Address Change Declaration Form

To SBI Cards & Payments Services Pvt. Ltd.Post bag No. 1, DLF Qutab Enclave Post OfficeGurgaon- 122 002, Haryana

Dear Sir,

My Credit Card No.

Declaration for current residential address by individuals

(Pursuant to RBI Circular on DBOD.AML.BC.No.119/14.01.001/2013-14 dated 9th June 2014)

I hereby confirm my current address and permanent address as below

Date:

I will notify SBI Card of the new address for correspondence within two weeks of such a change.

Signature of the Credit Cardholder

Middle NameName Mr. Ms. First Name

City

Residence Ph. No

Pincode

City Pincode

City Pincode

Surname

Current ResidenceAddress

Permanent ResidenceAddress

Office Address