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P.C. No. 36 -015 Individuals/Joint/Sole Proprietorship A/C
IndiaNetBank
INTERNET BANKING / MOBILE BANKING/TELE BANKING APPLICATION FORM To The Branch Manager
Indian Bank, ……………………………… Branch
Date:
CIF No (9 Digits) :
I, Mr/ Ms. ____________________________________(“USER”), S/o D/o, W/o ________________________________________ wish to apply for the following services from INDIAN BANK. (Please Tick whichever is required) Occupation: Internet Banking Date of Birth: Phone Banking Mobile Banking (Unique Mobile No. mandatory)
Res:_______________________________________________________ ________________________________________________________ ________________________________________________________ _______________________________________________________ PIN CODE: _____________ __________________________ *Mobile No:_______________________________
Address Off. : _________________________________________________ _________________________________________________ _________________________________________________ ________________________________________________ PIN CODE: _____________ _________________
Fax No. : ______________( if FAX statement Required) PAN No:______________________ Name of the cellular service provider: City/Town: E-mail Address : ___________________________@_______________________
The following accounts maintained in your branch/other branches of your Bank, may please be linked under the IndiaNetBank service. S.No Branch Name Account Number (s) Account Type SB/CA/TD Mode of Operations E or S/ A or S / Joint
1. 2. 3 4
For availing the internet facility • I note to maintain minimum balance stipulated. I am agreeable to pay charges as fixed by the Bank. I also note that if primary account designated by me is closed, I will have to forego the Internet Banking facility. • I authorise Indian Bank to debit my account No. ________________ at __________________branch towards the related charges ( OR ) I
P.C. No. 36 -015 Individuals/Joint/Sole Proprietorship A/C
IndiaNetBank
INTERNET BANKING / MOBILE BANKING/TELE BANKING APPLICATION FORM To The Branch Manager
Indian Bank, ……………………………… Branch
Date:
CIF No (9 Digits) :
I, Mr/ Ms. ____________________________________(“USER”), S/o D/o, W/o ________________________________________ wish to apply for the following services from INDIAN BANK. (Please Tick whichever is required) Occupation: Internet Banking Date of Birth: Phone Banking Mobile Banking (Unique Mobile No. mandatory)
Res:_______________________________________________________ ________________________________________________________ ________________________________________________________ _______________________________________________________ PIN CODE: _____________ __________________________ *Mobile No:_______________________________
Address Off. : _________________________________________________ _________________________________________________ _________________________________________________ ________________________________________________ PIN CODE: _____________ _________________
Fax No. : ______________( if FAX statement Required) PAN No:______________________ Name of the cellular service provider: City/Town: E-mail Address : ___________________________@_______________________
The following accounts maintained in your branch/other branches of your Bank, may please be linked under the IndiaNetBank service. S.No Branch Name Account Number (s) Account Type SB/CA/TD Mode of Operations E or S/ A or S / Joint
1. 2. 3 4
For availing the internet facility • I note to maintain minimum balance stipulated. I am agreeable to pay charges as fixed by the Bank. I also note that if primary account designated by me is closed, I will have to forego the Internet Banking facility. • I authorise Indian Bank to debit my account No. ________________ at __________________branch towards the related charges ( OR ) I