BN NG K S DNG DCH V NGN HNG IN T

VCB-eB@nking Registration Form

Ghi ch Notes:
Thng tin trn bn yu cu phi ng nht vi thng tin khch hng ng k vi Ngn hng
The information provided in this form must be the same as the information registered with the Bank

Cc trng c du * l trng bt buc

Please complete all fields where marked *

PHN DNH CHO NGN HNG [For Bank use only]

TN TRUY CP

K NHN [Acknowledgement]

B PHN TIP NHN YU CU

Receiving department
Cn b tip nhn
Cn b kim sot
Executed by Teller
Approved by Supervisor
Ngy/ Gi:................
Date/ Time:.................

(Username)

Ti xc nhn nhn mt bn c in tn
truy cp t NH TMCP Ngoi Thng VN
(I acknowledge that I have received one copy
of this form with username at Vietcombank)

H tn
H tn
Full name and signature
Full name and signature
Hiu lc t ngy ......./........./.........
Effective date ......./........./.........

Ch k v h tn khch hng
Full name and signature

THNG TIN V KHCH HNG [Customer Details]

* Tn khch hng:
Customer name
Giy t ty thn (Identification Document Details):
CMND:
ID

H chiu:
Passport

Khc:
Other

* S:
No.

* Ngy cp:
Issue Date

* Ni cp:
Issue Place

* a ch lin h:
Contact Address
* in thoi c quan:
Office Telephone

* in thoi nh ring:
Home Telephone

* Hp th in t:
E-mail Address

YU CU V DCH V CUNG CP [Services Details]

Dch v Ngn hng trc tuyn (VCB-iB@nking)

Internet Banking Service

Dch v Ngn hng qua tin nhn di ng

(VCB-SMS B@nking)
SMS Banking Service

Dch v Ngn hng trn in thoi di ng (VCB-MobileB@nking)

Mobile Banking Service

Dch v thanh ton trn in thoi di ng

cho thu bao Viettel (Mobile BankPlus)
Mobile Banking Service - Viettel subscribers

* S in thoi di ng
Mobile Phone Number
* Ti khon mc nh
Default Account
XC NHN CA KHCH HNG [Customers Declaration]

Bng vic k vo Bn yu cu ny, Ti xin xc nhn (By signing this form, I hereby commit that):
1. Nhng thng tin a ra trn y l y , trung thc v chnh xc (The information provided above is complete, true and correct)
2. c, hiu r, ng v cam kt tun th cc iu khon, iu kin ca Ni dung tha thun s dng dch v Ngn hng in t nh
km v Hng dn s dng dch v Ngn hng in t ca Ngn hng TMCP Ngoi Thng Vit Nam (Vietcombank) c ng ti trn
a ch website http://www.vietcombank.com.vn
I have read and fully understood Vietcombank's Regulation of VCB-eB@nking as well as VCB-eB@nking User Guide (found at http://www.vietcombank.com.vn)
and agreed to be bound by them

Ch k ca khch hng
Full name and Signature

Ngy ...... thng ...... nm ......

Date.........../............../...............