Paste one passport size photograph

e-Z Cards Application Form for Smart Card with State Bank of India
PART-I (To be filled by the Student) 1. 2. 3. 4. Card Holder's Name Date of Birth Sex Address

Male/Female

5. 6.

Telephone No. Mobile No.

DECLARATION I hereby declare that what is stated above is true to the best of my knowledge and belief. I undertake to inform as to any change in my residential address and to provide any further information that the Bank may require. State Bank of India will be at liberty to take such action as it may deem necessary if my above statements are found to be untrue.

Place: Date:

Applicant's signature

PART-II (To be filed by the Office at Department of Science & Technology, New Delhi ) We hereby identify the person named above as the bonafide student of _____________________________________________________________________________ _____________________ (school name and address) who is residing at the address mentioned above. We confirm that the particulars provided by him/her are correct to the best of our knowledge . We request State Bank of India to issue e-Z Card to him/her. Signature of the Officer with Stamp Department of Science & Technology, New Delhi

Enclosures : (To be attached with this form) As per List attached

List of Documents required for `Know Your Customer Form to SBI-Smart Card You need to provide only One document each for i) Proof of Photo Identity and ii) Proof of Address out of the listed accepted documents by the Bank as given below. The photocopy of the documents shall be Self-attested by the Scholar. Proof of Photo Identity 1. School Leaving Certificate with Photograph 2.Marticulation Certificate with Photograph 3.Self Bank Passbook with Photograph 4.Credit Card with Photograph 5. Passport 6. Certificate of Identity signed by a Member of Parliament or Member Legislative Assembly or Municipal Councilor or a Gazetted Officer [Original + self attested Photocopy to be sent] 7. Voters Identity Card 8.Driving License with Photograph Proof of Address

1. Self Bank Passbook with Recent Statement 2. Credit Card Recent Statement 3. Passport 4.Certificate of Identity signed by a Member of Parliament or Member Legislative Assembly or Municipal Councilor or a Gazetted Officer [Original + self attested Photocopy to be sent] 5. Voters Identity Card 6. Driving License

Note: While SBI shall issue the Card to the Scholar, the Scholar would require to provide
the self-attested documents as above to DST for Banks Record purposes.