How to fill Andhra bank ATM cum Debit Card Application form

New/renew/Replacement: If one is applying for a new ATM Card then he should tick on new and in case if one already has the ATM card but he want replacement with the new one, then he should tick on renew and replacement option.

To
The Manager
Write the name of the branch where you are submitting this form (this form should be submitted in the home branch) Branch

1. Name:  ( in Full & Block Letter): Write the Account Name in FULL Capital letters
2. Permanent address in full : Write the full residential address in this coloumn
3. Address to which PIN is to be sent: Write the address where you want the ATM Pin to be delivered
4. Mobile: Write the mobile number
5. Place of Birth: Write the place of your birth
6. Mother’s Name/Maiden Name: Write your mother name in this coloumn
7. E mail ID: Write the email ID if you want to specify
8. Name to be embossed: Write the exact name you want to be printed in the ATM Card
9. Primary account number: Write the account number for which you wish bank to issue you ATM card.
10. Secondary account number: If you another account with the same bank in another branch then one has to write the name of the branch and the another account number.
11. Additional information
    a) Date of Birth: write the date of your birth
    b) Wedding Anniversary: If you are married you can specify your date of marriage in this coloumn

Declaration

Signature of Joint A/c Holder: if this account is been operated by multiple account holder then the all joint account holder need to sign in this coloumn
Signature of the Applicant: The main Joint account holder or the in case of single account holder, one has to sign in this coloumn
For Branch Use: Leave all entries blank