Online Application Form - Diners Club International Card

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Important: Please read this before filling up the application form.
Kindly ensure that you meet the minimum income criteria (gross) for:
Diners Club International Card.

Salaried / Self-employed - Rs. 1,56,000 p.a.

Fields marked * are mandatory.

I would like to apply for a *

PLEASE TELL US ABOUT YOURSELF.

Personal Details

Name*

(Upto 26 characters)

Date of Birth*

Are you an existing Citibank customer?*

Yes No

What's the product / service you have

Your Relationship Number

E-mail ID:*

Contact Details

Office Name *

Office Address *

City: *

Office Phone Number: *

1.* Extn.:

2. Extn.:

Residence Phone Number:

1. 2.

Mobile Number:

Financial Details

Annual Income (in Rs.) *



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