Vous êtes sur la page 1sur 8

YES BANK MULTI CURRENCY TRAVEL CARD

Making life easier when you’re traveling abroad, with YES BANK Multi Currency Travel Card. It's the safe and secure alternative to
pockets full of cash or traveller’s cheques when you're away. Use your YES BANK Multi Currency Travel Card, pre-loaded with
foreign currency just like another credit/debit card for in-store purchases, online transactions or to withdraw money from ATMs
affiliated by MasterCard while away.
You can use your Multi Currency Travel Card at over 31.5 million merchants and over 1.9 million ATMs worldwide, wherever
MasterCard is accepted. The card automatically chooses the currency wallet as per the local currency of transaction from the
multiple available wallets on the Card. Load the currencies you want, lock in your exchange rate for peace of mind and save on
exchange rate fluctuations.

CONVENIENCE: SECURE:
ü One Card, multiple currencies ü Chip based Card for higher security
ü 24x7 access to your funds ü Real time Email and SMS alerts
ü Online account management ü Insurance coverage on Card
ü Longer validity ü Temporary Card lock feature
ü Toll-free international numbers

EASE OF USAGE:
ü Shop at any of the Merchant outlet (shops, restaurants, hotels, grocery stores etc.) accepting MasterCard just by swiping your
card
ü Make online purchases at any international merchant website secured with MasterCard Secure
ü Withdraw cash from any MasterCard enabled ATM worldwide

QUICK TIPS FOR USING YOUR TRAVEL CARD BETTER:


1. REMOTE RELOAD: Enjoy your overseas trip even when running short of balances, just leave a signed authority letter along
with the duly filled and signed Reload form with your close relative.
2. BALANCE ENQUIRY AND VIEW STATEMENT: Check currency wise available balance and view statement for past
transactions online
3. TEMPORARY LOCK/UNLOCK: During your trip or upon return to India you can lock your card temporarily and unlock it
anytime
4. INSURANCE BENEFIT: From the time of issuance and loading of the Card, you are auto enrolled for a maximum cover up
to INR 3 Lakh in the event of any type of unauthorized transaction or Lost/Stolen/Counterfeit Cards
5. SMS ALERT FACILITY ON INDIAN MOBILE NUMBER: Real time SMS alerts will be sent on your registered Indian Mobile
Number, if the same is not updated in our records you are advised to call YES BANK Customer Care for updation of the same
6. PRE-AUTHORIZATION DURING CHECK-IN IN HOTELS OR RENTING CAR/BIKE: Hotels/Car Rentals before check-
in/renting services etc. take a pre-auth on your card. A Pre-Authorization is essentially blocking of certain amount on your
card. At the time of checking out of the hotel/settling the bill, you should:
ü Ask the executive to settle the final bill against the pre-auth that was taken
ü Ask the executive to cancel the pre-auth (credit back the amount) that was taken and settle the bill by taking an authorization
for the actual bill amount
ü In case the pre-auth that was taken remains unclaimed by merchant up to 30 days then it would be automatically credited
back to the Card account on the 31st day. YES BANK is not responsible for any additional funds debited or charges levied on
your Card by Hotel or merchant.

We recommend do not use your Multi Currency Travel card for pre-authorization.
7. DYNAMIC CURRENCY CONVERSION (DCC): In certain countries, the overseas 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 your Travel 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 or US dollar by default)
If a customer selects the "home currency/INR" option, the same transaction will attract additional Cross Currency
Conversion Fee. Card holder must avoid selecting any option that prompts for a change in usage/transaction currency
(especially changes to INR or USD) to avoid any adverse exchange rate.
Please also note that the "Dynamic Currency Conversion" feature may appear with differing terminology on the Charge slip,
Sales–receipt or ATM screen depending on the overseas bank.
YES 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 the Travel Card.
(Page 1 of 8)
SCHEDULE OF CHARGES AND DAILY USAGE LIMITS:

