APPLICATION FOR STANDING INSTRUCTIONS FOR DEBIT OF CARDHOLDER’S
ACCOUNT TOWARDS SYNDICATEBANK GLOBAL CREDIT CARD DUES

From, Date: _________________ ___________________________ ___________________________ ___________________________ To, The Branch Head SyndicateBank Branch __________________ Dear Sir, Sub: Standing Instructions I hereby authorize you to debit my following account with the amount payable towards the dues of Syndicate Bank Global Credit Card, on Payment Due Date of every monthly Billing Statement as per under-mentioned details:
SyndicateBank Global Credit Card Nos. (16 digits)
Credit Cardholder’s Name
A/C No. (14 Digits) to which amount to be debited
Account Holder’s Name
Payment Options #
# Mention clearly whether Minimum Payment Due or Total Payment Due amount I undertake to maintain sufficient balance in my account on Payment Due Date of my Credit Card and that the Bank shall have the right to cancel my standing instructions, in case I fail to maintain required balance on Payment Due Date. In case of non-availability of sufficient balance in my account as on the date of carrying out Standing Instructions, I would be liable for payment of late payment fee, service charges and service tax in addition to billed amounts. Yours faithfully, Signature of Account holder FOR BRANCH USE Ref. No._______________ Date: _________________ We confirm that Standing Instruction has been recorded at S.No. _____in the Register and original of the Standing Instruction has been kept in Safe Custody.
Branch Name
Signature Verified By (Name)
Signature
Signature No. 
Forwarded to Card Centre: Bangalore for carrying out the Standing Instructions. FOR USE AT CARD CENTRE
Request processed on
Signature