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Mobile Phone Number Registration Form

Account No.:* Base Branch:* Customer Name:* Title Last Name:* First Name:* Mobile No.:*
(ISD Code (91 for India) followed by 10 digit Mobile No)

(Please use BLOCK CAPITALS ONLY) Please (a) fill the form either online & print or print & fill the form in hand; (b) sign it; (c) attach a passport size photo; and (d) submit to your base branch

PAN No

Date of Birth*

Commumnication Address:*
House No/ Flat No. Street/Rd Area/ Locality Landmark City State Optional Information: Do you own or use (Tick whatever applicable) Car House Debit Card Computer Zip Code Country

Broadband Connection

Internet Banking (Baroda Connect)

 Besides Transaction alerts I may be contacted for information/offers on Bank's products & services by E-mail/Mobile

Customer Signature Fields marked with a (*) above are mandatory

Date:

Customer Identified For Bank Use: A/C Open Date: Mobile No updated on:

Signature Verified Signature of Verifying Officer Specimen Signature No.:

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