Sr. Currency ATM Cash ATM Balance POS / ECOM Daily Limit for Daily Limit for
No. Withdrawal Fee Enquiry Fee Transaction Fee ATM Cash POS transactions
Withdrawal
1 United States Dollar USD 2.00 USD 0.50 NIL USD 5,000 USD 10,000

2 Great Britain Pound GBP 1.00 GBP 0.50 GBP 4,000 GBP 8,000

3 Euro EUR 1.50 EUR 0.50 EUR 4,500 EUR 9,000

4 Canadian Dollar CAD 2.15 CAD 0.55 CAD 6,500 CAD 13,000

5 Australian Dollar AUD 2.00 AUD 0.50 AUD 6,500 AUD 13,000

6 Singapore Dollar SGD 2.70 SGD 0.75 SGD 3,500 SGD 12,000

7 Arab Emirates Dirham AED 7.00 AED 1.75 AED 10,000 AED 40,000

8 Swiss Franc CHF 1.80 CHF 0.45 CHF 5,000 CHF 10,000

9 Japanese Yen JPY 204 JPY 51.00 JPY 5,00,000 JPY 10,00,000

10 Hong Kong Dollar HKD 15.50 HKD 3.90 HKD 40,000 HKD 80,000
Issuance Fee: Rs.125, Reload Fee: Rs.100, Refund Fee: Rs.75
Cross Currency Fee: 2.75%
Statement Fee: NIL, Chargeback Fee: NIL, Charge slip Retrieval: NIL, New ATM PIN: NIL
All fees and charges mentioned above are exclusive of taxes. Goods and Service Tax (GST) rate of 18% will be levied w.e.f
July 1, 2017
Some international bank ATMs may have their own charges which are displayed on the ATM screen while transacting. You
have the option of going to different ATMs in order to avoid this charge.
Daily limits set on your Travel Card is the higher limit, however foreign ATMs may have their own per transaction limit
depending upon their Bank or regulatory guidelines. You are requested to check the same in the ATM premise before
usage.

GOODS AND SERVICE TAX (GST) SLAB ON CURRENCY CONVERSION


SLABS FOR VALUATION OF SUPPLY
AMOUNT OF CURRENCY EXCHANGED VALUE OF SUPPLY GST @ 18%#
Up to Rs. 1,00,000 1% of gross amount exchanged, Rs. 180*
subject to minimum amount of Rs. 250
From Rs. 1,00,001 to Rs. 10,00,000 Rs. 1,000 plus 0.5% of gross amount exchanged Rs. 990**
Above Rs. 10,00,000 Rs. 5,500 plus 0.1% of gross amount exchanged, Rs. 1,170***
subject to maximum of Rs. 60,000
# 18% considered for the purpose of numeric understanding only
*Amount considered for exchange is Rs. 1,00,000
**Amount considered for exchange is Rs. 10,00,000
***Amount considered for exchange is Rs. 20,00,000
For detailed information, visit www.yesbank.in/mctc

YES BANK MULTI CURRENCY TRAVEL CARD APPLICATION ACKNOWLEDGEMENT


Travel Card UWKRN Number: Date of Application: D D M M Y Y Y Y

Branch Name: _______________________________________________ Branch Code:


Load Currency & Amount: USD ________ EUR ________ GBP ________ AUD ________ CAD ________
SGD ________ AED ________ HKD ________ JPY ________ CHF ________
Amount Received in INR: _________________________________ Others ________
Documents Received by: ___________________________________ Branch Stamp: ____________________________
(Page 2 of 8)
YES BANK MULTI CURRENCY
TRAVEL CARD APPLICATION FORM
(To be filled by applicant only)
Barcode
All fields marked "*" are MANDATORY Promo Code:

PERSONAL INFORMATION
Title Mr Ms Mrs Dr. First Name Middle Name Last Name

Name*

Maiden Name (If)

Title Mr Ms Mrs Dr. First Name Middle Name Last Name


Father's/Spouse Name*

Title Mr Ms Mrs Dr. First Name Middle Name Last Name

Mother's Name*

Marital Status Single Married Others Gender M F T Date Of Birth* D D M M Y Y Y Y No of Depends

