AXIS0160 - Forex card form

Form version - November 2023

(*Marked fields are mandatory)

Date*:

D D M M Y Y Y Y

Mr.

First Name* Last Name*Middle Name

Mrs. Ms.

Dr.

Customer Details*

Details of Travel*

PAN No.* PAN Belongs to* Self Father Mother Guardian

Forex Card Application Form

Date of Birth* Gender*

M F Third Gender

Driving Licence _____________________________________________________ Driving Licence Expiry Date

Voter ID Number __________________________________________________________

CKYC ID

Aadhar no (last 4 digits)

E-mail ID*

Residential Address*

Passport No.*

Your Axis Bank Forex Card Statement will be sent on the above e-mail ID when requested

Mother’s Name* Mrs.

If Axis Bank customer, please provide*

Place of Issue*

First Name* Last Name*Middle Name

Father’s Name* Mr.

Spouse Name* Mr. / Mrs.

Marital Status*

Unmarried Married

Others

Date of Issue* Expiry Date*

Office Name & Address

City*

STD Code* Landline No. Mobile No.*

Pin Code* State*

Country*

Landmark*

City

STD Code Landline No. Mobile No.

Pin Code State

LandmarkCountry

Tax Residential Status as per Income Tax Act, 1961*

Resident Non-Resident

Nationality* ______________________________________________

Residential Status* Resident Indian NRI PIO / OCI* Foreign National

Customer Information

(Please mention occupation codes as applicable for Non-individuals in case of HUF)

Occupation*

Salaried Self-Employed Unemployed Student Politician Retired Housewife

If salaried provide Number of Years in Employment*

If Salaried* - Public Ltd. Proprietorship Partnership firm Public Sector Government Multinational

Trust / Association / Society / ClubPvt. Ltd.

If Self Employed provide Nature of Business* -

Information Technology Professional Service Provider Agriculture Bullion / Gold Jewelry Stock Broker Real Estate

Trader Money Lender

Annual Income*

Number of Years in Business*

If Salaried provide - Employer Name* ________________________________ Job Role* _________________________________ Designation* _______________________________

(only numeric and absolute value to be filled here, No decimal or negative value allowed)

(Absolute numeric values only, no decimals allowed)

Date of Travel* Date of Return*:

Country of Travel*

Purpose of Travel*

1.______________________ 2.______________________ 3.______________________

Business

Education Medical Holiday / Leisure

FCY Amount (in words)

*End use of funds (If amount is more than USD 5,000 equivalent) _________________________________________________________________________

Reason for mismatch in country of travel and currency loaded (only in case there is a mismatch) _________________________________________________________________________

Currency

Forex Card Amt

USD EURGBP SEK CHF JPY HKD NZD

ZAR

Currency AUD CAD SGD AED SAR THB DKK

Emigration Pilgrimage NRE Repatriation

Details of Foreign Exchange required:

(Please note that Address mentioned in this Form will over write the existing Permanent and Communication Address available against any of your account with Axis Bank)

(Aadhar Physical copy should also be masked)

Customer ID

Coloured Photo Only

Occupation Code*

Choose your Forex Card*

Documents / Details Provided*

Source of Fund* (The complete section is mandatory)

FATCA-CRS Declaration*

Choose your Card:

a. Multi-currency Forex Card b. Axis Bank Club Vistara Forex Card

c. Miles & More Axis Bank World Traveller Card

Axis Bank Club Vistara Forex Card cannot be issued to a minor

Air Ticket / Visa

Passport Copy PAN Others ________________________________________________________________________

Investment Income Education Loan Others (In case of 'Others' please mention exact source*)

*For list of close relatives, please refer to Section 1

Salary

*Relation with person funding the Card

Section 1: A person shall be deemed to be relative of another if, and only if, (a) they are members of a Hindu Undivided Family; or (b) they are husband and wife: (c) the one is related to the other in the manner indicated above:

Business Income Agriculture

Self

Father (including Stepfather) Mother (including Stepmother) Son (including Stepson) Spouse

Son's Wife

Name of person funding the card*

PAN of person funding the card*

Daughter

Daughter's Husband Brother (including Stepbrother) Sister (including Stepsister)

I / We declare that the Forex Card so issued is not to be and shall not be used in countries under economic sanctions for any purpose.

Country of Birth*City of Birth*

Details under FATCA and CRS

(Please consult your professional Tax Advisor for further guidance on your tax residency, if required)

• Identification Type and Identification Number (Documents’1 submitted as proof of identity of the individual)

Name of the document submitted*_________________________________________________ Identification Number*________________________________________________

• Please tick the applicable tax resident declaration: (Any one)*

I am a tax resident of India and not resident of any other country I am a tax resident of the country / ies mentioned in the table on the next page

Country

Tax Identification Number**

Identification Type (TIN or Other

, please specify)

Place: ______________________________________________________________

FATCA - CRS Certification

I have understood the information requirement of this Form (and Terms & Conditions) and hereby confirm that the information provided by me on this form is

true, correct and complete and hereby accept the same.

FATCA-CRS Terms and Conditions

The Central Board of Direct Taxes has notified on 7

August, 2015 Rules 114F to 114H, as part of the Income Tax Rules, 1962, which Rules require Indian

Financial Institutions such as the Bank to seek additional personal, tax and beneficial owner information and certain certifications and documentation from all our accountholders.

In relevant cases, information will have to be reported to tax authorities / appointed agencies / withholding agents for the purpose of ensuring appropriate withholding from the

account or any proceeds in relation thereto.

Should there be any change in any information provided by you, please ensure you advise us promptly, i.e., within 30 days.

If you have any questions about your tax residency, please contact your Tax Advisor. If you are a US citizen or resident or Green Card holder, please include United States in the

foreign country information field along with your US Tax Identification Number. It is mandatory to supply a TIN or functional equivalent of the country in which you are tax resident

issues such identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this to the form.

To also include USA, where the individual is a citizen / Green Card holder of USA.

**In case Tax Identification No. is not available, kindly provide functional equivalent $.

Permissible documents are Passport, Election ID Card, PAN Card, ID Card, Driving Licence, UIDAI Card, NREGA Job Card and others.

Signature

Date:

Tax Residency City* Tax Residency Country* Proof of ID Submitted*

Tax Residency Address*

Payment Mode*

Other Bank Account

Other Bank Name

Cheque / DD numberCheque / DD

Transfer from own Axis Bank Account

I / We authorize you to debit my / our account number

the Forex Card funding, as detailed above, along with your applicable charges i.e. Foreign Conversion Tax, Commission

And Service Tax.

and effect

Debit Authority* (In case of Axis Bank Account)

In case Cheque / DD or any other bank account

Signature of the Accout Holder

PIO / OCI*

Foreign National

Funders Residential Status*

Resident Indian

NRI

OFAC Declaration

(This information is required only if the

card holder is not funding the card)

(This information is required only if the

card holder is not funding the card).

In case the applicant / nominee is a Minor# Details of Guardian and Declaration for Minor (Mandatory)

Declaration for Sole Proprietor (In case of a Sole Proprietor this declaration is mandatory)

Declaration*

Declaration for purchase of Foreign Exchange under the Liberalized Remittance Scheme of USD 250,000

Date

Whether under LRS (Yes / No) Purpose Code Description

As per the Annex

Sr. No.

Amount

Details of the remittances made / transactions effected under the Scheme in the current financial year (April ____ - March ____ )

Name and Address of AD branch /

through which the trahsaction has been effected

I wish to purchase a _________ denominated Forex Card for my ward, _____________________________________________ <name of the minor>. I declare that the funds being given

for the purchase of the Foreign Currency to be loaded on the card are being provided by me.

I hereby declare that the date of birth of the minor who is my ____________________ is ____ / _____ / ________ (dd/mm/yyyy) and I am his / her natural and lawful guardian

appointed by Court Order dt. ____________________________________________ (Copy enclosed). I state and confirm that the Forex Card is purchased for the actual use by the

minor and on behalf of the minor I confirm that I shall be liable for the misuse of Forex Card and shall abide by all applicable regulations regarding the usage of

Forex Card. Yours faithfully,

*Axis Bank Club Vistara Forex Card cannot be issued to a minor

First Name Last NameMiddle Name

Type of Guardian* Father Mother Court Appointed

Full Name of Guardian Mr. / Mrs. / Ms.*

Phone No. of the Guardian (in case applicable)

Signature Guardian

(Signature of Guardian)

Address of the Guardian* _________________________________________________________________________________________________________________________________

Document proof of Guardian* ________________________________________________________________________________________________________________________________

Funder’s Passport Number / Driver's License / Aadhaar Number (last 4 digits only) __________________________________________________________________________________________________________

Expiry Date (Applicable only for Driver's License & Passport Number)

I hereby declare that the currency being loaded on this Forex Card does not exceed the LRS limit of my individual capacity

and my sole proprietorship capacity combined together for this financial year.

Signature applicant

(Signature of applicant)

Name of the applicant _________________________________________________________________________________________________________

I / We hereby declare that:-

Declaration under FEMA 1999 as per A2:-

I / We hereby declare that –

1. The total amount of foreign exchange purchased from or remitted through, all sources in India, during this financial year including this application is within USD 2,50,000 (USD Two

lakh fifty thousand only) the annual limit prescribed by Reserve Bank of India for the said purpose as mentioned in the application

2. Foreign exchange purchased from me is for the purpose indicated in section Details of Travel. *(Strike out whichever not applicable).

Declaration-cum-undertaking:

Under Section 10 (5), Chapter III of The Foreign Exchange Management Act, 1999:

1. I / We hereby declare that the transaction details of which are specifically mentioned in the Schedule hereunder does not involve, and is not designed for the purpose of any

contravention or evasion of the provisions of the aforesaid act or of any rule, regulation, notification, direction or order made there under.

