The Surat People's Co-op Bank Ltd.

Estd.: 1922 Scheduled Bank

Regd./Central Office: "Vasudhara Bhavan", Timaliyawad, Nanpura, Surat - 395001.

Tel.: (+ 91-0261) 246 4621 to 4624 Fax: (+ 91-0261) 246 4577 & 4592
email: info@spcbl.in website: www.spcbl.in
APPLICATION FORM FOR INTERNET / MOBILE BANKING
(For filling the form use "tab" key of your PC to move from one field to another. After filling the form print & sign and submit to your base branch)

I/We request you to register my / our application for internet banking facility & link my / our accounts with your branch / other branch/es with
following rights (choose one).
Branch: Application No.:
Transaction Rights (To be filled by Branch)

View only (If you are not aware of your Customer ID, please enquire with your base branch)
CUSTOMER ID :

BASE ACCOUNT NO. :

NAME OF ACCOUNT HOLDER:

(In Block Letters)

DATE OF BIRTH:
DATE OF INCORPORATION: MARITAL STATUS: MARRIAGE ANNIVERSARY DATE:
(In dd/mm/yyyy format) (In dd/mm/yyyy format)

RESIDENTIAL STATUS: Resident Indian Non Resident Indian Foreign Resident

OCCUPATION:

COMMUNICATION ADDRESS:

City: State: Country: Pin:

Telephone Number: Mobile Number: 1.

2.

Email Address:

Details of existing accounts to be linked for Internet Banking (Attach additional sheet if space insufficient) - with same CIF.

Branch Name Name of Jt. A/C Holder Account No. Mode of operation

(whenever offered by The Surat People's Co-operative Bank Ltd.)

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Declaration:
I/We affirm, confirm and undertake that I/we have read and understood the Terms and Conditions for usage of The Surat People's Co-op. Bank Ltd.
Netbanking services and agree to them. I/We am/are aware that the usage of The Surat People's Co-operative Bank Ltd. Netbanking is governed by
the terms and conditions which are displayed on http://www.c-edge.in/OnlineSPCB/ the site of netbanking vendor of The Surat People's Co-
operative Bank Ltd and I/we have reviewed the contents of the same. Further, I/We accept the terms and conditions governing internet banking of
The Surat People's Co-operative Bank Ltd 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 http://www.c-edge.in/OnlineSPCB/. I/We thereby agree to and comply with all the provision 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.

Signature:

Date: (In dd/mm/yyyy format)

Place:

N.B. The Surat People's Co-operative Bank Ltd. Netbanking 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. Net Banking is provided on Customer Information File (CIF)
basis, Hence any customer having more than one CIF will be clubed in one common CIF data, before issuing User id & Pin. Each signatory to an
account requiring access to The Surat People's Co-operative Bank Ltd. Netbanking 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 registration please ensure that all information
given in the form is complete & correct.

For Office Use

Branch confirmation: For SPBNetbanking Operations Team:
We confirm that
User ID created on:
1. The customer details given above are correct and the
same are recorded in CBS also;
2. We have verified the signatures of the customer as
appended above;
3. All the accounts of the above customer have been Signature:
linked to one Customer ID as given above;
4. We have enabled the above Customer ID for E- Name:
banking in CBS;
5. We recommend granting E-banking facility to the User ID dispatched on:
above customer.

Password dispatched on:

Signature of the Branch Manager:

Name of Branch Manager:

Signature Number: Signature:

Name:

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 ANNEXUER I (For Granting Transactional Authority to Various Corporate Users)

PARTNERSHIP/CORPORATE DETAILS
Sr.No. Details of Divisions/Sections within the co. Designation within the co. Hierarchy within the co.

CORPORATE USER DETAILS

Sr.No. Name of User Date of Birth (dd/mm/yyyy) Access Option (V/T) Signature of User

V: view only (transaction authority not allowed),

T: Online transfer/Schedule transfer of funds to own account and third party account within the Bank, Online transfer/Schedule transfer of funds from linked account

Please attach separate sheet if more details to be furnished.

I/We hereby confirm that mandate from the competent authority has been obtained. Necessary Resolution/Authorization is enclosed on the letterhead.
Signature:

1. Name & Designation

2. Name & Designation
3. Name & Designation
4. Name & Designation
Place: Date :

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