APPLICATION FORM for KGB INTERNET BANKING – RETAIL MODULE

To, For Office use only The Branch Manager Application Sl No. : Gramin Customer ID : ______Date:

I wish to Register/Re-register for your Internet Banking- Retail services as a USER:-

Applicant’s Full Name:

Address : PIN Code : Date of Birth : Category General / Staff / NRE Number : Mobile No : + PAN Number : E-mail ID : Mode of Operation* (Operative Account SB/CA/OD/CC) : *Note:- 1. Following Mode of Operations are not permitted for Net-banking: - Any Two Jointly, Both or Survivor, Jointly, Jointly or Severally, Mandate Holder, No.1 and Any Other One Jointly, Official Liquidator, Others, Power of Attorney, Former or Survivor, Number 1 or Survivor 2. All the above fields are mandatory for Registration in CBS.

I. Internet Banking Facilities :

a. Inquiry and Download facilities like Account Summary, General Account Details, Account Statement, Mini Statement, Account Grouping, View/Inquire Transaction details, View Beneficiaries etc.,

b. Financial Transaction facilities like Quick Pay, Funds Transfer Own Accounts/Within Bank/Other Bank, Online Bill Payment, FD/RD Deposit Opening, Manage Beneficiaries etc.

c. Non- like Stop Cheque, Debit Card Hot-listing, Email Statement Registration/De-Registration, Mobile Banking Registration, Interest, TDS and Balance Certificate, TDS Enquiry, Update Nominee etc.

II. General Conditions:

a. The account number and customer details should be as per the Bank records.

b. Transaction rights are strictly as per mode of operation registered in Bank records.

c. Generally, Internet Banking Services is provided only in case of Either or Survivor/ No.1 Only type of Joint accounts. For other permitted mode of operations kindly contact Branch.

Declaration:

I declare that I have read and understood the document containing the “Terms & Conditions” and “Disclaimer clauses” governing Kerala Gramin Bank’s Internet Banking Services available in the Bank’s Internet Banking Portal (https://netbanking.keralagbank.com) accessed through Bank’s Official Website https://www.keralagbank.com and I accept the same. Further, I also agree that the transactions and requests executed in the above mentioned accounts through ‘Internet Banking under my User ID and Password’ will be legally binding on me and I am responsible for maintenance of secrecy and confidentiality of the information passed on to me by the Bank through Internet/Mobile/Email/Telephone. I have the mandate from the other joint holders to view/inquire/operate the joint accounts mentioned above.

DATE: APPLICANT’S SIGNATURE

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FOR OFFICE USE ONLY

Customer ID ______

Signatures, Account no. and Names of the applicant/s verified and found as per Bank’s records. Recommended and Permitted for providing Internet Banking services.

Date:

Signature of Officer (SP No.) Signature of Branch in-Charge

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FOR DBS Wing USE ONLY (In case of Re-registration Only)

User ID Created by Authorized and Activated

Date : Net Banking Administrator Net Banking Administrator

Request received from the Signature of the Customer verified and Account Activated Branch on ______Date : Signature of Administrator