Mobile Banking Application/ Amendment Form

1 Date: Date: Date: Mobile Banking Application/ Amendment FormRequest type (Tick preferred request type) NEW AMEND PIN RESET CANCELNote: If you do not have BSP Internet Banking and BSP Phone Banking you must apply by filling in a separate application formService type (Tick preferred service type) Mobile Banking (*131#) )#772*( TNEMYAP TEKCIT ENILRIA GNIKNAB ELIBOM Instructions:Requesting for Mobile Banking (*131#) and Mobile Banking Airline Ticket Payment (*277#), complete relevant sections IN BLOCK CAPITALS and complete all sectionsPlease obtain a copy of BSP Electronic Banking Ter ms & Conditions at your branch or log on to: Section A: Customer Details Mr Ms Miss Mrs Name Surname:Primary Account Number: CIF Number (BANK USE):Phone Number : +675 Postal/ Employment Address: Email Address: Section B: Linked Mobile Phone I agree that all my linked account(s) will be accessed/not accessed by this Mobile number.

2 Add Mobile Number: Section C: Declarationa) I acknowledge that I have read and understood the BSP Electronic Banking Ter ms and Conditions found at or obtained from a BSP Branch and by executing this document, I agree and am bound by the BSP Electronic Banking Ter ms and Conditions in my use of the Mobile Banking )I also acknowledge that the service provided by the Bank and my obligations under this agreement, in respect of the accounts nominated in this agreement are subject to the terms and conditions governing those ) I acknowledge that my first use of the Mobile Banking facility will indicate my acceptance of those BSP Electronic Banking Ter ms and : Customer Image: Date: Branch Section Confirm all account(s) are linked to customer & recipient s CIF/Z CardVerified that all account(s) a one(1) to sign authority Verified customer s signature.

3 Branch Officer s signature: Name:Name: Authorising Officer s signature: dd / mm / yyBANK USE ONLYB ranch SectionVerified customer s signature2nd Day Check Branch Compliance OfficerRBanking Maintenance ReportCheck Application form Compliance Officer s signature: dd / mm / yyBSP Mobile Banking Application / Amendment For mdd / mm / yyName:dd / mm / yy Delete Mobile Number:Home/ Residential Address:Current Profession.