2. I / We also understand that if I / We refuse to comply with any such requirement or make only unsatisfactory compliance therewith, the Bank shall refuse in writing to understand

the transaction and shall, if it has reason to believe that any contravention / evasion is contemplated by me / us report the matter to RBI.

3. I / We also hereby agree and undertake to give such information / documents as will reasonably satisfy you about this transaction in terms of the above declaration.

Declaration under liberalized Remittance Scheme for Resident Individuals:

1. I / We hereby declare that the total amount of Foreign Exchange purchased from or remitted through, all sources in India during the financial year including this application is within

the overall limit of Liberalized Remittance Scheme prescribed by the Reserve Bank of India and certify that the source of funds for making the said remittance belongs to me and

the Foreign Exchange will not be used for prohibited purposes.

2. I / We affirm that the residential status provided is true.

3. The remittance would be utilized for permitted Capital & Current Account transactions only.

4. I have not availed any loan / credit / borrowings for remitting under Liberalized Remittance Scheme for Capital Account transactions.

5. The remittance is not being requested for any transaction not permissible under FEMA and those in the nature for margin calls to overseas exchanges / overseas counterparty are

not allowed under the Scheme.

6. The Scheme is not available for capital account remittances to countries identified by Financial Action Task Force (FATF) as non-co-operative countries and territories as available

on FATF website www.fatf-gafi.org or as notified by the Reserve Bank.

7. The remittance is not being sent for purchase of FCCBs issued by Indian companies in the overseas secondary market.

8. The remittances is not being sent for trading in Foreign Exchange abroad.

9. I / We undertake to make all capital A/c transactions under LRS from Axis Bank only.

Declaration from Tour Operators:

I / We confirm that the remittance is being made for travel arrangements of:-

1. Resident Individuals as per enclosed list. The remittance made is within the limits prescribed by Reserve Bank of India for the Resident Individuals under Liberalized Remittance

Scheme.

2. Foreign tourist as per enclosed list. The amount of remittance does not exceed the amount of Foreign Exchange remitted to India by the Foreign Tourist.

General Declaration

1. The purpose and transaction details as mentioned above are true to the best of my knowledge.

2. I / We shall be responsible and liable for any incorrect detail provided by me / us.

3. The remittance is not being requested for any purpose specifically prohibited under Schedule I or any item restricted under Schedule II of Foreign Exchange Management

(Current Account Transaction) Rules, 2000.

4. The remittance is not being sent directly or indirectly to Nepal or Bhutan.

5. The remittance is not being sent directly or indirectly to those individuals and identified as posing significant risk of committing acts terrorism as advised separately by the

RBI to the Banks.

6. The transaction mentioned above does not involve, and is not designed for any purpose for which the drawal of Foreign Exchange is prohibited under Rule 3 of the Foreign

Exchange Management (Current Account Transactions) Rules, 2000, read with Schedule I thereof viz:

Please sign this authorization*

a. Remittance out of Lottery winnings

b. Remittance of income from racing / riding, etc. Or any other hobby

c. Remittance for purchase of lottery tickets, banned / prescribed magazines, football pools, sweepstakes, schemes involving money circulation, securing prize money / awards, etc.

d. Payment of commission on exports made towards equity investment in Joint Ventures / Wholly Owned Subsidiaries abroad of Indian Companies

e. Remittance of dividends by any company, to which the requirement of dividend balancing is applicable

f. Payment of commission on exports under the Rupee State Credit Route, except commission up to 10% of invoice value of exports of tea and tobacco

g. Payment related to “Callback Services” of telephones

h. Remittance of interest income on funds held in the Non-resident Special Rupee Account Scheme

i. Travel to Nepal and / or Bhutan

j. A transaction with a person residing in Nepal or Bhutan

7. I / We agree that submission of request does not necessarily imply processing of the transaction. Axis Bank has full rights to reject the transaction based on regulatory and

internal guidelines.

8. I / We agree that in the event the transaction could not be executed / debited to my / our account, after submitting the request for processing to the Bank on the account of

insufficient / unclear balance at the time of execution of the transaction in my / our account, Axis Bank shall not be responsible for not being able to process the transaction. Any

exchange losses incurred in this connection, due to reversal of the forex deal, can be charged to my

/ our Axis Bank account.

9. I / We agree that in the event the transaction is cancelled or revoked by me / us after submitting the request for processing to the Bank, any exchange losses incurred in this

connection, can be charged to my / our Axis Bank account.

10. I / We undertake that I / We will not remit payments directly / indirectly outside India in any form towards overseas Foreign Exchange trading through electronic/internet

trading portals. I am aware that effecting such transactions would make me / us liable to be proceeded against with for contravention of the Foreign Exchange Management Act

(FEMA), 1999 besides being liable for violation of regulations relating to Know Your Customer (KYC) norms / Anti Money Laundering (AML) standard.

