Channel Registration Form Internet / Mobile/ Phone / E-mail / Debit Card / Bill Pay / AccountAlerts activation authorisation form {or individuals / sole proprietorship firms only Branch fl Date Debit Card Number: Customer 1D (ityou aeady have ore) Please activate the following service(s) on my account(s) with IDB! Bank (please tick) C Rocoipt of bank statoment by email C Receipt of demat holding statement by email Use of internet banking for transacting bank & demat accounts Use of mobile banking services (SMS & WAP) for transacting bank & demat accounts DUse of phone banking services for transacting bank & demat accounts Cilssue of debit card (I don't have one) Linking of existing debit card to addtional accoun's Order Bank Account Number Scheme Code (Tobe filed by Ban) 1) Primary 2) Ober 3) Over 4) Oher Demat Customer 1D Demat CustomerID Demat Customer 1D Demat CustomerID Name Date of Bith Mating Address (ferent rom the one in or records) Gime city State Pin Code Country Phone (Home): (Offee) (Mobile Fax Enril 0 Mother's Maiden Name (oreferatty non-ofialid, max 25 characters) (max 25 characters) Preferred language for transacting at ATM () English © Hd © Marathi Tamil (Subject to avalabiy) Name for use on Debit Card (you dont have an Debit card yt) (25 charactors max) (OLE banking for all Rega. Office: IDB! Tower, WTC Complex, Cute Parade, Mumbai 400 005, Website: wwwr.iabi.comFill this section only if you already have an Debit Card (Details of existing account (0 be linked to Debit Gard) Primary Account Number I you want your Debit Card to be linked 10 any other savings andlor current accounts), (including joint accounts where mde of ‘operation is either or survivor) hat you maintain wth the bank, please provide details of these accounts in this section. Debit Card Number i Bank Account Number ‘Schome Cods (to be filed by bank) | confim having read and understood IDB! Bank terms and concitions for all the services | have requested above. | eccept and agree to be bound by the said terms and condltions for the use of the above selected services, Nome Signature We authorze the applicant to access the accounts) vie the channels selected and authorize IDBI Bank to ink new accounts opened by the applicant tothe channels selected. /We accept and agree to be bound by the sad ferms and conditions for the use of the above selected services Name Signature Name Signature Name _. Signature 1 Name Signature Important : (please tick wherever applicable) C1 For issue of new card, initiate issue of new card on finacie O For re-issue of new card, initiate re-issue of new card on finacle Forreptacement of card, intiate replacement of card on finacie i For any modification of card, initiate modification of card on finacle For linking any additional account to card, initiate linkage of card on finacle O For card deletion, it Confirmed that : D customer nas been properly Intoduced tate deletion of card on finacle D Signatures verified of ll account holders CL_ATM Card operation has boon porformed on finacle CF The customer is duly authorized to access the account O Thisis nota minor account C1 This is not a jointly operated account Remarks | Prepared and contirmed by Vertted By | Date,rsonal Details Putnam aw na Last cusomerio I TM 0) 0 owen. =: [IT TTTIT TTI) Emal ID aoe Reta Ser atamrarhcbac oar wap rasan bc ry to a hs Hi 6 Spy. — oy stottene : | LI caine (ts provided elec Co) cpm ig UN. (apes) [wos pay to, automaticaly Telephone ‘Name of the Company. — City Shon Name Tr consumer No is providedby te Tephane Co} taephowe os TLL LTT 1) Name in wien Ttphone ised [Clastopaypay tn yo Rs utoraicalty Cellatar Phone ‘Name of the Company — city Shotome : | TTT | Consumer A No (provided by the Celular Co) Mobi No, | Jautepaypay til upto Rs. automaticaly Insurance ‘Name ofthe Company city stor name EEL) reno Promiun Arent Premium Frequency (Ql Yara [| Aatopay pay bi upto Rs. automaticaly Name of the Company oy ‘Short Nama LO ‘Consumer Re No (hs prondedby te Serres FrovierCo) (lastpaye pay oposite {he read and nduniodine Teme & Condos (a coryo nich am in posession a reatingo opening oa cur and van serosa bol od (0) ‘i (Prone arin) obleBakng (nent Bk BlPayanszeptand ees baundty tesa Teme & Condns edn and exssanghmtng he aniisianiy lundortand thatthe ackmay, ie selection, sgoorinus any othe navaen comply a paral hut any nates tome, laroe hat tha Bank may debit my account for sonicecharges as appcabie am tine ome. Signature Place Dae “To pay bls through nternat Ban |] Register me for internet Bank [Register me for Mobile Banking now. "carton having ead and unerstod DBI Banks tems and condtons fr the service | have requested above | acept and ante to te bound by he sald ems and conditons tthe ‘wef the above selected sence {in case of joint accounts, all account holders must sign. \Weauthor the appleant acces the acount) vate hanna speed and auborze 08! Bank link new accounts opened by he applicant othe channel selerte. We accept ‘and soranto be bouncy the midterm and canon orth use of ba above select nervens. ‘Senaiuee Name Sipnature Name Signature Nane Sionature Branch ‘Slgnature Verifedby ‘ccouni No, Yered By Received at NRI (Altern col at CPU.(Please fill the form in biock letters only) Personal Dtats: Name cust ‘Account No Ema IO: Mobile No: 9 1 {FOr CDNA phones, inl prefx te STD code othe motile umber) Vai ot or tobe nuTDers nina. Type otAers Mode 1 "Salary deposit to my account Alertme on | )SMS_— |_| Email | My account geting eredited above [5 |" 104[ 20K" )80K ‘Aetmecn SMS Emall [5] My account goting eobted above || 5k/~|104| 20k 60K Aonmoon (SMS Email | Cheque stopped by me ‘Aetmeon SMS Email Cheque doposted by me retured ‘Altmecn (SMS Ema (Day om Pay Netmooy (SMS Emal 7) Weekly Balance (ony if transacted iat week) Nemec [SMS | Ema * only for customer's who have salary account's with !DBI Bank ** ony for registered presentment bills ‘Application for Accountalerts, lve ereby request Bank, (the Bank) activate the courte acy aeredby te Bark reeive customized Art messages though the short nesseaing service ((SMS" over mtilepnone or as an emai as chosen by mau wh respec: to evenarransactonsiormationreaingia my acu Sted aDDre weave ea and uncrtodtherms and conn lng to Aes seve being oly he Bank andagres to bie by Ne sane Asay be arndedy the Bank lo cert hat the dott uishedin tis Applicaton are corect and UWe giv mylur consent orecsivesuchinforraonermalundertis Accounts Fay. We shall ‘bis the Bonk rmeriatalyn caso of ay emenge nary he above detail & rman gan ns Aeleaton Form Ue ape to prove any futher inormaton ‘oquted ara dertandes by the Bank. ro tm tine, or pov tne Accounts serve. Iie auocze the Bak fecove as erargs ead To he Alot Faciy 38 ‘oterminoc by Bank ra tie tote. ‘Signature of Applicant 1 For indus, sqratue of te account toe: For Sole popitorship account, signature ofthe Soe ropritor ‘Signature of Applicant 2 Note Thc treaty not avatbia the operating Instron ae nity bya Fatty or Actors ‘Signature of Applicant 3 Vo arene cons tian ee en ‘toe ete Schur izle nr nee “Tene Spat et ttre 8 8 ‘ibe ty af sn somone 25, Toctrnsnmmerre ay oy ‘noe Poeonds rayon ns aes a Tage st cn ie a a ae mgyseetantnatmon onan sat ot ‘Toews nes naa cae ** ccna arora Sa ee a {eclammhe tetera nae SEE efor sai ep Dt amar fiona eb ant ehe at snp cng Datehentnneenimnsi terete Eiintonoe severance tages toot iter eancoraa moa eee eehrte envernet StStenmambatonce toate ‘Norm menue hpreens nerpa et Pee ‘inet anasto he want ones meeeetereere ‘Stay ce nn ore Soper nc on tone ee te Seize se ememmcnnaeahns Ser eprom restces ey eaeaeceateenreate Seen eee ierteeeereme nes Seen eases Tar main emda Sie aeeecnes fom