Request form for availing Bank of India Star Services >< mnb (Internet / Tele / Mobile Banking &

Payments) for Individual / Sole-Proprietorship concern

Connect

RETAIL
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The Manager Bank of India,____________________Branch. Dear Sir / Madam,

Annexure IV

Request for availing BOI StarConnect Services- Internet/Tele/Mobile Banking I

First Name

Middle Name

Last Name

My Customer ID(s) Residential Status: Name of the Firm* Activity Type* Indian Resident Trading Non Resident Indian NGO Services Foreigner Others __________________

Manufacturing

(* Applicable in case of Sole-Proprietorship/ Partnership/ Body Corporate concern)

Date of Birth __________________ Mothers Maiden Name____________________________ (DD/ MM/ YYYY) I wish to have any one of the following User ID mentioned in the order of preference. Guidelines for User ID* selection :
1) The first character has to be an alphabet only 2) Minimum length is 6 and maximum length is 10 3) Cannot contain special characters like * ,_, @, & ,+ 4) Cannot contain spaces

* User ID shall be allotted to you subject to its availability and shall be advised by a PIN Mailer at your communication address.

Services Required (please tick your choice) Internet Banking :With out Fund Transfer Tele Banking With out Fund Transfer Mobile Banking & Payments Yes A/c Number Communication address

With Fund Transfer With Fund Transfer No

City Phone(O) Mobile Declaration

State Fax

Phone(R)

Pin Code Email

I confirm that I have read and understood the Terms and Conditions annexed hereto / as given on the Banks web site for the usage of Bank of India StarConnect Services and unconditionally accept and agree to abide by the same and such other modifications made by Bank of India (BOI) from time to time. I am aware of the nature of services offered by Bank of India through StarConnect Services and shall pay charges / taxes as applicable, from time to time, as set forth in Bank of Indias web site or communicated / demanded by Bank of India from time to time. I also agree to all the terms / conditions of opening / applying / maintaining / operating as applicable / modified for usage of Bank of India StarConnect Services - as may be in force from time to time. I further authorize Bank of India to debit my Account(s) towards charges for availing of services through Bank of India StarConnect Services. I declare that all the particulars and information given in this form are true, correct, complete and up-to-date in all respects and I, have not withheld any information. I agree and undertake to provide any further information that Bank of India may require. I agree and understand that Bank of India reserves the right to reject any application or block or withdraw the Bank of India StarConnect Services - to any or all account(s) without assigning any reason. I authorize Bank of India or their agents to make references and enquiries which BOI or its agents consider necessary in respect of or in relation to information in this application/further applications.

Date____/___/______ Place______________

Signature _____________________________ Name (___________________________ )

Bank of India: Star Connect Services

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Request form for availing Bank of India Star Services >< mnb (Internet / Tele / Mobile Banking & Payments) for Individual / Sole-Proprietorship concern

Connect

RETAIL
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For Branch use only (Strike out which ever is not applicable) 1. Customer Details (Please tick relevant boxes)

Name

: __________________________________________
: Male Female : Individual Sole Prop. HUF Karta Director : Single Married Divorced : Under Graduate Graduate Post Graduate : _______________ : Staff General Valued Customer : _______________ Partner Others

Gender Status Marital Status Education Occupation Type Annual Income

Doctorate.

2. The Customers particulars, signature/s and details have been duly verified and the same are as per the Banks record. 3. Resolution / Documents (wherever applicable) is obtained and kept on record. 4. We recommend for providing the Bank of India StarConnect Services to the applicant and confirm that the applicant has been enabled for Internet Banking / Tele banking / Both Mobile Banking & Payments set at the Finacle Core on __________________
(Note:- All Forms / Supporting documents obtained from the customer to be retained at the Branch after processing)

5. We confirm that customer request along with its supporting documents have been duly verified and kept on branch records. Date: ___/___/20___ Place ________________ Signature:.. Sign Code:__________ Name:__________________________________________

Bank of India: Star Connect Services

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