Pan Card* UID (Aadhaar)

GSTIN
What are your Passport Number* Passport Expiry Date* D D M M Y Y Y Y
Identification
Number? Passport Issuance Date* D D M M Y Y Y Y Issued At:* Place

Driving License Driving License Expiry Date D D M M Y Y Y Y

NREGA Job Card Voter ID

Do you wish to update your GSTIN YES NO If YES, Please provide________________________ GST State______________________
What is your Education qualification? 10th or below 10+2 or below Graduate Postgraduate & above Other (Please Specify) ________
What is your Nationality?* Resident Indian NRI Foreign National Person of Indian origin (PIO) Overseas Citizenship of India (OCI)

What Is Your Country of Citizenship?*

Country Name 1 Country Name 2

What is your Current Residential Address?*

Flat/Door No. & Building Name


Road Number/Road Name
Area/Locality Name/Landmark
City Pin Code
State Country

What are your Personal Contact Details?


Mobile* Residence
Country Code Number
Landline Country Code Area Code Number

Personal Email ID*

What is your Permanent Address?* Select Tick Box, if same as current resident Address

Flat/Door No. & Building Name


Road Number/Road Name
Area/Locality Name/Landmark
City Pin Code
State Country

What are your Permanent Address Contact details?


Mobile* Residence
Country Code Number
Landline Country Code Area Code Number

(Page 3 of 8)
OCCUPATIONAL INFORMATION
What is Your Occupation? Salaried Self-Employed Retired Home Maker Student
If Salaried, employed with: Private Limited Partnership Proprietorship Public Limited Government
Multinational Others
If Self-employed, your firm is: Private Limited Partnership Proprietorship Others
If Self-employed, your are a: Broker Chartered Account Consultant Doctor Engineer
Firms/Entertainment Financier Real Estate Agent Lawyer Journalist
Agriculturist Manufacturer Software Professional Trade/Distributor Others
Total period in Employment/ Business Years Months Period in Current Employment/ Business Years Months
What is your Office Address?
Company Name
Department
Employee Number Designation
Address Line 1
Address Line 2
Area/Locality Name/Landmark
City Pin Code
State Country

What are your Official Contact Details? Office Landline


Country Code Area Code Number Extension
Office Email ID
FINANCIAL INFORMATION

For YES BANK Customers* Account No. Customer ID

Account Type* Current Savings FD Demat A/C


Income Details
Gross Monthly Income from all sources (IN INR) Additional Monthly Income Average Monthly Expenses (IN INR)
RELATIONSHIP DECLARATION
Do you have any Relationship with any Director or Senior officer of Yes Bank? Yes No
Name of Director/ Relationship with the
Senior Officer Director/Senior Officer
TRAVEL DETAILS*
Country of Travel Country 1 Country 2 Country 3

Date of Travel D D M M Y Y Y Y Date of Return D D M M Y Y Y Y No of Days Travel

Travel Type Leisure (Personal Trip) Business Education (Studies Abroad) Medical Emigration
Employment Film Shoot Others _____________________________
Travel Documents submitted - Air-Ticket or Visa Passport Copy Pan Card/Form 60 (as applicable) Others (Please specify)
(Self attested Photocopies) Pan/
Passport Number*
GIR No.
Passport Passport
D D M M Y Y Y Y D D M M Y Y Y Y Issued At: Place
Issuance Date Expiry Date
PAYMENT MODE* (All fields are mandatory)
Loading Details Cash (up to INR 50,000) Debit to YES BANK Account
YBL A/c. No. or Customer ID
Enclosed YES BANK Cheque Other Bank Cheque/DD (Card activation subject to availability of clear funds after clearing)
Cheque/DD Amount _____________ Instrument No. ___________________ Drawn on (Bank Name) _________________
Instrument Date ________________ Branch Name ____________________
Funding Amount in INR (in words) _________________________________________________________________________________________________________
Load Currency & Amount USD _________ EUR ___________ GBP _____________ SGD ___________ AUD ___________
JPY __________ AED ____________ HKD _____________ CHF __________ CAD _____________
THB __________ SAR ____________ ZAR _____________ NZD __________ SEK _____________
MYR __________ OTHERS ____________
Source of Funds Salary Business Income Rent Income Other (please specify) ____________________
Relation* with person Self Family Member (Please enclose Letter of authority from Cardholder (in case of third party))
funding the Card:
A person shall be deemed to be a relative of another, if and only if, (1) they are members or a Hindu Undivided Family (HUF) or (2) they are husband and wife or (3)
theone is related to the other in the manner indicated below:
(Page 4 of 8)
(1) Father (incl stepfather) (2) Mother (including stepmother) (3) Son (Incl stepson) (4) Son’s wife (5) Brother (incl stepbrother)
(6) Sister (incl stepsister) (7) Daughter (8) Daughter’s husband"

