NEW ATM APPLICATION FORM....

                                        POST OFFICE SAVINGS BANK

ATM CARD/e-Banking/Mobile banking REQUEST FORM for existing customers

who have opened accounts after Migration to CBS

Post Office______________________Date________________ SOL ID___________________

Account Number

CIFID

For Applicant(s)

1. ATM Card required for (please tick √ the empty box)

Self

All  Joint Account Holders

2. Name to be printed (embossed) on the Card (in Capital Letters)                       Date of Birth

1
2
3

3. Please tick relevant requirement from below:

New Card (please tick one)   1. Insta Card                (OR)       2. Personalized Card 

Internet Banking Request                           Mobile Banking Request

PIN regeneration request:-  Net Banking PIN          Mobile banking          Phone Banking PIN        ATM Card Pin

Cancellation of ATM card    {Please provide  card number(s)} --------------------------------------------------------------------------

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4. Internet Banking/Mobile banking and SMS alerts: (Please tick wherever applicable. Applicable only for the first time)

Internet Banking	Applicant (1)		Applicant (2)		Applicant(3)
Mobile Banking
SMS Alert
Mother’s maiden Name

                                                                

Declarations/Terms & Conditions

I/We declare that above information is correct. I/We authorize Department of Posts to debit/ recover the charges as applicable from time to time from my/our account for withdrawals using my ATM/Debit Card. I/We undertake to maintain sufficient funds excluding the minimum balance stipulated in my account. I/We accept full responsibility for my/our ATM/Debit Card and agree not to make claims against Department of Posts in respect thereto.

Signature/Thumb Impression:-        1^st Applicant                                     2^nd Applicant                                        3^rd Applicant

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For Office Use only

Certified that I have verified the documents submitted with this application form and confirm that KYC norms are fully complied with.

Following items issued:-

Insta ATM/Debit Card No. with PIN………………………………………………..

Date of Issue……………………………………………………….

                                                                                                 Signature of Chief/Sr./Sub/ Postmaster

Date Stamp of Post Office