Application for availing MOBILE BANKING Services
[Please read the terms & conditions carefully before filling up this form]
The Head of the Branch
SyndicateBank
_____________________ (Branch)
_____________________ (City)
Dear Sir,
I/we wish to subscribe to the Mobile Banking facility offered by the Bank for my/our following Account/s for which the mode of operation of the account/s is Single/Either or Survivor/Anyone or Survivor. I/we confirm that for the accounts mentioned below, none of the account holder/s is a minor.
Name of the customer
Mailing Address
Date of Birth
E-mail
Bank Account Number
(opened under same customer ID)
(maximum 2 accounts allowed)
Mobile Number
(Only one inland mobile number to be given)
(10 digit)
Declaration
I/we affirm, confirm and undertake that I/we have read and understood the Terms and conditions for usage of the Mobile Banking service of SyndicateBank as set forth in http//www.syndicatebank.in and that I/we agree to all the terms/conditions of applying/availing/maintaining/operating (as applicable) for usage of Mobile Banking service of SyndicateBank as may be in force from time to time. I/we further authorize SyndicateBank to debit my/our account/s towards any applicable charges for mobile banking service, payable currently or in future.
Place:_____________________
Date:______________________ _______________________
(Signature of the customer)
FOR BRANCH USE
It is confirmed that:
 The information provided by the applicant is verified and found correct.
 The Mobile banking registration process has been completed (CIM78) as per request.
 Mobile Banking facility is flagged positive in the Account Master (CH021) for all accounts opted for by the applicant.
Chief Manager / Sr. Branch Manager / Branch Manager
Please Note: No separate Data file need to be sent to CO:DIT. Do not send physical application or fax copy to CO:DIT. Please retain the application form at branch for record purpose.