DCB On the Go - Instant Mobile BankingCustomer Request Form

Acknowledgment for DCB Mobile Banking Customer Request Form

Name:

Customer ID:

Signature(s) & Date Receipt Stamp

Date: //D D M M Y Y Y YBranch Name: ___________________________________

Account Information:

I wish to register for the DCB Mobile Banking Service / Services and receive such services which are displayed on the Bank’s website - www.dcbl.com

I wish to avail the DCB Mobile Banking Service / Services for the below mentioned Customer ID.

Name:

Customer ID:

Mobile No.:

Email ID:

(I hereby authorize the Bank to update the mobile number and email id mentioned above as my registered mobile number and email id in the Bank’s records for the above mentioned Customer ID. I also authorize the Bank to replace the mobile number currently registered with the Bank with the mobile number provided hereinabove for SMS alerts)

Enrollment for Alternate Service Delivery Channels

Please note that you are being enrolled for the following services offered by the Bank. However, if you DO NOT wish to avail any / either of these facilities, you may please indicate accordingly with a tick mark in the box against the respective service

DCB Phone Banking No DCB Internet Banking No E-mail Statement of Account No

Declaration: I affirm, confirm and undertake that I have read and understood the Terms and Conditions and Disclaimer for usage of mobile banking service of Development Credit Bank Limited and I am aware of charges applicable for the mobile banking services as set forth in www.dcbl.com, and that I agree on my behalf, or as the mandate holder on behalf of joint account holders, and will adhere to all terms and conditions of opening / applying / availing / maintaining / operating (as applicable) for usage of mobile banking service of the Bank as may be in force from time to time. I further authorize the Bank to debit my account(s) towards any charges for mobile banking services in line with the Schedule of Charges displayed on the Bank’s website www.dcbl.com and as amended from time to time and the same need not be intimated to me separately.

I declare that all the particulars and information given in this application form and all documents referred or provided herewith are true, correct, complete and up-to-date in all respects and I, and other joint account holders have not withheld any information. I understand certain particulars given by me are required by the operational guidelines governing banking companies. I agree and undertake to provide any further information that Development Credit Bank Limited may require from time to time.

I shall not hold the Bank responsible for leakage of information related to my account owing to messages received on aforesaid mobile number.

Name of the Account Holder: _____________________________________________________

Date: _____________________________ Signature of the Account Holder: _________________________

For Office Use Only

Signature(s) Verified By

Mobile Banking Registration

Employee Code:

KYC Compliance: I/We confirm that the account is KYC compliant and correct address is updated in CBS (Finacle). I / We confirm that the Mobile Banking application form has been signed by the customer(s) in the presence of the Bank Officials.

Date: //D D M M Y Y Y YSignature(s) of Bank Officials

Change of Address:

Mailing Address:

Instruction: In case of change of address, please submit the address proof (applicable for accounts less than 6 months old). Please notify change in Mobile Number to Bank immediately.

Date of Birth: //D D M M Y Y Y Y

Mother’s Maiden Name:

Company Name / FlatNo. & Bldg. Name:

Road No. / Name:

Landmark:

City: PIN Code:

State: Country:

Tel. (O): Extn. No.: STD Code: Tel. (R):

Yes, I wish to change my mailing address There is no change in my mailing address

Mandate for DCB Mobile Banking Service

(Applicable for Joint Bank Accounts)

To,

Development Credit Bank Limited,

_______________________ Branch

Dear Sir/ Madam,

I/ We, _____________________________________________________________________________________________________________________________________

(all account holders other than first holder) the undersigned, am/ are the joint account holder(s) of

Bank Account No.: SB / CA with Development Credit Bank Limited

along with ___________________________________________________________________ (name of the first holder).

I / We hereby authorize __________________ _________________________________________________ (name of the first holder) to avail the DCB Mobile Banking

service for the said account(s) for and on my/ our behalf.

I / We affirm, confirm and undertake that I/ We have read and understood the terms & conditions for usage of the DCB Mobile Banking services as displayed on

the website - www.dcbl.com, and that I / we agree to abide by them.

I / We hereby state that should I/we wish to revoke the above authorization, I/ we shall duly issue a letter of revocation to Development Credit Bank Limited in this

regard. I / we hereby agree that until ten days after receipt of such revocation letter by the Bank, the authorization as aforestated shall hold good.

Name: ___________________________ Name: __________________________

Signature: ________________________ Signature: ________________________

Date: ____________________________