BSP Application Form
BSP Application Form
Request type (Tick preferred request) New Amend Enable Disable Password Reissue
PRINT IN BLOCK CAPITALS in a blue or black ball point pen and complete all sections. You can also fill out this Form on the BSP
Website at www.bsp.com.pg and print for signing.
Surname:
Given Name/s:
Mailing Address:
Email Address:
If there are additional accounts you would like to link for BSP Online Personal Internet Banking, Mobile Phone Banking and Telephone
Banking, please copy or reprint this section as required and attach the page/s to this Form.
Section E - Declaration
• I acknowledge that I have read and understood the BSP Electronic Banking and BSP Online Personal Internet Banking Terms &
• Conditions and by executing this document, accept these documents and agree to be bound by them in my use of BSP Online Personal
• Internet Banking, Mobile Phone Banking and Telephone Banking.
• I also acknowledge that the services provided by BSP and my obligations under this Agreement, in respect of the accounts nominated in
• this Agreement, are subject to the terms and conditions governing those accounts.
• I acknowledge that amendments or cancellation of any other authority on the accounts listed in Section B, now or in future will not affect
• this authority, which is to continue in full force and effect until the bank receives notice of amendment or cancellation in writing.
• I warrant that I am 18 years of age or above and acknowledge that BSP reserves the right to immediately terminate my BSP Online
• Personal Internet Banking, Mobile Phone Banking and Telephone Banking access in the event that such access was mistakenly provided
• to a person under the age of 18 years.
• I agree that the contents of this application and the supporting documentation provided together with this form are true and correct and
• that my signature below indicates my understanding of, and consent to all matters set out in this application form, including the Privacy
• and Consent statement above.
Signature: Date: