INTERNET BANKING APPLICATION FORM For ... - Cosmos Bank · PDF fileFor Resident / Non Resident...
Transcript of INTERNET BANKING APPLICATION FORM For ... - Cosmos Bank · PDF fileFor Resident / Non Resident...
Personal Details :
Mr. /Mrs./ Ms.
(Surname) (First Name) (Middle Name)
D D M M Y Y Y YDate :
For Resident / Non Resident Individuals
E-mail : [email protected] Website : www.cosmosbank.com
Branch : ________________________
(Please fill the form in BLOCK Letters only)
(Please leave one block space between two words)
CUST ID
Communication Address :
Details of accounts for which Internet Banking services are to be activated.
INTERNET BANKING APPLICATION FORM
Order
PrimaryAccount
1st Account
2nd Account
3rd Account
4th Account
Bank Account Number A/C Operation Customer ID*
(*If you are not aware of your Customer ID, please enquire at your nearest branch)
Access
View Only
Transaction
View Only
Transaction
View Only
Transaction
View Only
Transaction
View Only
Transaction
Sr. No. :
ESTD. 1906 (Multistate Scheduled Bank)THE COSMOS CO-OP. BANK LTD.
(with STD Code) (with STD Code)
Flat/Door No./ Building Name :
Survey No. / Road Name :
Nearest Landmark :
City:
Phone (R) Phone (O) Mobile
Email ID :
Residential Status : Resident Indian Non Resident Indian Foreign National
Date of Birth :
(Please provide complete address for faster courier delivery)
Pin Code: Country
State
Area / Locality Name :
D D M M Y Y Y Y Mother's Name :
D D M M Y Y Y YDate :
Comprehensive DeclarationI have read, understood and agreed to all terms & conditions including the interpretation of rules, risk, limits, charges & other conditions. Those will be applicable as updated from time to time under the heading “Terms and Conditions” for Internet Banking on Bank’s website www.cosmosbank.com
Further in case if you find multiple customer Ids attached for my different accounts, I accept & agree to merge those multiple Customer Ids in one Customer ID, which will be used as authenticated login user ID for Internet Banking.
Instructionsl In case of Joint accounts, the applicant is required to submit the attached mandate for the joint account holder(s).l Account holders can avail Internet Banking facility only where the mode of operation of bank account is Single / Either or Survivor /
Anyone or Survivor / Joint.l Cosmos Bank shall not be responsible and liable to monitor the nature of expense incurred by the use of the said Net Banking facility.
Joint Holder MandateApplication for individuals having Joint account operations.
1) Name : _______________________________________
User ID : ______________________________________
Level : ______________________________________
E-mail : _______________________________________
Mobile No. ______________________________________
Birth Date : ____________ Mother's Name _____________
Signature _______________________________________
are the joint account holders of Account number I/We hereby authorize the other joint holders to have View / Transaction access for the said account on my/our behalf.
lI/We further agree that since the mode of operation of our Account is joint (one initiator & all other approvers), the transaction/s initiated by any one holder will have to be approved by other joint holder/s. I/We further affirm, confirm and undertake that I/We will be responsible for any action by any of us using Internet Banking facility
lI/We hereby state that should I/we wish to change/revoke the above authorization, I/We shall duly submit a change mandate to that effect to the bank. I/We hereby agree that till 10 (Ten) working days, after receipt of such change mandate existing account operations shall be hold good.
lI/We confirm having read and understood the terms & conditions for the usage of Internet Banking service as displayed on the bank’s website www.cosmosbank.com I/We accept and agree to be bound by the said terms and conditions.
To be signed by all account holders
Account Operation : Either or Survivor (EOS) Joint / Both Any One Any Two
Important Note : l Level - 1 Initiater l Level - 2, 3 Approver l Level - 4 Initiater & Approver (Only in case of A/c operation E/S)
1. Name __________________________________________
Signature ____________________
3. Name __________________________________________
Signature ____________________
2. Name __________________________________________
Signature ____________________
4. Name __________________________________________
Signature ____________________
CUST ID
I/We
1.
2.
3.
4.
Former or Survivor (F/S) Any Three Others
2) Name : _______________________________________
User ID : ______________________________________
Level : ______________________________________
E-mail : _______________________________________
Mobile No. ______________________________________
Birth Date : ____________ Mother's Name _____________
Signature _______________________________________
3) Name : _______________________________________
User ID : ______________________________________
Level : ______________________________________
E-mail : _______________________________________
Mobile No. ______________________________________
Birth Date : ____________ Mother's Name _____________
Signature _______________________________________
4) Name : _______________________________________
User ID : ______________________________________
Level : ______________________________________
E-mail : _______________________________________
Mobile No. ______________________________________
Birth Date : ____________ Mother's Name _____________
Signature _______________________________________
For Office Use Only (To be filled by Branch Officer)
Signature of the Officer :
Name : ________________________________________
At the time of accepting the application :
All A/C Nos, A/C Holders and mode of operation on
All signatures and other details on
Documents available on Record-
1) Photo Identity : 2) Photo :
3) Address Proof : 4) PAN No. / Form 60 :
Application Accepted By : Verified By :-
Name : _____________________________________
Designation : ________________________________
Employee ID : ________________________________
D D M M Y Y Y YDate : D D M M Y Y Y YDate :
D D M M Y Y Y Y
D D M M Y Y Y Y
Designation : ______________________________
Employee ID : _____________________________
Signature of the verifying Officer :
Customer ID Merging & Verified : Customer is KYC complied :
Unwanted Customer ID Disabled : Customer ID merging NA (Not Applicable) :
Unique Customer ID after merging all duplicate customer records is :
Checked & Verified accounts are not : Frozen Closed Inactive
Minor Overdue
NRE / NRO status verified :
Valid Passport available on record Valid Visa available on record
CUST ID
Email ID updated in Finacle : Mobile No. updated in Finacle :
Confirmed :
Application Accepted in Internet Banking Cell :-
Cust ID :
Name of the Officer : _________________________
Employee ID : _____________
For Office Use Only (To be filled by Internet banking Cell)
Signature : __________________
D D M M Y Y Y YDate :
Checked Details & found correct in Finacle :
Account Created :
Signature : __________________
Name of the Officer : _________________________
Signature : __________________
Name of the Officer : _________________________
Account Verified :
If Application is rejected, then specify the reason.
Employee ID : _____________
Employee ID : _____________
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