APPLICATION FORM for Internet (Retail) / Mobile / Tele Banking Facilities

TO: For Office use only

The Branch Manager Application Sl.No.: Canara Bank _____________________ Date: I wish to apply to your Internet / Mobile / Tele Banking services as a U !"#$ Applicants Name: Address: Pin: Date of Birth: Telephone (O): ( ): Mobile No: !"mail #D: Operation $ondition% SO& ' A(S ' )O* ' )OO % O&# ole Owner' (U #(uthorise) ignatory' *OF#*oint or First' *OO#*oint or Others Account No

My (ccount +o'# B ,( OF- / .-" / "OT/!"

#. #NT! N!T BAN+#N, *A$#-#T#!S !.(# !D:

/!S ' NO (Tic0 1hiche2er is applicable) a' In0uiry facilities like In0uiry of (ccount -etails1 viewing transaction )etails1 etc'1 is sufficient' b' Financial Transaction facilities like Fun)s Transfer1 e$pay2ent1 -eposit Opening1 top 3ay2ent1 etc'1 is re0uire) c' I re0uire facility of !$3ay2ent of -irect Ta4es' If1 facility is re0uire)1 3lease furnish your 3(+ +o' _______________________ T(+ +o' ________________________ ##. MOB#-! BAN+#N, *A$#-#T#!S !.(# !D: /!S ' NO (Tic0 &hiche2er is applicable) a' M "e0uest Facility # "e0uire) / +ot "e0uire) b' (lert Facility# "e0uire) / +ot "e0uire) Mobile +o' 5&ith ,ountry ,o)e6_________ #f Alerts facilit3 is re45ired6 pro2ide the follo1in7 details# 5Fill the below bo4 with appropriate values6 l' Type of (lert (2t' above which (/c +o' for which alert If the facility is re0uire)1 +o alerts to be sent to be sent 5More than tick one of the following 5Min' (2t' shoul) be one a/c can be ite2s through which alert "s'7818886 2entione) here6 2essage to be sent 7' -ebit transaction !2ail / M / both 9' ,re)it transaction !2ail / M / both :' Balance (lert on 2onthly +ot applicable !2ail / M / both basis ;' TO-s in the accounts +ot applicable !2ail / M / both Email_id to which email alerts to be sent ________________________________ III. TELE BANKING FACILITIES REQUIRED : YES / NO (Tick whichever i !""#ic!$#e%

Ge&er!# C'&(i)i'& : 7' !ach <oint account hol)er )esirous of availing the service shall use a separate application for2' 9' The account nu2ber an) custo2er )etails shoul) be as per the Bank recor)s' :' Transaction rights are strictly as per 2o)e of operation registere) in Bank recor)s' ;' Internet1 Mobile an) Tele Banking ervices is provi)e) only in case of single an) either or survivor type of <oint account' Dec#!r!)i'&:
I declare that I have read and understood the document containing the Terms & Conditions and disclaimer governing Canara Bank!s Internet & Mobile Banking "ervices as #rovided in the Bank!s Internet Banking $ebsite % www&canarabank&in and I acce#t the same& 'urther( I also agree that the transactions and re)uests e*ecuted in the above mentioned accounts through +Internet( Mobile and Tele Banking under m, -ser I. and /assword will be legall, binding on me and I am res#onsible 0or maintenance o0 secrec, and con0identialit, o0 the in0ormation #assed on to me b, the Bank through Internet1Mobile1Email1Tele#hone& I have the mandate 0rom the other 2oint holders to view1in)uire1o#erate the 2oint accounts mentioned above&

.ate3 A//4ICANT!" "I5NAT-6E FO" OFFI,! U ! O+=> C* )'+er ID ,,,,,,,,,,,,,,,,,,, Si-&!)*re . !cc'*&) &'. !&( &!+e '/ )he !""#ic!&)/ veri/ie( !&( /'*&( ! "er B!&k0 rec'r( . Re1*ire( ervice !re e&!$#e( i& FCR +'(*#e. Rec'++e&(e( !&( 2er+i))e( /'r "r'vi(i&I&)er&e)/3'$i#e/Te#e B!&ki&- ervice .

D!)e: ch!r-e

Br!&ch S)!+"

Si-&!)*re '/ O//icer (S2 N'.%

Si-&!)*re '/ Br!&ch i&4

*O DATA $!NT ! (S! ON-/ -ser Id 777777& Authori8ed and activated Created

-ate #

Internet ()2inistrator

Internet ()2inistrator

Acknowle ge!ent recei"e fro! t#e C$sto!er on %%%%%%%%%%%%%%%%%

&ignat$re of t#e c$sto!er "erifie an Acco$nt Acti"ate 'ate ( &ignat$re of A !inistrator