Retail Internet Banking Service Form

Note: Internet Banking access will be issued to SINGLY operated accounts only. Account holder cannot sign this request on behalf of joint applicant (if applicable). Please use BLOCK letters. Fields marked * are mandatory.

Branch*: ___________________________________________________

Date*:DD

MM

YYYY

Customer Name*: ____________________________________________________________________________________________________________________ Account Number*: E Mail Address*: _________________________________________________

New Internet Banking User I want to apply for the Internet Banking facility and link my account(s) to my User ID.
Please provide User ID to be used for Internet Banking User log in.

Guidelines
A) Between 6 10 Characters (can be alpha or combination of alpha numeric) B) Lowercase alphabets only (a-z) C) No space or special characters allowed (*, . +- -)

Preferred User ID*

Option 1 Option 2 Option 3

Please provide all THREE options. The Bank reserves the right to allocate a different User ID if the above is/are in use. Your User ID will be sent to your correspondence address available in Banks record.

Existing Internet Banking User

(i) (ii) I have an Internet Banking User ID, but cannot remember it. Please resend it to me. I have an Internet Banking User ID following opted password(s). Login Password Transaction Password , but have forgotten my password(s). Please reissue the

Customer can also call Barclays 24 hour Contact Centre (+92 21 111 CALL US) from his/her registered number to inquire about his/her Internet Banking User ID and or for reissuance of password(s).

Password Collection Preference

I will collect the password(s) from my parent branch. I would like the password(s) to be sent to my correspondence address available in Banks records.

Declaration
I acknowledge receipt of Customer Agreement Terms and Conditions and confirm that: A) I have read and fully understood the Terms and Conditions contained in the Customer Agreement. B) I agree to be bound by said Terms and Conditions; C) I acknowledge that the Terms and Conditions may be amended from time to time by the Bank as stated therein. D) Bank may withdraw all or any facility(ies) under Internet banking without giving any reason or notice to the User and/or without incurring any liability or responsibility whatsoever by reason of such withdrawal. E) I warrant that all information provided to Barclays Bank by me or at its request is true and accurate in all material respects. F) I, through this application, request Barclays Bank to issue me an Internet Banking User ID and Password as per details provided above. I have read, understood and agree to abide by the Terms and Conditions of usage of the service mentioned on www.barclays.pk. I understand/agree that the Internet Banking Password will only be valid for Barclays Bank website www.barclays.pk. G) By signing this application below, I agree that information related to me will be used by Barclays Bank to market their own and third party goods and services. Marketing material may be communicated in a variety of ways (Including Post, Telephone, SMS and Email). H) I agree that any information provided in this application may be used by Barclays Bank in order to update its record concerning me in relation to any other product or account of/with Barclays Bank which I may have utilized.

Account Holders Signature:

For Bank Use Only

Front End: Customer Type: General Banking Premier BAW If BAW, provide Company Name: _________________________________________ _______________________________________________________________________ Customer ID: In Person Mail Messenger Staff Name: Staff Signature: E Channel Ops:
Barclays Bank PLC is a public limited company, incorporated in Great Britain.

Branch Ops: Signature Veried: Yes Signature Veried by (Name): Signature Veried by (Signature):

No

Receiving Date: DD

MM

YYYY
RIFE0001V03BBP090811