11. I / We confirm that we are aware of Axis Bank Limited's Sanctions Policy Statement and that Axis Bank, including its subsidiaries and affiliates (the “Group”), is firmly committed

to complying with all applicable sanctions laws (as imposed by UN, US, UK, EU or any other Government and / or Regulatory authorities) that are legally binding upon the Group

and its businesses.

12. I / We are further aware that Axis Bank Limited may be unable to process any transactions that involves or have linkages / reference to any sanctioned countries*/ territories*/

parties including for cases where transshipment is involved.

13. I / We confirm that shipment and / or transshipment of goods covered under this transaction shall not involve any sanctioned countries / territories / parties.

14. Any statutory levy including duties or taxes payable as a result of the use of the Card shall be Cardholder’s responsibility and if imposed on / recovered / sought to be recovered

from Axis Bank (either directly or indirectly), such statutory levy shall be deducted from the Axis Bank Multi-currency Forex Card Balance and / or recovered directly from the

card funder and/ or from any accounts (including joint accounts) maintained by the Cardholder with Axis Bank or its group companies.

a). If aggregate foreign currency purchases in any form during the financial year exceeds ₹ 7 Lakhs and where the foreign currency purchase was made under LRS by the card

funder, card funder shall bear the applicable Tax Collected At Source (TCS) at the rate of 5% under applicable laws on the amount exceeding ₹ 7 Lakhs

b). In cases where the amount loaded or reloaded for the purpose of pursuing education abroad through an education loan obtained from a financial institution, in such a case

card funder shall bear the applicable TCS at the rate of 0.5% under applicable laws on the amount exceeding ₹ 7 Lakhs For the sake of clarity, Financial institution shall have the

same meaning as defined u/s 80E of the Act

15. I / We hereby confirm that my personal / KYC details may be shared with Central KYC Registry.

16. I / We hereby consent to receiving information from Central KYC Registry through SMS / E-mail on the my registered number / E-mail address.

*Sanctioned Countries and Territories include Cuba, Iran, Syria, North Korea (also known as Democratic People's Republic of Korea), Crimea and Sevastopol also known as Crimean

Autonomous Republic) and Sectorial Sanctioned Countries and Territories include Russia and Venezuela. The list of sanctioned countries and territories change from time to

time, hence visit https://www.axisbank.com/sanction-policy-statement for updated list of sanctioned countries and territories.

17. I / We hereby agree and acknowledge that Ecommerce and Contactless transactions on the Forex card when issued will be blocked. The same can be activated through Internet

Banking, Mobile Banking, Axis Prepaid Card Portal or Axis bank branch.

18. I / We also acknowledge that channels like ATM, POS transactions at merchant outlets, Online or contactless and their limits can be enabled or disabled / increased or

decreased through Internet Banking, Mobile Banking, Axis Prepaid Card Portal or Axis bank branch.

19. I / We agree and acknowledge that in accordance with Finance Act, 2021, sections 206AB and 206CCA in the Income-tax Act 1961, I / we will be levied higher rate of TCS

(wherever applicable) if found to be a Specified Person as per Income Tax Department records.

20. I / We hereby agree and acknowledge that the information provided in this form will over write the existing details available against any of my accounts with Axis Bank.

21. I / We hereby agree, as per the PML rules, to ensure to inform the bank of any changes in the KYC documents submitted earlier within 30 days of change.

Signature

Date

Place

I hereby apply for the issuance of Axis Bank Forex Card to me and declare that the information included in the application is true and correct, and that I am an Indian citizen, and I

am eligible to apply for an internationally valid Card. I accept that Axis Bank is entitled in its absolute discretion to accept or reject this application, without assigning any reason

whatsoever. I hereby confirm that I have received the Terms and Conditions as applicable to the Axis Bank Forex Card, and have read and understand the same. If this application is

accepted, I shall be bound by the Terms and Conditions governing the Axis Bank Forex Card, as may be in force from time to time, and the use of the Card shall be deemed to be

acceptance of those Terms and Conditions. I am aware that by agreeing to this, I am estopped from taking a plea subsequently, that I have not been aware of the Terms and

Conditions. I authorize Axis 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 requirements, or maintaining my account in good standing. I agree to

an ongoing confirmation for use of my name address, e-mail and mobile number for marketing / merchandising offers between Axis Bank and other companies. I understand and

acknowledge that local laws and Reserve Bank of India Rules and Regulations lay down norms and limits for the purchase and use of Foreign Exchange. I undertake that the usage

of the Axis Bank Forex Card by me will be in accordance with the Exchange Control Regulation of the Reserve Bank of India, and the applicable laws in force from time to time, in

particular and without information, the Foreign Exchange Management Act, 1999 (“FEMA”). In the event of any failure on my part to comply with Rules and Regulations or in the

event of any information supplied by me being incorrect and inaccurate, I agree that I will be solely liable for any / all penalties and / or action under the local laws and / or regulations

as may be in force, governing the purchase and use of the Axis Bank Forex Card, and shall indemnify Axis Bank for any losses or damages caused to the Bank. I also understand that

a Service Tax is applicable on all fees, interest and other charges as per the Government of India regulations, and agree to pay same. In case I have applied for an Additional Card

