ONLINE BANKING - APPLICATION FORM

(FOR INDIVIDUAL ACCOUNT HOLDERS & PRIMARY CARD HOLDERS)

MY PERSONAL DETAILS

Application instructions: Please write in BLOCK letters. Please tick the boxes as applicable.

Title : Mr Ms
Name :
(First Name) (Middle Name) (Surname)

E-mail address :

Telephone No. (R) : Telephone No. (O) :

(STD Code) (STD Code)

Mobile No. : Date of Birth : - -

(Country Code) DD MM YYYY

I maintain the following account(s) / Credit Card with Standard Chartered Bank:

Savings / Current Accounts Deposit Accounts Loan Accounts

Credit Cards (Including all supplementary / add on cards)

Expiry Date : -
MM YY
Expiry Date : -
MM YY
Expiry Date : -
MM YY
Expiry Date : -
MM YY

DECLARATION

By signing below, I hereby apply for Standard Chartered Bank’s (Bank) internet and electronic banking services (collectively “Electronic Banking Services”)as may be made
available to me by the Bank from time to time. Further I acknowledge that my use of the Electronic Banking Services shall be governed by the Bank’s prevailing Electronic
banking Terms and Conditions (copies of which are available at any of the Bank’s branches in India and on the Bank’s web-site at www.standardchartered.co.in) and I declare
that I have read and fully understood the said terms and conditions and accept the same.

I hereby instruct and authorize the Bank to mail / courier my Electronic Banking ID and Electronic Banking Password (collectively “Security Codes”) relating to my access to the
Electronic Banking Services to my address as per the Bank’s records and I agree that the risk of non-receipt and / or disclosure of the Security Codes to an unauthorized third
party shall be fully borne by me. I confirm and agree that the Bank shall not be held responsible in any way for any losses that may be suffered by me as a result of such non-
receipt or disclosure of the Security Codes to an unauthorized third party.

Subject to the Banks’ prevailing terms governing the use of the Services, I hereby authorize and instruct the Bank to act on any instructions received through the use of my
Security Codes, including but not limited to the transfer of funds (subject to limits as may be imposed by the Bank from time to time) from my account(s) with the Bank (which I am
entitled to operate on a single signing basis) to the third party accounts named under the heading “Designated Accounts” above and to any account which I may designate from
time to time for this purpose under the Bank’s prevailing procedures.

I warrant that all the information provided in this application furnished by me is true, accurate and complete in all respects.

Signature

Date - -

FOR BANK USE ONLY

City Unit Signature verified by

Employee Code Password Serial No. allotted

Phone Banking Numbers:

Allahabad, Amritsar, Bhopal, Bhubaneshwar, Chandigarh, Cochin / Ernakulam, Coimbatore, Indore, Jaipur,
Jalandhar, Kanpur, Lucknow, Ludhiana, Nagpur, Patna, Rajkot, Surat, Vadodara 3940444 / 6601444
Ahmedabad, Bangalore, Chennai, Delhi, Hyderabad, Kolkata, Mumbai, Pune 39404444 / 66014444
Gurgaon, Noida 011 - 39404444 / 011 - 66014444
Jalgaon, Guwahati, Cuttack, Mysore, Thiruvananthpuram, Vishakhapatnam 1800 345 1000
Siliguri 1800 345 5000