Debit Authorization:
I/ We authorise YES BANK to debit my/ our account number _____________________________ and effect the Multi Currency Travel Card Funding, as detailed above,
alongwith your applicable charges & taxes.

P
______________________________________________________________________________________________________
Signature of the Multi Currency Travel Card Holder (To be signed by Natural Guardian/Parent in case of Minor Applicant)
Name: __________________________________________________ Date: ___________________ Place: ________________________
I hereby accept the below mentioned terms and conditions:
Declaration:
1. I hereby apply for the issue of a YES BANK Multi Currency Travel Card to me and declare that the information included in the application is true and correct and that I am eligible to apply for an internationally valid
Card. If this application is accepted, I will be bound by the Terms and Conditions governing the YES BANK Multi Currency Travel Card, as may be in force from time to time and use of the Card shall be deemed to be
acceptance of those Terms and Conditions. 2. I authorize YES 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 maintaining any account in good standing. 3. 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. 4. I undertake that the usage of the YES BANK Multi Currency Travel Card by me will be in accordance with the Exchange Control Regulations of
the Reserve Bank of India and the applicable laws in-force from time to time, in particular and without limitation, to the Foreign Exchange Management Act, 1999. In the event of any failure on my part to do so, in the
event of any information supplied by me being incorrect or inaccurate, I agree that I will be solely liable for any / all penalties and / or action under local laws and / or regulations as may be in force, governing the purchase
and use of the YES BANK Multi Currency Travel Card. 5. I agree and acknowledge that YES BANK will act on requests made by any persons for reload of the YES BANK Multi Currency Travel Card issued to me. 6. In
case of YES BANK Multi Currency Travel Card issued to me at the requests of my employer, I hereby authorize YES BANK to act on the requests made by my employer for reload, cancellation and refund of the YES
BANK Multi Currency Travel Card. 7. I understand and take responsibility to surrender any unutilized balances of value greater than $ 2,000 (or equivalent) on the Card within 180 days from completion of my travel as per
the FEMA guidelines.8. I understand that there can be scenarios when a Multi Currency Travel Card can get over-utilized, resulting in the Bank paying on behalf of the Cardholder, and the Card getting into a negative
balance. I understand and take responsibility to make good this negative Card balance to the bank, as the Bank has paid this sum for the goods/services utilized by me. I also accept that the bank reserves the right to
regularize negative Card balance by debiting my account or any other Prepaid Card held with the bank without giving any prior notice.9. I acknowledge that I carry the risks of reloading a wrong Card number by
communicating a wrong Card number to the Bank. I understand that the Bank cannot be held responsible for the same.10. I agree and acknowledge that the fees are non-refundable.11. 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.12. I understand that the Alert facility offered by YES BANK Limited
(""the Bank"") will enable me to receive customized Alert messages through the Short Messaging Service (""SMS"") over my mobile phone, as chosen by me, with respect to events and transactions on my Card.13. I have
read and understood the Terms and Conditions relating to the Alerts service being offered by the Bank. If this Application Form is accepted I shall be bound by the said Terms and Conditions as in force, and as may be
amended by the Bank and use of Alert facility will be deemed to be acceptance of those Terms and Conditions.14. I certify that the details furnished in this Application Form are correct and I give my consent to receive
such information under this Alert Facility. I shall advise the Bank immediately in the agreed manner as acceptable to the Bank, in case of any change in any of the above details & information given in this Registration
Form.15. I agree to provide any further information and necessary documentation or any additional KYC required and demanded by the Bank, from time to time with respect to the regulatory and statutory guidelines.16. I
acknowledge having received a sealed YES BANK Multi Currency Travel Card kit.17. I hereby agree that the YES BANK Multi Currency Travel 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."