(Add-on Card) available for a resident Indian – parent, spouse, brother, sister or child over 12 years of age or for myself, I will receive the details of transactions done using Add-on

Card along with the Primary Card. The facility of an Additional Card being a facility, continuation of the membership of the Additional Card member will be dependent on the

continuation of my membership. I agree and acknowledge that Axis Bank will act on requests made by any person(s) other than me, claiming to represent me for reload of the Axis

Bank Forex Card issued to me. In such an event I shall not contest the said reloading. I, hereby request and authorize agree and acknowledge that, Axis Bank to act and rely on any

instructions or communications given by me or any person(s) other than me, directly or indirectly, via. telephone, cellphone, facsimile, untested telexes and faxes, telegraph, cable,

e-mail or any other form of electronic communication, for any purpose, related to Axis Bank Forex Cards. I agree and acknowledge that Address mentioned in this form will over

write the existing Permanent and Communication Address available against any of my account with Axis Bank.

I / We, understand and acknowledge that there are inherent risks involved in giving or sending the instructions or communications via. telephone, cellphone, facsimile, untested

telexes and faxes, telegraph, cable, e-mail or any other form of electronic communication, and at times the said instructions or communications may not be clear, complete, visible,

readable and as such I hereby agree and confirm that Axis Bank shall not be held liable for and shall be indemnified from, any losses or damages including legal fees, arising upon

acting on, or failure to act on such instructions, or communications, wholly or in part in accordance with the said instructions or communications so received. In case of Axis Bank

Forex Card issued to me at the requests of my Employer, I hereby authorize Axis Bank to act on the requests made by my employer for reload, cancellation and refund of the Axis

Bank Forex Card. 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, and shall not hold the Bank liable for any failure and / or errors in operation of Cards at the ATMs / EDC terminals. I hereby agree that the Axis Bank Forex Card will

not be funded by the Bank in the event there is any breach of the limits as prescribed under FEMA, and as applicable to me, or if there is any discrepancy / breach of the KYC

requirements, and I shall not hold the Bank liable for non-funding due to the reasons mentioned aforesaid. The Forex card will be funded post all documents are received and

compliance verification is completed successfully I agree that my transaction data related to my Miles & More Axis Bank World Traveller Card will be transmitted to Miles and More

GmbH, Unterschweinstiege 8, 60549 Frankfurt Main) (Miles & More) Germany. My transaction data will be processed and used for marketing activities related to the Miles & More

Axis Bank World Traveller Card issues. Therefore, I agree that Miles & More is allowed to use my transaction data for offers specially designed for Miles & More Axis Bank World

Traveller Card holders, and to communicate it directly through various channels such as e-mails and direct mailing. In addition, I agree that Miles & More Axis Bank World Traveller

Place: ______________________________________________________________

Signature of the Card holder

Axis Bank Club Vistara Forex Card (Only in Axis Bank Club Vistara Forex Card)*

To earn Club Vistara Points with your Axis Bank Club Vistara Forex Card you have to be a member of the Club Vistara Program.

Please enroll me for Club Vistara Membership. The membership will be issued in your name subject to Club Vistara T&Cs; please visit www.airvistara.com for details.

Axis Bank will share your name, contact information and other necessary details with Club Vistara for them to be able to provide the Axis Bank Club Vistara Forex Card benefits and

Club Vistara membership to you. Once enrolled customer is bound by terms and conditions of Club Vistara.

Miles & More Pogram (Only in case of Miles & More Axis Bank World Traveller Card)*

To earn award miles with your Miles & More Forex Card you have to be a member of the Miles & More program

Yes, I am a Miles & More member. My Miles & More Service Card Number is (15 digits)*

*Please, enter your existing Miles & More Service Card Number to ensure you earn miles on every purchase. Failure to do so will result in a duplicate automatic enrolment.

If you have forgotten your Miles & More Service Card Number please contact your the Miles & More Service Center: +1800 102 5838* (Mo-Sa 09-18h)

No, I'm not a Miles & More member. Please enroll me. I hereby agree that Axis Bank may transfer the data relevant in particular for the enrolment to the Miles & More Program

to Miles & More GmbH and Deutsche Lufthansa AG for the purpose of administering the Miles & More Program“

Herewith I agree with Miles & More Terms & Conditions and Miles & More Data Protection Regulations

Miles & More would like to keep you informed about relevant topics

Yes, I wish to receive information and offers in connection with my membership of the Miles & More programme and consent to Miles & More GmbH and Deutsche Lufthansa

AG contacting me for this purpose via. electronic communication services (e.g. by e-mail, SMS / MMS and messenger services and telephone) – also on a personalized basis –

and identifying my main areas of interest for the purpose of receiving personalized offers on the basis of data collected about me including my usage and consumer behaviour

(e.g. by the use of cookies, web beacons, program data and booking data).

