APPLICATION FORM FOR INTERNET BANKING (FOR INDIVIDUALS)
I/We request you to register my/our application for internet banking facility & link my/our
accounts with your branch/other branch
Transaction Rights View Only
CUSTOMER ID:
ACCOUNT NO.:
NAME OF THE ACCOUNT HOLDER:
DATE OF BIRTH: □□-□□-□□□□
RESIDENTIAL STATUS
COMMUNICATION ADDRESS:
City: State: Pin Code:
□ Same as above
PERMANENT ADDRESS:
City: State: Pin Code:
Email address: Mobile:
OCCUPATION:
Mother’s Maiden name:
Details of any existing accounts to be linked for internet banking (If space insufficient attach addition sheet)
Branch Name Name of Jt. A/C Holder Account No. Mode of Operation
Signature of the Customer/s
P.T.O.
Declaration:
I/We affirm, confirm and undertake that I/we have read and understood the Terms and Conditions for usage of the Baroda U.P. Bank e-Banking Retail
services and agree to them. I/We am/are aware that the usage of Baroda U.P. Bank e-Banking is governed by the terms and conditions which are
displayed on https://Bupbib.barodarrb.co.in the site maintained by Baroda U.P. Bank and I/we have reviewed the contents of the same. Further,I/we
accept the terms and conditions governing internet banking of Baroda U.P. Bank applicable for bank accounts as displayed on bank’s website.I/We
accept and agree that I/we are aware of the contents of the terms and conditions and that all my/our rights and liabilities would be governed by the said
terms and conditions by my/our act of accessing on https://Bupbib.barodarrb.co.in. I/we thereby agree to be subject to and comply withall the provisions of
the terms and conditions which are incorporated by reference herein and deemed to be part of this application form to the same extent as if such provisions
had been set forth in full herein.
I/We do hereby indemnify and forever keep indemnified the Bank and its successors and assigns, from and against any and all claims, actions,penalties
that may be made, suffered or incurred by the Bank by reason of non-compliance of any of the terms and conditions mentioned therein.
Preferred User IDs:-
1.
2.
3.
Date: Signature of the Customer/s
Place:
N.B.: Bank’s e-banking Retail Services are provided only in those accounts where the mode of operation is one of the following – (1) Self; (2) Either
or Survivor; (3) Anyone or Survivor/Survivors. Each signatory to an account requiring access to Bank’s e-banking Retail Services must have a
separate User ID and PIN and therefore a separate form must be used for applying for these services by each signatory to an account. For
expeditious registration please ensure that all information given in the form is complete & correct.
For office use only
Branch confirmation: For Baroda U.P. Bank e-Banking Operations
We confirm that
1. The customer details given above are correct and the same are
Team:
recorded in CBS also;
2. We have verified the signatures of the customer as appended
above; User ID created on: □□-□□-□□□□
3. All the accounts of the above customer have been linked to one
Customer ID as given above;
4. We have enabled the above Customer Id for e-banking in Finacle
and
5. We recommend granting e-Banking facility to the above customer.
Signature of Branch Manager:
Name of Branch Manager: Signature:
Signature Number:
Name:
Branch Alpha:
SOL ID
