Cheque Book Request Form of Axis Bank BHUTAN NATIONAL BANK by uqs23775

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									                                    BHUTAN NATIONAL BANK Ltd.
                                                  P O S T   B O X    :   4 3 9
                                                T H I M P H U   :   B H U T A N


APPLICATION FORM FOR INTERNET BANKING– FOR CURRENT / JOINT ACCOUNT
                                                                                  Date: 2/1/2011
                                      COMPANY DETAILS

Company Name:_________________________________________________________
Location:_______________________________________________________________
P.O Box: ______________________________________________________________
Telephone No: __________________________________________________________
Fax No: ________________________________________________________________
Website:________________________________________________________________
Nature of Business:________________________________________________________
Registration/Incorporation No:_______________________________________________
Registration/Incorporation Date:_____________________________________________
BIT/CIT No (TPN):_______________________________________________________
Trade License no:___________________________License expiry date………………….
Details of the persons authorized to operate above accounts through Internet Banking
service: *(if you avail the service for fund transfer only)
               Name
               Mobile No. /Tele No.
               E-Mail ID
  Initiator    Date of Birth                            ID No.
               Name
               Mobile No. /Tele No.
Authorizer E-Mail ID
      1        Date of Birth                            ID No.
               Name
Authorizer Mobile No. /Tele No.
      2        E-Mail ID
 (optional) Date of Birth                               ID No.

Note:
           Approval letter from the management or Board resolution should be attached
           Copy of Id of authorized signature should also be attached.




* Please specify the maximum limit for Fund Transfer
                   SIGNATORY PERSONAL INFORMATION
Signature 1
Full name:                                     Marital Status
Mr/Miss/Mrs/Ms
Address for                                    ………………………
correspondence
                                               Nationality

Email address                                  …………………………

Date of Birth
Residential
                                               Country Of residence
Address
                                               ………………………..
Telephone no
Mobile No
Fax No
Position held in
Company
ID no


Signatory 2
Full name:                                     Marital Status
Mr/Miss/Mrs/Ms
Address for                                    ………………………
correspondence
                                               Nationality
                                               …………………………
Email address
Date of Birth
Residential
                                               Country Of residence
Address
                                               ………………………..
Telephone no
Mobile No
Fax No
Position held in
Company
ID no
Signatory 3.
Full name:                                                                Marital Status
Mr/Miss/Mrs/Ms
Address for                                                               ………………………
correspondence
                                                                          Nationality

Email address                                                             …………………………

Date of Birth
Residential
                                                                          Country Of residence
Address
                                                                          ………………………..
Telephone no
Mobile No
Fax No
Position held in
Company
ID no


Mode of Operation of Accounts (Tick only)

   Any One                    Any Two            All                     Joint
   Other (specify):………………………


SL#            Account No. to be accessed(Including Other       Branch Name
                               Branches)
  1
  2
  3
  4

Please tick the facilities you want to avail (Tick).

      1.   View Only
           (Balance Inquiry; Accounts statement, Account summary and information;Cheque book
           request,Cheque book status and cheque stop; Loan details, Rates for Fx, View Loan Details)

      2.   View and Transfer / Transactions
           (Balance Inquiry; Accounts statement, Account summary and information;Cheque book
           request,Cheque book status and cheque stop; Rates for Fx, FD creation; View Loan Details, Loan
           Repayment; Fund transfer: own account, within BNB account; Fund transfer to other banks –
           BOB in Bhutan and HDFC / AXIS in India; Bill Payment, Bulk Upload)
     Declaration
     I/We have read and understood the Terms and Conditions provided in the Bank’s website www.bnb.com.bt relating to the BNB
     Internet Banking services. I/We accept and agree to be bound by the said Terms and Conditions and any changes applicable if any or
     made to if from time to time. I understand that the Bank may discontinue the Internet Banking services completely or partially without
     any notice to me. I/We also declare that all the particulars and information given in this application form are true, correct, complete
     and up-to-date in all respects.




              Legal Stamp                                       Legal Stamp                                Legal Stamp




         Signature of the Applicant                    Signature of the Applicant                     Signature of the Applicant
           (Affix Legal stamp)                             (Affix Legal stamp)                          (Affix Legal stamp)



                                                     FOR BANK USE ONLY

Signatures, account no. and names of the applicant(s) verified and found as per Bank’s records.
Required services are enabled at the account level. Recommended and Permitted for provided
internet Banking services. Application Received Date* _________________________Name &
Signature of Dealing/Passing Officer*_______________________________




                             FOR USE AT DELIVERY CHANNELS GROUP ONLY

Created by *_____________________________User ID allotted*
1.__________________________________2.____________________________________________
3.______________________________________Date*_____________________________________



                                                   PIN MAILER ISSUED TO

Name*__________________________________________________________________________
Date*___________________________________________________________________________
________________________________________________________

								
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