Yes, I wish to receive information and offers (e.g. customer satisfaction surveys, personalized offers and newsletters) including partner information [www.lufthansa.com/xx

/en/Lufthansa-ID partner] from Deutsche Lufthansa AG, Austrian Airlines AG and Swiss International Air Lines AG. I consent to

Consents and Undertakings

Why we need your consent?

We require your consent for certain processing of your personal data, in line with our internal procedures and with applicable data protection laws such as the EU General Data

Protection Regulation 2016 / 679 (“GDPR”). This is for the following reasons:

• we need to process certain information about you that is considered ‘special categories of personal data’ or information about criminal offences and convictions (together ‘sensitive

personal data’) and is highly protected under the GDPR. We need this information for the purposes of issuance of Forex Card, Loading of Forex Card and allowing usage on the same;

• we may wish to use exclusively automated processing techniques to make decisions about you, for example your suitability to receive a specific discount, offer etc, or to create a

customer profile that will help us assess the risks associated with any feature or services you apply for, and you have a right under the GDPR to object to us using these automated

processing practices.

• we would like to send you marketing communications by email, text or phone to let you know about our products and services, and any promotions or special offers we are running.

What types of data we will process?

We need to use a range of your personal data in order to comply with our legal requirements and to provide our products and services. Below we set out the types of data for each

of the activities we ask your consent for:

Processing of sensitive personal data

We wish to use Name, Birth date, Nationality, Residential status, Details of travel, Occupation, Annual income, Source of funds, biometric data for ID purposes, genetic data

Automated processing

For automated decision making, we wish to use Name, Birth date, Nationality, Residential status, Details of travel, Occupation, Annual income, Source of funds, biometric data for ID

purposes, genetic data.

For profiling activities, we wish to use Name, Birth date, Nationality, Residential status, Details of travel, Occupation, Annual income, Source of funds, biometric data for ID purposes,

genetic data.

Direct marketing

In order to provide you with marketing communications relating to products or services we think you might be interested in, we wish to use email address, name, mobile number

What happens if you refuse to provide consent?

If you do not provide your consent, we will not use your personal data for the activities listed above.

Where you refuse to provide consent for us to use your sensitive personal data, we may be unable to provide you with the services you have requested from us.

Where you refuse to provide consent for us to use automated processing to make decisions about your suitability for our features, products and services, we will ensure that decisions

are reviewed by members of staff in the relevant Axis banking team.

Where you do not want us to use automated processing for profiling purposes, we will not do so. This may affect any risk assessments we make in respect of any products or services

you have applied for, and may impact on our ability to suggest the most appropriate Axis product for you.

Where you do not consent to receiving marketing communications from us, we will not add you to any of our marketing lists and you will not receive any such communications. .

What happens if you change your mind about consent?

You are free to withdraw your consent at any time. If you would like to do this, please email us at www.axisbank.com/support and we will ensure that we no longer process your

personal data in this manner.

Where you receive marketing emails from us, we always include an unsubscribe link to enable you to withdraw your consent. This is the easiest way of withdrawing consent for

marketing messages, however you may also use the link above.

Where can you find more information about our processing of your personal data?

You can find out more about how we process your personal data, including the types of personal data we process and who we share it with, by reading our Customer Privacy Notice,

available online at www.axisbank.com . If you would like to receive a hard copy, please write to us at www.axisbank.com/support

Consent* (Mandatory)

If you are happy to provide your consent, please tick the appropriate boxes below:

I consent to the processing of my sensitive personal data for the purposes of:

• communicating with me over phone, email, regarding any information on Forex Card processing and documentation;

• developing, marketing, and communicating their products and services to me;

• data analytics on my personal data to understand usage of products and services and creating opportunities to offer better products and services;

• processing data as the Bank’s Cookie Policy over Axis Bank's digital channels relating to behavioural pattern and develop relevant products.

I consent to the Bank making fully automated decisions in respect of offering Forex Card product, services and allowing usage on the card.

I consent to the Bank using fully automated data processing techniques to create a customer profile

I consent to the Bank and / or its affiliates to send marketing communications in respect of its various products and services from time to time by:

• E-mail

• SMS text messages

• Telephone

_________________________________________

Signature

Yes

Yes No

Nomination

(DA1 Form) (Only one individual nominee permitted & to be signed also in case of no nomination. This nomination is for Forex Card)

If nominee is Minor, Date of Birth

to receive the amount of deposit on behalf of the nominee in the event of my / our / Minor's death during the minority of the nominee.

Signature of Witness***____________________________________________________________________________________

Name _________________________________________________________________________________________________________

Address ______________________________________________________________________________________________________

Date_________________________, Place _______________________________

Signature of Primary Applicant** _______________________________________________________________________________

Name ______________________________________________________________________________________________________________

Address ____________________________________________________________________________________________________________

Signature of the Joint Applicant(s) _____________________________________________________________________________

**Where deposit is made in the name of a Minor, the nomination should be signed by a person lawfully

entitled to act on behalf of the Minor.

***In case of thumb impression, nomination to be filled in as annexure.

*Strike out if nominee is not a Minor.

Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule 2 (1) of the Banking Companies (Nomination) Rules 1985 in respect of Bank Deposits

I / We (Name)* __________________________________________________________________________________ (Address)* _________________________________________________________________________________

Nominate the following person to whom in the event of my / our / minor's death the amount of deposit in the above account may be returned by Axis Bank Ltd.

I wish to nominate

Name*

*As nominee is Minor, I / We appoint (Name

Address Same as Primary Applicant If different

Relationship with Minor*

If different from Primary Applicant

Address Same as Primary Applicant

I do not wish to nominate

Nominee Date of Birth*Age Years

Relationship with depositor* Father Mother Spouse Daughter Son Others

Payment Purpose

Purpose Code

S0301

S0303

S0304

S0305

S0306

S1307

Travel for education (including fees, hostel expenses, etc.)

Business travel (Including all kinds of incidental expenses for business conference, commercial shoot, distribution and

projection services, etc.)

Description

Travel for pilgrimage

Travel for medical treatment

Other travel (including holiday trips and payments for settling international Credit Cards transactions)

Outflow, on account of migrant transfers including personal

S0014 NRE Repatriation

For Branch use only*

Signature

Date* Place*

This is to certify that the remittance is not being made by / to ineligible entities and that the remittance is on conformity with the instructions issued by the Reserve Bank from time

to time under the Scheme.

Forex Card*

Minor Declaration Sole Proprietorship Declaration

If applicable attach:

Account Reference*

Name of issuing Authority* Employee ID*

Branch Name* Branch Code

Stamp and Seal*

Field marked* (star) are mandatory.

- The Lufthansa Group contacting me via. electronic communication services (e-mail, SMS / MMS, messenger services, telephone) for this purpose (also on an individual basis) and

- The use of my personal data, which has been collected by companies belonging to the Lufthansa Group [www.miles-and-more.com/joint-partner], including my usage and

consumer behaviour (e.g. by the use of cookies, web beacons, program data and booking data), in order to identify my main areas of interest for the purpose of receiving

customized information and offers.

I can find detailed information about the content and scope of the processing of my data and the content of communications and offers in the Privacy Policy

[www.miles-and-more.com/privacy-statement].

Miles & More newsletters – Information on your account balance, early reminders about mileage expiry and up-to-date programme information at a glance

Miles & More offers – Regular information about current offers from Miles & More and its partner companies

Market research – Your opinions about Miles & More and your interests in earning and redeeming miles

I can edit my communication settings at any time in my customer profile on www.miles-and-more.com, and / or withdraw and / or restrict my consent in full or in part (e.g. by

telephone at the Miles & More Service Centre). In addition, I can deactivate push notifications to mobile end devices in the respective Miles & More app.

Miles & More GmbH and Deutsche Lufthansa AG can send me legally relevant information about the Miles & More programme (such as changes to the Terms and Conditions of

Participation), irrespective of whether I have given or withdrawn my consent.

If I do not give my consent, I will not receive information from Miles & More GmbH and Lufthansa Group Airlines [www.miles-and-more.com/joint-partner]. I can find out about

my mileage balance myself (including early reminders about mileage expiry) in my customer profile on www.miles-and-more.com.

Referral Agent’s Use Only

1. We request Axis Bank to send outward remittance(s) / issue Demand Draft(s) / Forex Card(s) on behalf of our customer (Applicant) as per details

submitted in this Application Form. This Applicant is referred to Axis Bank basis the Referral Agreement cum Indemnity executed between Axis Bank

and us dated __________. All the Terms and Conditions stated in the said Referral Agreement cum Indemnity shall be applicable to this remittance /

purchase transaction. The Applicant shall submit all the required KYC and other necessary documents as required by Axis Bank. The funds for the

said remittance / purchase transaction(s) shall be arranged directly by the Applicant to Axis Bank.

2. We confirm and declare that the facts stated above are true and correct and that we are aware that Axis Bank has solely relied on the above

statement for undertaking the remittance / purchase transaction(s) as requested by the Applicant and that Axis Bank is not under obligation to verify

the veracity of the statements as above and Axis Bank shall not be held liable for any discrepancies or erroneous statements as contained herein

and we further confirm that Axis Bank shall stand indemnified at all times for any loss incurred by Axis Bank on account of any misrepresentation

by us or by the Applicant.

