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Channel Access Request Form

This document is a channel access request form for individuals and non-individuals to request access to various banking channels like phone banking, net banking, mobile banking, debit card services, and more. It collects details like date, Siebel ID, PAN, primary account number, and contact details. The form allows customers to request services like password reissuance, transaction rights, view rights, blocking, card replacement, PIN generation, and application for MyImage debit card which offers benefits like higher withdrawal limits and insurance covers. It notes that charges may apply for some services and confirms terms and conditions of debit card usage.

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Ravi Ramrakhani
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432 views3 pages

Channel Access Request Form

This document is a channel access request form for individuals and non-individuals to request access to various banking channels like phone banking, net banking, mobile banking, debit card services, and more. It collects details like date, Siebel ID, PAN, primary account number, and contact details. The form allows customers to request services like password reissuance, transaction rights, view rights, blocking, card replacement, PIN generation, and application for MyImage debit card which offers benefits like higher withdrawal limits and insurance covers. It notes that charges may apply for some services and confirms terms and conditions of debit card usage.

Uploaded by

Ravi Ramrakhani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Channel Access Request Form (Individual and Non-Individual)

Date Siebel ID

NR Resident Individual Resident Non-Individual

PAN

Primary Account Number #

Phone Banking Password Reissuance

Net Banking-Transaction Rights* Password Reissuance


$
Physical E-Mail

Password Reissuance
Net Banking-View Rights*
$
Physical E-Mail

Mobile Banking Blocking


Deactivation
Deregistration

$
This option is applicable only if valid E-mail Id / Mobile Number is updated in the Bank records. There are no charges for this service.
Card No required for below request :

PIN Re-issuance* Replacement of Card** Permanant Blocking of Card Priority Pass***

*Generate your Kotak Debit Card PIN instantly. Visit Kotak.com.> Explore Products > Generate PIN for Debit Cards or Visit www.bit.ly/CardPIN.

MyImage Debit Card request

• Higher daily ATM withdrawal and purchase limits of up to Rs. 3 lakhs each.
• Complimentary insurance cover up to Rs. 55 lakhs.
• Personal Accident Death cover upto Rs. 10 lakhs.
• Unlimited ATM withdrawals at all ATMs in India.
• Enjoy Fuel Surcharge waiver up to Rs. 750 in a calendar month.

This is confirm that I have read and understood the terms and conditions relating to the Debit Card and that the Add On Debit Cardholder will be
permitted to use the Add On Debit Card as per the said Terms and Conditions. I also confirm that the Add On Debit Cardholder may avail all the facilities
and will be entitled to carry out all transactions under the said facilities and also receive all information relating to the Add On Debit Card. I understand
that by default, the Add On Debit Cardholder will have access to all the accounts linked to my card, unless I delink the accounts which I do not want Add on
Debit cardholder to access.
I accept that the usage of the Add On Debit Card constitutes the acceptance of the said terms and conditions relating to the Debit Card, including as may
be amended from time to time by the Bank. I acknowledge that all charges as applicable or charges incurred by the Add On Debit Card will be deemed
charges incurred by me and will be recovered from my primary account and I will be fully liable for discharge of all obligations in respect of all the
transactions performed by the Add On Debit Cardholder. I agree to pay the Bank damages and compensation including direct and indirect damage, cost
expenses that may be caused, incurred by the Bank arising out of any actions/omissions on the part of the Add On Debit Card Holder.
Your Mobile Number and E-mail Address registered with the Bank will be used for all alerts sent by the Bank. Please ensure to update correct Mobile Number in Bank records in order to receive
Account Transaction and Maintenance related Alerts. In case of non-updation of correct Mobile Phone Number, Bank will not be responsible for non-receipt of Account Transaction and
Maintenance related alert in case of a fraudulent transaction in your account. Further Bank will be constrained to restrict electronic transactions (e.g. NB, MB, E-Commerce, POS) in your
account and allow only ATM Cash withdrawals in case of non- availability of Mobile Number. If you wish to update this information, kindly fill “ModificationForm” for the same available at
bank branch.The bank will also use these details for sending out information and updates about products & services. In case you do not want to receive these information / updates, you can
register yourself for “Do Not Contact” by logging in to NetBanking at www.kotak.com.

KMBL/Aug-2018/V 1.03

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