Application Form For Services Of Internet Banking, Fax Banking, And Automated Message Notification Page 2

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New Delhi Branch
Authority for Making Transactions
* If “All Accounts” below is chosen, it shall include the Applicant’s Debit Accounts for Internet Banking below and the
accounts of the Applicant’s third party pursuant to the Application for Notice of Authorization to Third Party
submitted by such third party.
Sequential Authorization*
* If the Authorized Amount is not filled in, it will be deemed as having no ceiling amount. If there is no currency
designated, INR shall be applied.
* To designate a Maker, please fill in the Maker Code as described above, such as M1, M2…
Authorized Amount
Group/Checker Code
Designated
Types of
Authorized
Currency
Maker
Transactions
Account
Min (
≦ ≦ ≦ ≦
)
Max (
≦ ≦ ≦ ≦
)
1
2
3
4
5
INR
No Designation
No Specification
All Accounts
INR
INR
INR
*If the sequential authorization is chosen, the transaction shall be approved by each of the Checkers in accordance with the numerical sequence.
The Bank will only act in accordance with this Application Form or any subsequent Amendment Form for set and change on Group of Checkers and
Authority for Making Transactions above.
(Accounts set by the Bank for the discharge of debts owed to the Bank are not
Debit Accounts for Internet Banking
eligible to be chosen as Debit Accounts.)
Debit Account No.
Debit Account No.
I/We hereby authorize the Bank to transfer or deduct the related funds from the Debit Account(s) above without our written instruction or
confirmation. The Bank’s record regarding the balance of the Debit Account(s) above shall be final and conclusive without manifest error.
Delivery Instruction
The Bank will deliver password letters and related equipment (Token etc.) via postal service or courier to the following:
Address:
Addressee:
Same as contact address
Contact Phone No.:
Fax Banking Services
Please specify the pin code below. I/We understand and agree that each and all of the fax instructions sent to the Bank shall properly contain the
pin code for authentication. The Bank will not act or execute the fax instruction(s) which contain(s) the wrong pin code. I/We represent and agree to
take any and all necessary measures to keep the pin code in safe custody and shall ensure that no one other than me/us may have access to and
use the pin code. Any and all losses or damages resulted from any improper use of the pin code shall be borne by me/us, and the Bank shall in no
event be held liable or responsible with respect thereto.
Pin Code
□ □ □ □
(in 4 digits)
Please specify the contact persons below. The Bank will contact any of the contact persons below upon its receipt of fax instruction involving a
transaction with a total amount exceeding _0_ or another amount decided by the Bank. I/We hereby authorize the Bank to contact with any of the
contact persons via phone to confirm the content of the fax instruction(s). If the Bank fails to get in touch with the contact person to confirm the
content of the fax instruction(s) for whatever reasons, the Bank may refuse to act or execute such fax instruction(s).
Contact Persons
Name
Position
Tel No
Mobile
Name
Position
Tel No
Mobile
1.
3.
2.
4.
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