My Account No. is : |__|__|__|__|__|__|__|__|__|__|
My Name is : |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
 
  Yes I would like to convert my Citibank Suvidha Account into Joint Account with either or survivor signature requirement.
  ________________________________________
Signature of First Applicant      
About Joint Applicant
Name : Mr.   Mrs.   Ms.   Dr.   Prof.
|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
(Please leave one box space between names and underline the surname)
Male      Female
Date of Birth : |__|__|  |__|__|  |__|__|__|__|     (dd / mm / yyyy)
Introduction

Please enclose any two of the following attested documents (photocopies only) with the application form for the Joint Applicant.
*One document from Section A is mandatory.

IMPORTANT NOTICE: Photocopy to be attested by the primary account holder and a Citibank officer.

Section A
  Joint Applicant Document Number :  _________________
Valid Driving Licence :      Valid Passport       :       Ration Card (with Photograph) :
Valid Electoral Card   :      Valid PAN Card     :
Section B
Joint Applicant
 Document Number : _______________
Photo Credit Card/Debit Card Credit Card Statement (within last 30 days)
Citibank Credit Card Bank Statement (within last 30 days) 
Certified Marriage Certificate Utility bill with Name and Address
 Registered Lease Deed    Ration Card (without Photograph)   
TDS Certificate  
If the address in the attached introduction document is not one of the addresses you are currently staying/working at, please enclose any one of the following in original.
Joint Applicant
Bank Statement : Credit Card Statement : Telephone Bill :
CBDT Form 60 (Mandatory)
For Joint Applicant : PAN / GIR No. : _________________
Please provide a photocopy of the PAN Card (mandatory)
If you do not have a PAN / GIR No. please fill in the following :
Are you a tax assesse?                     Yes       No
If yes,
(i) Details of Ward/Circle/Range where the last return of income was filed : ________________
(ii) Reasons for not having PAN / GIR No. : __________________
Joint Applicant :
 

Yes! I would love to put my photograph on my          ATM / Debit Card
Please do not issue me a photocard



Agreement & Signature

I/We hereby apply for the Citibank Suvidha Account and declare that the information included in this application is true and correct and that I and my Joint Applicant are residents of India. I/We accept that Citibank is entitled in its absolute discretion to accept or reject this application without assigning any reason whatsoever. It is my/our responsibility to obtain the Terms and Conditions mentioned in your form no A-T(1999) / 07 applying to the Citibank Suvidha Account and read the same. If this application is accepted, I will be bound by the said Terms and Conditions as may be in force from time to time and use of Citibank Suvidha Account will be deemed to be acceptance of those Terms and Conditions. I/we agree that the Bank may debit my/our account for service charges as applicable from time to time. I/we conform that the attached photographs are the present true identity of myself/ourselves, which I/We authorize Citibank, N.A., to apply to my/our ATM / Debit Card and for which I/We accept full responsibility and agree not to make any claim against Citibank, N.A., in respect thereto. And that this condition applies in addition to the Terms and Conditions which govern the use of my/our ATM / Debit Card.

Name:                                         _____________________________________________
Joint Applicant's Signature:        _____________________________________________
Date :  |__|__|  |__|__|  |__|__|__|__|     (dd / mm / yyyy)                            Time :   |__|__|__|__|   (hh / mm)

Mail this form to :
Citibank N A
P.O. Box 4830
Anna Salai
Chennai 600002.