Declaration for Purchase of Foreign Exchange under Liberalised Remittance (LRS) Scheme of $ 250,000

Details of remittances made/ transactions effected under the scheme in the current financial year April 20___________ to March 20_____________________

Sr. No. Date Amount Name & Address of AD branch/FFMC through


which the transaction has been effected

Sr. No. Weather under Purpose Code Description


LRS (YES/NO) (Please refer list as
annexed)

(Page 5 of 8)
*Please add annexures in case of multiple records
I, declare that- 1) I, hereby declare that the total amount of foreign exchange purchased from or remitted through all sources in India during the financial year, is within the overall
limit of USD 250,000/- (US Dollar Two hundred and Fifty Thousand only), which is the limit prescribed by the Reserve Bank of India for the purpose and certify that the sources of
funds for making the said remittance belong to me and the foreign exchange will not be used for prohibited purposes. 2) Foreign exchange purchased from you is for the purpose
indicated in the form.
Declaration under Liberalised Remittance Scheme for Resident Individuals:
I hereby declare that- 1. I am a person resident in India. I am not a non-residing Foreign National / NRI / PIO / OCI. 2. I shall be responsible and liable for any incorrect detail
provided by me 3. I shall also hereby agree and undertake to give such information / documents as will reasonably satisfy you about this transaction in terms of the above
declaration. 4. I have not availed any loan / credit / borrowings for remitting under Liberalised Remittance Scheme for Capital Account transactions
5.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. 6. The remittance is not being requested for any transaction not permissible under FEMA and those in the nature of remittance for margins or
margin calls to overseas exchanges / overseas counterparty are not allowed under the Scheme. 7. The remittance is not being sent directly or indirectly to Bhutan and Nepal or
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. 8. The remittance is not being sent directly or indirectly to those individuals and entities identified as posing significant risk of committing acts of terrorism as advised
separately by the RBI to the banks. 9. The remittance is not being sent for purchase of FCCBs issued by Indian companies in the overseas secondary market.10. The remittance is
not being sent for trading in foreign exchange abroad.
Declaration-cum-undertaking under Sec 10(5), Chapter III of FEMA 1999, is enclosed as under: 1. I hereby declare that the transaction details of which are mentioned above
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 also understand that if I 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 , report the matter to RBI. 3. I also hereby agree and
undertake to give such information / documents as will reasonably satisfy you about this transaction, in terms of the above declaration.

Yours faithfully,

P
_________________________________________________________________________
(Authorised Signatory /* Natural Guardian of the Applicant in case of minor applicant)

Name: ______________________________________________________ Date: __________________________ Place: ___________________

Purpose Code Purpose Code Description


S0301 Business Travel
S0303 Travel for Pilgrimage
S0304 Travel for Medical treatment
S0305 Travel for Education (including fees, hostel expenses etc.)
S0306 Other Travel (including holiday trips and payments for settling international credit cards transactions)
S1107 Education (e.g. fees for correspondence courses abroad)
S1301 Remittance for family maintenance and savings
S1307 Outflows on account of migrant transfers including personal effects

