Request Form For Issue of Replacement of Global Debit Card

Company Name(s): 

REQUEST FOR ISSUE OF REPLACEMENT CARD IN LIEU OF LOST / STOLEN
SYNDICATEBANK GLOBAL DEBIT CARD
From- Date _____________ ____________________ ____________________ ____________________ ____________________ Phone No.: _________________________ e-mail id: ___________________________ To, The Branch Head SyndicateBank ______________________ Branch. Dear Sir, Ref: My SyndicateBank Global Debit Card No. (16 digit) __________________________ Reg: Issue of Replacement Card in lieu of Lost/ Stolen Debit Card. I wish to inform you that I have lost my above Debit Card on __________(Date) at ______________ (Place) and got the Card hot listed on ___________(Date) and at _________(Time) through your branch/Help Line/Card Centre. I request you to issue me a Replacement Debit Card in lieu of above lost / stolen Debit Card immediately to enable me to continue availing Debit Card facility. I hereby authorise you to debit the stipulated charges to my account no. ______________________ at your branch. Further, I wish to inform you that [tick ( ) whichever is applicable) -
1. I have already lodged a Police Complaint / FIR and copy of the same is enclosed for your perusal and records (not mandatory).
OR
2. I am yet to lodge the Police Complaint / FIR and I will submit you copy of Police Complaint / FIR shortly.
OR
3. I do not intend to lodge a Police Complaint / FIR. I confirm that my Lost Card has not been misused and all the transactions carried out through my Lost Card prior to Hot Listing & debited to my account have been done by me only. I am aware that filing of police complaint is necessary in case my Debit Card is misused.
Yours faithfully, (Signature of the Cardholder) Name: _________________