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PERSONAL DATA
FIRST NAME
MIDDLE NAME
LAST NAME
ADDRESS
STREET
CITY
STATE
PINCODE
TELEPHONE-RESIDENCE
FAX
MOBILE
EMAIL-ID
GENDER
MALE
FEMALE
SALUTATION
Miss
Ms
Mrs
Mr
Dr
NAME ON CARD
HOW DO YOU WANT TO BE ADDRESSED
DATE OF BIRTH
(MM/DD/YYYY)
BLOOD GROUP
[Select One]
A1-POSITIVE
A1-NEGATIVE
A1B-POSITIVE
A1B-NEGATIVE
O-POSITIVE
O-NEGATIVE
A-POSITIVE
A-NEGATIVE
AB-POSITIVE
AB-NEGATIVE
B-POSITIVE
B-NEGATIVE
A2-POSITIVE
A2-NEGATIVE
MARITAL STATUS
SINGLE
MARRIED
ANNIVERSARY
(MM/DD/YYYY)
SPOUSE NAME
SPOUSE DATE OF BIRTH
(MM/DD/YYYY)
SPOUSE OCCUPATION
STUDENT
BUSINESS
EMPLOYED
RETIRED
NUMBER OF CHILDREN
TOTAL NUMBER OF DEPENDANT
PROFESSI0NAL DATA
ACADEMIC QUALIFICATION
SCHOOL
DIPLOMA
UG
PG
PROFESSIONAL
OCCUPATION
STUDENT
EMPOLYED
IF EMPLOYED YOUR FIRM IS
PROPRIETARY
PARTNERSHIP
PRIVATE LTD
PUBLIC LTD
TYPE OF INDUSTRY
ADVERTISING
AGRICULTURE
ARCHTECTURE
ARMED FORCES
BANKING
CONSULTANCY
ENGINEERING
ENTERTAINMENT
EXPORTS /IMPORTS
HOSPITALITY
INSURANCE
LEGAL
MANUFACTURING
MARKETING
MEDIA
MEDICARE
SERVICE / BPO
SOFTWARE
TEACHING
TRAVEL
YOUR POSITION
MANAGEMENT
MIDDLE LEVEL
JUNIOR LEVEL
ADMINISTRATIVE
CLERICAL
NAME OF INSTITUTION
ADDRESS
STREET
CITY
STATE
PINCODE
TELEPHONE-OFFICE
FAX
MOBILE
EMAIL-ID
FINANCIAL DATA
ANNUAL INCOME IN RS
NAME OF THE BANK
BRANCH
CREDIT CARD
AMEX
VISA
MASTER
DINERS
HOUSE
OWN
RENTED
TWO WHEELER
YES
NO
TWO WHEELER MAKE
FOUR WHEELER
YES
NO
FOUR WHEELER MAKE
PREFERENCES
I wish to receive mailers from Café Coffee Day
I wish to receive mailers from select partners of Café Coffee Day
COMMUNICATION
TELEPHONE-RES
TELEPHONE-OFF
MOBILE
EMAIL
CORRESPONDANCE
TELEPHONE-RES
TELEPHONE-OFF
PAYMENT FOR SMART CARD
CASH
CREDIT/DEBIT
LOYALTY REDEMPTION
CARD MANAGEMENT FEE
CASH
CREDIT/DEBIT
LOYALTY REDEMPTION