UNION BANK of INDIA, Ebanking Division

From To UNION BANK OF INDIA, eBanking Division, BRANCH______Retail Banking Department, (IBR Code)______Central Office, Mumbai.

Union e-Banking (Retail) Application Form

FULL NAME FIRST NAME MIDDLE NAME SURNAME

CUSTOMER ID NO

Short Name [for user id –choice 1] (Min. 6 characters) Short Name [for user id –choice 2] (Min. 6 characters)

ADDRESS

CITY PIN

Email ID

TEL(Off) Mobile Res Fax

Date of birth DD MM YYYY

Mother’s maiden name

 Yes, I would like to avail of the Union e-Banking Services and would like to link the following accounts for the purpose.

 I confirm that I am the sole account holder or I have the required mandate from the joint account holder of the linked accounts, in case of joint accounts, to operate the accounts through Union e-banking Services.

Accounts to be linked for Union e-banking Services. Details of Branch UBI *We permit the applicant to access all account/s Customer ID these accounts through Union [Title of e-banking Services. We also permit Account, Type of linkage of new accounts/folios opened Account and by the applicant to this user Account number] ID/Relationship number **Joint Signature of Jt. A/c. holder(s)/co. holder (s)/ Co. name applicant

*In case of joint accounts the applicant needs to take mandate from the joint account holder(s)/primary cardholder in the columns indicated above.

** Each joint accountholder desirous of availing the services shall use a separate application form.

Access through Union e-banking Services in respect of bank account will be permitted only where the mode of operation of the account is single/either or survivor/any one or survivor.

1 Declaration:

I have read the Terms and conditions applicable to Union e-Banking Services and agree to them. I confirm that I am aware that the usage of Union e-Banking is governed by the Terms and Conditions, which are displayed on http://www.unionbankonline.co.in the site maintained by Union Bank of India and I have reviewed the contents of the same. Further, I accept the Terms and Conditions governing internet Banking of Union Bank of India applicable for UBI bank accounts as displayed on Bank’s website. I accept that I would be deemed to be aware of the contents of the Terms and Conditions and that all my rights and liabilities would be governed by the said Terms and Conditions by my act of accessing on http://www.unionbankonline.co.in. I thereby agree to be subject to and comply with al 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.

Additional Terms & Conditions for NRI customers: I/we agree that the facility of Union e-Banking shall be available only in specified type of account/s notified by Bank as eligible for internet banking facility from time to time. I/We do hereby undertake that I/we shall not make available to any person resident in India, Foreign currency against reimbursement in Rupees or in any other manner in India. I/We further confirm that all debits to my/our accounts for the purpose of investment in India and Credit representing sale proceeds of investment in India are covered either by general or special permission of Reserve Bank of India. I / We agree that the facility of Internet Banking is available intra Bank only and no fund transfer can be effected from other banks to my /our account maintained at Union Bank of India as well as no fund transfer is permissible from Union Bank Of India to accounts maintained with other Banks. I / We further undertake and declare that any request made by me /us through Union e- Banking facility for transfer of fund shall be for the approved bonafide transactions of domestic nature only and in any event such request will not be in contravention to the various Regulations framed under Foreign Exchange Management Act 1999, Foreign Exchange Management [Deposit] Regulations, 2000 and other rules and regulations laid down by Reserve Bank of India including Exchange Control Regulations.

I/We do herby indemnify and forever keep indemnified the Bank and its successors and assigns of from and against any and all claims, actions, penalties that my be made, suffered or incurred by the Bank by reason of non-compliance of any of the term and conditions mentioned herein.

Signature: ______

Date: ______Place: ______DD MM YYYY

The applicant may access Union e-banking through the Internet.

For Branch Use For Central Office Use (DIT) We confirm having verified the signatures and mandates for Union e-banking accounts. Union e-Banking facilities are Recommended. User Created on: ______

Branch Manager. Branch SOL No.: P.A. No.: Sys. Admin [Internet Banking]- DIT

For Central Office Use (RBD)

Union e-banking

PIN mailer dispatched on: ______

Officer [Retail Banking Department]

Place: