Prime Bank Limited

……………………………………. Branch
Internet Banking ALTITUDE Application Form

D D M M Y Y Y Y
Name: (same as mentioned in account opening form)

(BLOCK LETTER)

Email Address (same as mentioned in account opening form):

Mobile Number (same as mentioned in account opening form):

Local Number

Foreign Number

Account Number(s):

CD, SB, SND, Continuous Loan

Account only

Enable Fund Transfer [Yes/No] If left blank will be treated as No.

I/we agree that I/we have read and understood the Terms and Conditions available on the Bank’s website
and I/we accept the same and I/we want to operate the above mentioned accounts through the Internet
Banking Service.
Specimen Signature:

Applicant Signature & Date Signature (Nominated Operator) & Date

Branch Use Only
T24 Customer ID:

Account Operational Mode: Singly/Jointly

Signature Verified By: Approved By HOB/MO:

Signature with PA NO ,Date & Seal Signature with Date & Seal
ADC Use Only
ALTITUDE User ID:
Input By: Authorized By:

Signature with Date & Seal Signature with Date & Seal