________

There are no annual fees on the Add-on credit card. However, ﬁnance charges applicable on the unpaid due amount as per the applicable rate

from the date of transaction.

DOCUMENTS REQUIREMENT

Proof of Identity (any one) Proof of Address (any one)

• PAN number • Aadhaar card

• Aadhaar card or Virtual ID • Passport

• Passport • Voters ID

• Voters ID • NREGA job card

• National Rural Employment Guarantee Act

(NREGA) job card

• Driving licence

• Driving licence • Others __________________________

For information on additional documents acceptable as identity/address proof, please get in touch with the nearest HSBC branch in India or your HSBC Relationship Manager or call

the HSBC Contact Centre.

Documents accepted as a Proof of Address should mention the address details.

Self-attested copy of the latest salary slip or Income tax returns or Form 16 (wherever applicable).

For credit card customers without a bank account, a stenciled copy of the Primary Cardholder’s credit card is required. (To make a stencil copy of the credit card, place a blank paper

on the front of the credit card and then run a pencil across the paper, form an impression of the credit card number on the blank paper.)

If you are not comfortable in providing the stencil copy, please visit the branch with the primary applicant carrying his/her current ID and address document(s).

Kindly submit the documents to HSBC Representative or to nearest HSBC Branch in India with a duly completed and signed card application form, photocopies of the Proof of ID

and Proof of Address documents. You are requested to carry the original documents for veriﬁcation by the HSBC representative.

Terms and Conditions apply. For further details on the products and services oered by HSBC, please visit www.hsbc.co.in or refer to the credit card services guide.

Issued by The Hongkong and Shanghai Banking Corporation Limited, India. Incorporated in Hong Kong SAR with limited liability.

ACKNOWLEDGEMENT - BANK

Sr. No.

_______________________

Agency Name _____________________________________________________

Sales Executive’s Name

______________________________________________

Sales Executive’s Code

Received completed application form and relevant documents for credit card

from ____________________________________________________________

(If approved, your credit card will be despatched within 7 days. Please contact HSBC

24X7 customer service centre after 7 days to know the status of your application).

X X

Signature of Sales Executive Signature of Customer

ACKNOWLEDGEMENT - APPLICANT

Sr. No.

_______________________

Agency Name _____________________________________________________

Sales Executive’s Name

______________________________________________

Sales Executive’s Code

Received completed application form and relevant documents for credit card

from ____________________________________________________________

(If approved, your credit card will be despatched within 7 days. Please contact HSBC

24X7 customer service centre after 7 days to know the status of your application).

X X

Signature of Sales Executive Signature of Customer

Customer Name

D D M M Y Y Y Y

DO NOT CALL SERVICES

From time to time, HSBC, India communicates various features/products/

promotional oers which oer signiﬁcant beneﬁts to its Cardholders and

may use the services of third party agencies to do so. If you do not wish

to be informed about such beneﬁts through telephone calls/SMS, you can

subscribe for the ‘Do not call’ service.

Please ﬁll up the form given below and mail it to Direct Response Cell,

HSBC, P. O. Box 631, Mumbai GPO, Mumbai - 400 001. Your request will

be implemented within 30 days from the date of receipt.

Name __________________________________________________________

First Middle Last

City ________________________________________

Please enter at least one of the following contact numbers:

Tel. No.

gggggggg

gggggggggggggg

(STD Code)

Mobile No. gggggggggggggggggggggg

CC_ADD-ON FORM_09/2023

Issued by The Hongkong and Shanghai Banking Corporation Limited, India. Incorporated in Hong Kong SAR with limited liability.

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