Agent Name Referral Code Signature & Stamp

This is to certify that the remittance is not being made by / to ineligible entities and that the remittance is in conformity with the instructions issued by

the Reserve Bank from time to time under the Scheme. For NTB Customer, 'OSV of KYC docs is done by Branch / Operation Head' & 'AML due diligence is

done for high Cash Value Transactions'. We have ascertained and verified the source of funds for the applicant and found in order.

Name ________________________________________________________________ Designation of the Authorized Official ____________________________________________________________________

Place ______________________________ Stamp __________________________________ Signature & SSN _______________________________ Date ________________________________

I certify that I have verified the Customer's signature as per Bank records and retained the originals of all the scanned documents and forms submitted

by the remitter for the above transaction.

Certificate by the Authorized Dealer* (Mandatory for Branch to fill the complete section and sign)

All packed for your trip' here's what you need…

How would you like to spend your trip abroad - attending to important business, enjoying sightseeing, dining out, taking breathtaking landscape and exotic

culture of the country or would you like to spend your precious time concerned about carrying cash and its safety!

We, at Axis Bank, understand how important and memorable each moment of your trip abroad is, and present you with the Axis Bank Forex Card -

a hassle-free, secure and convenient way to carry money and make payments when you travel abroad.

Power packed Card

• A VISA / MasterCard / Discover prepaid Foreign currency Card

• You can use the card for multiple trips as long as the card is valid. The validity is mentioned on the card.

• A secure 4-digit PIN helps to secure your cash withdrawal transactions

• Reloadable via. Internet Banking & Axis Mobile App (Only for Axis Bank Account Holders)

• Earn award miles that can be redeemed across more than 350 local & global Miles & More partner (Only for Miles & More Axis Bank World Traveller Card)

• Get free enrolment to the prestigious Miles & More membership programme (Only for Miles & More Axis Bank World Traveller Card)

• With Axis Bank Club Vistara Forex Card get Complimentary Base Tier membership of India's Fastest Rewarding Flyer Program - Club Vistara. Earn Club Vistara

points Points that you can redeem for Award flights and upgrade Awards

Convenience Guaranteed

• Anytime access to your cash at over 1 million MasterCard / VISA / Discover ATMs, and in any denomination you wish to withdraw

• Accepted at over 80 million MasterCard / Visa / Discover Merchant Outlets across the world

• Know the transaction details on your Card anywhere, anytime, through Internet Banking or Mobile App

• Forex Cards can be used on all international trips, merchants / websites, except those as per the FEMA guidelines

• With the Contactless technology of Paywave make your payments faster

Assistance just a call away

• For any assistance or for reporting the loss / theft of your Card, just call the 24 Hour Axis Bank Customer Service Number +91 40 6717 4100 or e-mail by

visiting www.axisbank.com/support. Your Card will be immediately blocked to secure your money, and a replacement Card will be mailed to you within

2 working days

• As a Cardholder you can also access VISA's Global Customer Assistance Service / MasterCard Global Service, which can be used to report a lost or stolen

Card, get emergency cash assistance, and make inquiries (charges applicable)

• Toll-Free numbers available for following countries - India +91 40 6717 4100 (Paid Number), USA 1855 205 5577, UAE 8000 3570 3218, UK 0808 1785 040,

Saudi Arabia 800 850 0000, Qatar 00800 100 348, Australia 1800 153 861, Canada 1855 436 0726, Singapore 800 120 6355

Insurance

• Lost Card Cover: Insurance Coverage equivalent of up to ₹ 3,00,000 for loss of Card from the time you report the loss to us For more information on

customer liability in case of fraudulent transaction please

visit www.axisbank.com/docs/default-source/noticeboard/customers serviceinformation/customer-protection-policy.pdf

Unutilized balance. flexible options

When you return from your trip, you can choose to:-

1. Get your balance on the Card encashed.

2. Or simply let the balance on your Card (aggregate up to $2,000 or its equivalent, in the above mentioned currencies as per RBI Regulation) remain, so that you

can use it for any future trips.

Axis Bank Forex Card

Dynamic currency conversion

In certain countries, the acquiring Banks may choose to activate the feature of 'Dynamic Currency Conversion' on their ATMs and POS machine network. As

per this facility, the ATM / POS machine identifies the Forex Card as a Card issued from a foreign country, and prompts the customer to transact in their

'home currency' (in case of Indians, this would be Indian Rupees). If a customer selects the 'home currency / ₹' option, additional cross-currency charges are

levied by the acquiring Bank the bank that runs the ATM / POS machine.

We urge you to note that as the Forex Card is purchased and loaded with the purpose of using the Card in the respective foreign currency, the customer must

avoid selecting any option that prompts for a change in usage currency, to avoid any adverse exchange rate, the 'Dynamic Currency Conversion' feature may

appear with differing terminology, depending on the overseas Bank.

Axis Bank is not responsible for any 'Dynamic Currency Conversion' related charges, and will not be able to refund any such charges, in case they are levied

on account of wrong usage of Card.