fot;k cSad VIJAYA BANK

foHkkx % lwpuk o izks|ksfxdh

Dept: Information Technology

iz/kku dk;kZy; Head Office,

41/2, egkRek xka/kh jksM MG Road,
csaxywj BANGALORE - 560 001

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V-NET BANKING - REQUISITION FOR RESETTING PASSWORD
( For Individuals)

Date

To
The Branch Manager
____________________________ Branch

Present User Id
Name
Date of Birth
D

/
/

/
/

- E-Mail Address

/ .
I request you to reset my following passwords.

Sign On Password

Transaction Password

, www.vijayabankonline.net / . ,
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. , .
Declaration: I agree and bound by the Terms & Conditions of Internet Banking Services made available by Vijaya Bank at www.vijayabankonline.net and/or any other Websites the Bank may adopt.
I also place on record our consent for all the changes that may be made from time to time by the Bank at its sole discretion. I understand that the bank may, at its absolute discretion, discontinue the
service(s) completely or partially without any notice to me. I further authorize Vijaya Bank to debit my Account(s) towards any charges for extending the Internet Banking Services and/or any other
charges connected with Internet Banking transactions.
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I declare that all the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all respects and I have not
withheld any information from Vijaya Bank. I understand that certain particulars given by me are required by the operational guidelines governing banking companies. I agree and undertake to provide
any further information that Vijaya Bank may require.
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I agree and understand that Vijaya Bank reserve the right to reject any application or block the Internet Banking facility to any account or withdraw the Internet Banking service without assigning any
reason. I agree and understand that Vijaya Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and will not return the same to me.
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), , ,
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I agree and understand that I have to complete further applications for specific liability products/services from Vijaya Bank, as prescribed from time to time, and that such further applications shall be
regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in such further forms as prescribed, the particulars and information set forth herein as well as the
documents referred or provided herewith are true, complete and up-to-date in all respects. I agree and understand that such further applications will require incorporation of the application form
number, and/or such details as Vijaya Bank may prescribe, to facilitate data management.

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SIGNATURE OF CUSTOMER

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 FOR BRANCH USE

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(If Customer has different Cust Ids for his accounts then all these Cust Ids has to be merged to one Cust Id, before forwarding the application to Data Center for processing. Branch has to verify that
all accounts & Cust Ids belongs to that customer only)

Applicant's name
Branch Code

Branch Name

.
Branch Reference No.
,
Customer ID, Address & Signature
Verified by
.
Signature & SS No.

Branch Recommendation
Remarks

Date

Changes requested should be incorporated

( )
Branch Manager (Name & Signature)

Changes requested should not be incorporated

Date

FOR DATA CENTER USE

FOR USER ID
Date
(//)
(DD/MM/YYYY)

Events
*
Password Generated *
*
Password Printed *
*
PIN Mailer Dispatched *
*
Acknowledgement Received *
*
User ID Enabled *

Signature

.
SS No.

Courier Details
USER ID MAILER
. Mailer Reference No
Courier Name
. Receipt No.
PIN MAILER
. Mailer Reference No
Courier Name
. Receipt No.
* If Applicable

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