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					   ………..                                                                      United Bank of India
                                            Application Form for Internet Banking (United Online) – Retail


                                                                                                                               Application Number :             ________________
                                                  (PLEASE FILL IN BLOCK LETTERS ONLY)                                         (To be filled by Branch)

   UNITED BANK OF INDIA                                                                                                             Application Date:             /    /
   …………………………………Branch                                                                                                                                         DD / MM / YYYY

   I request you to register my application for Internet Banking Facility (United Online) & link my accounts with your
   branch/branches with following rights.

   Are you already registered with United Online                          :                       Yes                        No

   If Yes, kindly provide the existing User ID                                     :

   Customer ID      :*                                 (If not aware of Customer ID, Please contact your Branch)
   (All the accounts linked with the Customer ID mentioned above will be active in Internet Banking.)
   Account No              :*
                                                         First Name                             Middle Name                              Last Name
   Name of Account Holder : *

   Gender                      :                     Male                     Female

   Marital Status               :                    Single                   Married                   Divorced                  Widow/Widower

   Residential Status           :*                   Resident Indian                                    Non-Resident Indian

   Occupation                           :

   Communication Address : *

                           City              :*                                                          State   :*
                           Country           :*                                                          Pin Code:
                           Phone             :                                                           Mobile :
                           Email ID           :
         * Mandatory Fields (must be filled up)
Declaration
I affirm, confirm and undertake that I have read and understood the Terms & Conditions for users of United Bank of India - United Online (Internet Banking Services) and agree to them. I
am aware that the users of United Bank of India internet banking are governed by the Terms & Conditions which are displayed on <www.unitedbankofindia.com>. Further I accept the
Terms & Conditions governing internet banking of United Bank of India bank accounts as displayed on Bank’s web site. I accept and agree that I am aware of the contents of the Terms &
Conditions and that all my rights and liabilities would be governed by the said Terms & Conditions by my act of assessing on <www.unitedbankofindia.com>. I hereby agree to be subject
to and comply with all the provisions of the Terms & Conditions which are incorporated by reference herein and deemed to be part of this application form to the same extent as if such
provisions had been set forth in full herein.
Additional Terms & Conditions for NRI Customers :
I agree that the facility of United Bank of India, United Online shall be available only in specified types of account(s) notified by Bank as eligible for internet banking facility from time to
time. I do hereby undertake that I shall not make available to any person/s resident in India foreign currency against reimbursement in Rupee or in other manner in India. I further confirm
that all details of my accounts for the purpose of investment in India and credit representing sale proceeds of investments are covered either by general or special permission of Reserve
Bank of India. I agree that the facility of Internet Banking is available intra bank only and no fund transfer can be effected from other Banks to my account maintained at United Bank of
India as well as no fund transfer is permissible from United Bank of India to accounts maintained with other Banks. I further undertake and declare that any request made by me through
United Online a Banking facility for transfer of fund shall be further approved bonafide transactions of domestic nature only and in any event such request will not be in contravention to
the various regulations framed under Foreign Exchange Management Act 1999, Foreign Exchange Management (Deposit Regulations 2000) and other Rules and Regulations laid down
by Reserve Bank of India including Exchange Control Regulations.
I do hereby indemnify and forever keep indemnifying the Bank and its successors and assigns from and against any and all claims actions and penalties that may be made suffered or
incurred by the Bank by reason of non-compliance of any of the Terms & Conditions mentioned therein.

Place :____________________________                                                                                    Signature :______________________________________________

In a joint account all account holders are entitled to register as user of ‘United Online’ but transaction would be permitted based on the account operation rights recorded at the branch.
Each signatory to an account requiring access to United Online Retail Services must have separate User ID and Password and therefore a separate form must be used for applying for
these services by each signatory to an account.
                                                                                  For Office Use
   Branch Confirmation:
   We confirm the following and recommend for granting internet banking facility (United Online) to the above customer.
       1. The Customer details given above are correct and the same are recorded in CBS.
       2. We have verified the signature of the customer as mentioned above.
       3. The communication address with Pin Code as given by the customer has been updated in CBS.
       4. All the mandatory fields marked by ‘*’ have been filled by customer and updated in CBS.

   Sol ID                          :
   Branch Code                     :

   Verified By                      :                                                      Signature of Verifying Officer with signature Number

				
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Description: united bank of india internet banking application form