Card Statement and Payments Page 1 of 4
Affix Photo
Request ID :A0000839186
Citibank Cardholder Application Form - Commercial Cards
(Centrally Billed)
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Citibank Cardholder Application Form - Commercial Cards
(Centrally Billed)
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Citibank Information
1. Program Name AGILENT TECH INDIA PVT
2. Billing Account Number 5527905000204639- null AGILENT TECH INDIA PVT Select the Billing Account Number
- based on the information
provided by your Implementation
Manager
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Cardholder Personal Information
1. * Title MR (e.g. Mr, Mrs or Ms)
2. * First Name Jonas Daniel Please provide your first name as
per PAN Card
3. Middle Name Please provide your middle name
as per PAN Card
4. * Last Name Christopher Chelliah Please provide your last name as
per PAN Card
5. * Embossed Name on card Jonas Daniel Your name as you would like it to
appear on your card - Maximum
19 characters (No special
Characters). Please note that your
name will appear in upper case on
your Corporate Card
6. * Gender MALE
7. * Date of Birth 21/03/1991
8. Place of Birth Tirunelveli
9. * Mother's Maiden Name Hepzibah
10. * Home Address Line 1 No 70, First Floor, Sai complex
11. Home Address Line 2 Maidangarhi Road, Chattarpur
12. Home Address Line 3
13. * Home City New Delhi
14. * Home Country INDIA
15. * Home Postal Code 110074
16. Home Telephone 91-837-7822-982 country code(91) - state
code(STD Code) - number -
extension
17. * Mobile Phone 91-8377822982 Please provide your 10 digit India
mobile number.You will be
receiving SMS transaction alerts
and you will require to get OTP for
all online transactions.
18. * Email Address
[email protected] This will assist Customer Services
should we need to contact you
urgently regarding your card
account
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Cardholder Employment Information
1. * Employee ID 01012861 - Jonas Daniel
2. * Business Address Line 1 Keysight Technologies India Private Limi
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3. Business Address Line 2 Unit No 404-A, Corporate One,
4. Business Address Line 3 Plot No 5, Non- Hierarchical Commercial
5. * Business City New Delhi
6. * Business Country INDIA
7. * Business Postal Code 110025
8. Business Telephone 91-837-7822-982 country code(91) - state
code(STD Code) - number -
extension
9. Cost Center Please indicate here your Cost
Centre, which will assist with your
organisation's reporting purposes.
10. Cost Center Description Cost Centre Description
11. Embossing Company Name
12. Reporting Unit 000003003 KEYSIGHT TECHNOLOGIES INDIA PVT LTD In case you are not sure about the
Reporting ID, please contact your
Program Administrator
13. * PAN Number XXXXXX266P
14. Deliver Bill To Business In case you are receiving a paper
statement, it would be send only
to your business address.
15. Deliver PIN To Business Please indicate here if you would
like us to send your Citi Corporate
PIN to your business address or
to company Primary PA.
16. Deliver Card To Business Please indicate here if you would
like us to send your Citi Corporate
Card to your business address or
to company Primary PA.
17. * Statement Option ONLY ONLINE STATEMENT
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Cardholder Limit Details
1. Monthly Credit Limit 600000 This is the monthly spend limit to
be applied to the card.
*Please update credit limit in
whole value and not decimals (Eg:
Use 1000 instead of 1000.00).
2. Single Transaction Limit 200000 Please indicate here if you wish
for the cardholder to have a single
transaction limit - this is the
maximum amount allowed of any
single transaction. Please update
single transaction limit in whole
value and not decimals (Eg: Use
1000 instead of 1000.00).
3. Monthly Cash Limit 20000 Please indicate whether you wish
the cardholder to be able to
withdraw cash with the card. Also
Please update cash limit in whole
value and not decimals (Eg: Use
1000 instead of 1000.00).
4. Daily Cash Limit Please indicate if you wish to set
a daily limit for cash access (if
cash access is provided). Also
Please update cash limit in whole
value and not decimals (Eg: Use
1000 instead of 1000.00).
5. Daily Cash Count Please indicate if you wish to set
a daily limit on the number of
counts for cash access (if cash
access is provided)
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CITIBANK CARDHOLDER ACCOUNT AGREEMENT
Conditions of use (COU)
Most Important Terms & Conditions
Fees and Charges
1. Joining & Annual Fees: These Fees, as applicable, will be communicated at sourcing and will be documented.
2. Cash Advance - Fees: 3% of the cash advance amount. (Subject to a minimum of Rs.300 or US$7 at overseas ATMs)
3. Late Payment Charges: 3 % of amount of outstanding beyond due date of payment (subject to a minimum of Rs 500)
4. Over Credit Limit Charge: 3% of amount over credit limit (subject to a minimum of Rs.500/-)
5. Cheque Bounce charge: Rs.250/-
6. Reissue of lost, stolen or damaged Card: Rs. 500/-
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7. Outstation Cheque Charge: Rs 100/-
8. Foreign Currency Transactions: Mark Up 3.00% on Foreign Currency spends.
Note: All fees and charges are described and detailed in the contract signed between Citibank N.A., India Branch and your employer company. As
charged to the credit card account, they will reflect on the monthly statements. In the event of discrepancy between fees and charges as in the tabular
statement above and as set out in the contract between Citibank N.A., India Branch and your employer company, the fees and charges as provided for in
the contract would prevail and be applicable. Your employer company will inform you of applicable changes to fees and charges as may be payable from
time to time.