FORM DA1 -NOMINATION DETAIL (Applicable for individuals/sole proprietors


I wish to nominate I do not wish to nominate
"Nomination under section 45ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules, 1985 in respectof bank deposits"
I/We (Name (S) and address (es) --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Nominate the following person to whom in the event of my/my minor’s death the amount of the deposit in the account, particulars whereof are given below, may bereturned
by YES BANK Ltd.
Deposit/Account NATURE ADDITIONAL DETAILS, IF ANY
NOMINEE NAME (Nomination should be only in favour of an individual) ---------------------------------------------------------------------------------------------------------------------------
Relationship with depositor, if any..........................................................Age.....................If minor, nominee’s date of birth (DDMMYYYY)
"*As the nominee is a minor on this date, I/we appoint Shri / Smt. / Kum. (name) .............................................................................................................. (age)......................
(Address)................................................................................................................................................................................................................................................................
....................................................................................................................................................................................................................... to receive the amount of the
deposit in the account on behalf of the nominee in the event of my/minor’s death during the minority of the nominee.
Agree / do not agree for the name of my nominee to be displayed on the Fixed Deposit Advice/ Statement of Accounts and/or other documents/ letters.

P
_____________________________________________________________________________
**Signature / Thumb Impression of Applicant (Guardian's Signature if applicant is a minor)
Date ______________ Place_________________________________
*Strike out if nominee is not a minor
** Where deposit is made/account is held in the name of minor, the nomination should be signed by a person lawfully entitled to act on behalf of the minor.
*** Witness signatures are required only for cases where the customer is providing thumb impression.
**** In case the customer does not opt for nomination this declaration needs to be mandatorily obtained.

(Page 6 of 8)
FORM NO.60 (See Third Provision to Rule 114B) (Not to fill, if already having PAN)

1. Full Name & Address 3. If YES A. Details of ward/circle/range where the last ITR was filed

B. Reason for not having PAN Number

4. Address Proof attached Passport Driving License


Utility Bill Ration Card Voter ID Rent Agreement
2. Are you a tax assessee? Yes No Bank Account Statement Others
VERIFICATION
I hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today the day of . Place P
Primary Applicant’s Signature

FATCA-CRS Declaration For INDIVIDUALS

Section A: Personal Details


Please Tick the applicable
I am a tax resident of India and not resident of any other country I am a tax resident of the country/ies mentioned below
tax resident declaration: (Any One)

Residence Address for Tax Purpose (Ticket against one which is applicable)
Same as the address mentioned in Application Form / provided for Bank Record
Mailing Address Permanent Address Other (Provide detailed address below)

Flat/Door No. & Building Name


Road Number/Road Name
Area/Locality Name/Landmark
City Pin Code
State Country

Type of the provided address (Ticket against one which is applicable) Residential Business Registered Office

Section B: Document submitted as proof of identify of the individual (tick against one which is applicable and provide Identification Number)

Document Type Passport Voters ID Pan Card Govt. ID Card


Driving License Aadhar Card NREGA JOB CARD Others

Identification Number

Section C:TAX Residence Declaration


Country Tax Identification Number (TIN)
Identification Type (TIN or Other, please specify)

Section D: Certification, terms & conditions and instructions

P
(Signature) Place Date D D M M Y Y Y Y

Terms and Conditions: The Central Board of Direct Taxes has notified on August 7, 2015, Rules 1114F 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 certification and documentation form all our account holders. 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 question about tax residency, please contact
your Tax Advisor. If you are a US citizen or resident or green Cardholder, please include United Stated inthe 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 youare 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.

(Page 7 of 8)
For Referral Agent's Use Only
Referral Agent Name:
Referral Code Date: D D M M Y Y Y Y

Signature _______________________________ Stamp __________________________________

FOR BRANCH/OFFICE USE ONLY


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.

Travel Card Number:

Travel Card UWKRN Number: (This reference no. is present on the welcome kit envelope)

Funded Amount Cash Sell Rate Date D D M M Y Y Y Y

Branch Name Branch Code Charge Code

SSC Code (Sourcing RM code)

Document Checked by Employee Code: Sign & Date: __________________________________

Document Approved by Employee Code: Sign & Date: __________________________________

FOR NOC / OFFICE USE

Employee Code:
Document Checked by

Sign & Date

(Page 8 of 8)