Annexure-l

Aadhaar Enabled Payment system (AePS)

Business Correspondent channel
Customer Request Form
Account No
Customer name
Branch name
Date
I7 We, hereby provide my our explict consent tor ARegistration/Modticabon de-registration of
AePS (debit transactions) facãity in above savings acoount: (Kindly tick the boxes against the
request opted for)
Permissible limit: ONUS transactons Minimum 50. Maximum 30000
OFFUS transacions Minimum 501- Maximum 10000/
A. New Registration (Please tick appropriate option)
Sr Registration Type Please tick | Yes, please mention limit per transaction
ONUS transactions only Yes / No ONUS Per Txn Max Lmt:
(Le. transactions allowed at
SBI Kiosk Ouiets oniy)
Both ONUS & OFFUS ONUS Per Txn Max Lmt:
transactions Yes / No
(Le. transactions abwed at
Other Bank Kiosk Outlets OFFUS Per Txn Max Limt:
aso)

B. Modification of Registration status &limit

Sr Registration Type Please tbck yes, please mention limit por transaction
ONUS transactons only Yes/ No ONUS Per Txn Max Lmt:
(Le. ransactions alowed at
SBI Kiosk Outiets oniy)
2 Both ONUS & OFFUS ONUS Per Txn Max Lmt:
transactons Yes / No
(Le. transactions albwed at
Other Bank Kiosk Outlets OFFUS Per Txn Max Limt:
aso)

C. De-Registration: Kindy de-register lor AePS transaction tacility

Ihave read, understood and agree to the terms of avaling AePS (debit transacions) facility. lalso
agree voluntarily provide my Aadhaar details tor AePS registration. Bank may debit service
charges plus taxes to my account, wherever applicable.
Iam aware that the transaction limits and other guidelines are subject to change trom time to time
as per BankRBINPCVGol guideines.

Signature of Account holder) (Signature ot Branch Official)

(S.S. Number)