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Ecom Activation Form

This document is an application form for the activation of e-commerce services for a debit/credit card at The Eastern Railway Employees' Co-operative Bank Ltd. It includes a declaration by the cardholder to indemnify the bank against any fraudulent use and confirms the accuracy of the provided information. The form requires personal details such as cardholder name, card number, date of birth, mobile number, and email ID.

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smartrahul9572281438
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5 views

Ecom Activation Form

This document is an application form for the activation of e-commerce services for a debit/credit card at The Eastern Railway Employees' Co-operative Bank Ltd. It includes a declaration by the cardholder to indemnify the bank against any fraudulent use and confirms the accuracy of the provided information. The form requires personal details such as cardholder name, card number, date of birth, mobile number, and email ID.

Uploaded by

smartrahul9572281438
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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THE EASTERN RAILWAY EMPLOYEES' CO-OPERATIVE BANK LTD.

10 STRAND ROAD, KOLKATA- 700001

E-com Activation Application Form


-----------------------------------------------------------------------------------------------------------------------------------------------------

The Branch Manager, Date: ________


____________ Branch
THE ERECB LTD,

Application To Enable E-Commerce/Online Transactions

Dear Sir/Madam

Please activate e-com service in my Debit/Credit with below mentioned details. I hereby undertake to
indemnify the Bank against any fraudulent use, claim, loss or any kind of responsibility that may arise to the
Bank in future due to activation of e-com service.

Card Holder Name: _____________________________


Card Number: xxxx xxxx xxxx _________
Date of Birth: ____/____/______ (DD/MM/YYYY)
Mobile Number: _____________________________
Email ID: _____________________________

Declaration:

I/we hereby declare that the information provided here are correct and true in my/our knowledge. I/we will
be responsible for any online transactions made through use of this card. The Bank may, without prior
notice suspend this service at any time for reasons including maintenance/ repair or in case of any
emergency or for any security reasons or any other situation as the Bank may deem fit. I/we shall be fully
responsible for any negligence and or/unauthorized disclosure of the password to any other person and
shall bear the risks of the password being used by unauthorized persons.

____________________
Card Holder Signature
Card Holder Name :
Bank A/c Number:

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