Service Tax as notified by Government of India is applicable on all fees, interest and other charges. The levy of service tax is subject to change from time
to time as per relevant regulations of Government of India.
Drawal Limits
Credit limit/ Available Credit limit/ Cash withdrawal limit: The Credit and Cash withdrawal limits are maintained as per instructions received from your
Company.
The Available Credit limit is displayed in each monthly statement.
Billing
1. Billing statements: Citibank will send monthly statements, reflecting payments made in the previous month, and transactions for the month, but provided
the Card has been used in that month. You may access your statement online by logging into:
https://home.cards.citidirect.com/CommercialCard/Cards.html
2. Amount payable: The Amount Due as per the monthly statement, is payable in full.
3. Method of payment: Payments may be made by Cheque/ DD/ PayOrder/ NEFT/ RTGS/A2A Transfers (Citi-Citi). The details of payment options will be
available on the backside of monthly statement
4. Billing disputes resolution: Citibank must be informed, within 30 days of the statement date. Citibank may reverse the charge on a temporary basis. If
on completion of subsequent investigations, the liability of such charges is to your Account, the charge will be reinstated as and from the date on which the
charge was incurred, along with applicable interest, in a subsequent statement. Additionally, a fee of Rs. 100/- will be levied.
5. Contact particulars : 24 – Hour Priority Service:
i. India toll-free number : 18004258767
ii. International Number : +91 44 28490243 or 28490244 or 28490245
6. Grievances Redressal: The Grievance Redressal Officer of Citibank can be contacted at [email protected]
7. Citibank’s complete postal address: Citibank, N.A., Citi Center, G, C-61, Bandra Kurla Complex, Bandra (East), Mumbai 400051
8. Toll-free number for customer care services:
i. India toll-free number : 18004258767
ii. International number: +91 44 28490243 or 28490244 or 28490245.
Termination / revocation of card membership
1. Procedure for surrender of card by card holder - due notice: Card, cut into two pieces should be handed over to the Program Administrator of the
Company, and Citibank call center should be immediately informed, on the toll-free number-
i. India: 18004258767
ii. International: +91 44 28490243 or 28490244 or 28490245.
Loss/theft/misuse of card
1. Procedure to be followed in case of loss/ theft/ misuse of card -mode of intimation to card issuer: In case of loss/ theft/ misuse of Card please
immediately call
i. Toll-free number - 18004258767
ii. International - +91 44 28490243 or 28490244 or 28490245.
2. Liability of card holder in case of above: Customer would be liable for all spends/transactions on the card till intimation of Loss/Theft are made on the
toll-free numbers.
Disclosure
1. Type of information relating to card holder to be disclosed with and without approval of card holder: Information as required under law or any applicable
regulation, and at the order of a court of law, or at the request or order of any statutory, regulatory or supervisory authority with whom Citibank customarily
complies, shall be disclosed. Information and data relating to the Customer, Account/s, Cards and Cardholders including but not limited to associated
information and information relating to default, if any, may be disclosed and furnished, to the Reserve Bank of India (“RBI”) and/or to the Credit Information
Bureau (India) Ltd and/or to any other agency authorized in this behalf by RBI, to service providers, professional advisers and consultants of Citibank.
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Note to Applicant
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PLEASE READ THE NOTE TO APPLICANT INSTRUCTIONS BELOW
Please print a single sided copy of this Application Form, card applicant to sign on it.
Mandatory Details
Attach a Black & White visible photocopy of Permanent Account Number (PAN Card): duly self-attested by the Card Applicant
Recent Passport-sized color photograph to be affixed on Card Application Form
First Name , Middle name & Last Name of the Applicant mentioned on the form should be match as per PAN Card copy.
Application will be processed only if all mandatory documents and mandatory fields are updated.
Send your signed application form with mandatory documents to to your nearest one of the listed Citi branch mentioned below:
Commercial Card Operations. Citibank NA, 293 D. N. Road, Bombay Mutual Building, Fort, Mumbai 400 001
Citibank N.A., Fort House, 4th Floor, Unit 1, 224, Dr. D.N. Road, Fort, Mumbai – 400 001
Commercial Card Operations, Citibank N.A., 2nd Floor, #5, M. G. Road, Bangalore 560001.
Commercial Card Operations, Citibank N.A., DLF Square, 5th Floor, M Block, Jacaranda Marg, DLF City, Phase II, Gurgaon - 122002.
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Cardholder Declaration
I, the cardholder, acknowledge that all information on this application is true and correct. I understand the terms governing usage of this cards and
that it is my responsibility to notify Citibank immediately if my card is lost or stolen.
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Citibank, N.A., India Branch
CardholderSignature
I, the cardholder, acknowledge that all information on this application is true and correct. I understand the terms governing usage of this cards and that it
is my responsibility to notify Citibank immediately if my card is lost or stolen.
Cardholder’s Name: _________________________________________________
Cardholder’s Signature: ______________________________________________
Date Signed: ____/____/_________
