Electronic Banking Application Form

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Channel application and agreement

Customer details

Title Mr Mrs Miss Dr Other (Please specify)

Surname

First names

Identity/passport number

Date of birth (YYYY-MM-DD) Mobile number

Email address

CIF Number

Internet banking/Mobile banking (WAP and USSD) Registration

Internet banking user ID/CIF ID

Registration De-registration

Reason for de-registration

Internet banking password

Password received Password reset Re-issue of user name

Declaration of password secrecy

I, (full names)
undertake to be held solely responsible for my password issued and therefore it should not be told to anyone under any circumstances.

MyUpdates (SMS and email alerts) - Registration

Registration De-registration Notifcation

Reason for de-registration

Alert schemes (Please tick)


Threshold
Account number limit Default Transactional Value added Cheque Loan E-Banking

1 

2 

3 

4 

5 

6 

Preferred contact times Any time (24 x 7) Extended hours (6am to 10pm) Off ce hours (8am to 5pm)

*This limit def nes when you will receive alerts.

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Alerts scheme details

Default Alerts Scheme (Mandatory) Transactional Alerts Scheme (Mandatory) Value-Added Alerts Scheme

Cash withdrawal alert Send alert to benefciary

Birthday alert Deposit matured alert

Welcome alert 
Point-of-sale purchase alert

Benefciary payment alert Deposit maturing (reminder) alert

Add/amend biller (via Internet banking) alert

Add/amend benefciary (via Internet banking) alert 
Biller payment alert

Login password expired (Internet banking) 
Deposit alert

General/broadcast message alert 
Recurring transaction alert

Account opening alert 
Mobile Top-Up Failed alert

Dormancy alerts (Inactive and full dormancy) 
Future-dated payment alert

Debit card collection alert

PFM Category Threshold

PFM Goal Management Loan Alerts Scheme E-Banking Alerts Scheme
Cheque Alerts Scheme New loan disbursed alert Submit request successful alert
Cheque deposited alert Loan instalment overdue alert Submit request failed alert
Cheque returned alert Loan repayment due alert User enabled alert
Successful loan repayment alert Account opening alert
Service request raised alert

By signing this form, I confrm that the attached terms and conditions have been explained to me and I understand them. I agree to abide by the under-
takings contained in them

Signature Date (YYYY-MM-DD)

*Additional contact details


Mobile number Email address

*Note: All alerts subscribed for will be sent to these mobile numbers and email addresses as well as your primary mobile number and email address,
as supplied above.

For bank use only

Registration recorded by

Date (YYYY-MM-DD)

Time

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