Channel Registration Form Internet / Mobile/ Phone / E-mail / Debit Card / Bill Pay / Account Alerts activation authorisation form {or individuals / sole proprietorship firms only Branch Date Debit Card Number: Customer ID (you alreaty nave one) Please activate the folowing service(s) on my account(s) with IDBI Bank (please tick) (Ch Recoipt of bank statement by emai Receipt of demat holding statement by email Use of internet banking for transacting bank & demat accounts C1Use of mobile banking services (SMS & WAP) for transacting bank & demat accounts Use of phone banking services for transacting bank & demat accounts issue of debit card (I don't have one) Linking of existing debit card to additional accounts, Details of accounts for which above selected services are to be activated. Order Bank Account Number ‘Scheme Code (To be filled by Bank) 41) Primary Ls 2) Other 3) Other 4) Other Demat Customer ID Demat Customer ID Demat Customer ID Demat Customer ID Personal Details Name 1 Date of Birth 1 Gammon Mailing Address 1 {tf ferent rom the one in our records) City 1 State 1 Pin Code 1 Country 1 Phone (Home) L 1 (Office) 1 (Mobile) 1 Fax 1 E-Mail ID Mother's Maiden Name (preferably non-ofidal ia, max 25 characters) Name for use on Debit Card (tfyou don't have an Debi Care yet) (25 characters max) (1) IDBI BAN DBI Bank Limite, Regd, Offs: IDB Towor, WTC Complex, Cue Parade, Mumbal - 40006, ‘oll Fee Numbers reachable from any lndline/Mbile phones: 800-200-1847 1200-22-107, Non - Tol Free Number 02236927000, Wabsta ww omFill this section only if you already have an Debit Card (Details of existing account to be linked to Debit Card) Primary Account Number I you want your Debit Card to be linked to any other savings andior current account(s), (including joint accounts where mode of ‘operation is either or survivor) that you maintain with the bank, please provide details of these accounts in this section. Debit Card Number Bank Account Number ‘Scheme Code (to be filed by bank) | confirm having read and understood IDBI Bank terms and conditions forall the services | have requested above. | accept and agree to be bound by the said terms and conditions for the use of the above selected services, Name 1 Signature 1 We authorize the applicant to access the accounts) via the channels selected and authorize IDBI Bank to link new accounts opened by the applicant to the channels selected. We accept and agree to be bound by the said terms and conaiions for the use of the above Name 1 Signature 1 Name 1 Signature , 1 Name 1 Signature 1 Name 1 Signature , 1 Important: (please tick wherever applicable) C0 For issue of new card, initiate issue of new card on finacle U For re-issue of new card, initiate re-issue of new card on fnacie O For replacement of card, initiate replacement of card on finacle G2 For any modification of card, initiate modification of card on finacle C2 For linking any additional account to card, initiate linkage of card on finacle C2 For card deletion, initiate deletion of card on finaco Confirmed that: Customer has been properly introduced G2 Signatures verified of all account holders ATM Card operation has been performed on finacle The customer is duly authorized to access the account 2 This is not a minor account CI This isnot a jointly operated account Remarks 1 Prepared and confirmed by 1 Verified By 1 1 Date 1BILL PAY REGISTRATION FORM. 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We auorizo e apteant to acces he account) via the channel elected an autoie IDB Bankto Ink new acount opened byte appscantto he chanel eleces UWe acopt and aro to be bounty he sai tems and conditons fr house ofthe above selaced sonicos. Name: Signature Name: Signature Name: Signature For Bank Use only Branch Signature Veron by Account No, Vertied By Received at NRI/ Atemate cell at CPU