CORPORATION BANK

(A Government of India Enterprises)

Interbank Mobile Payment Service (IMPS) REGISTRATION FORM

Branch: .. Are you registered for SMS/Mobile Banking Date : Yes No

(Please register for SMS/Mobile Banking first if you are not already registered)

Enter your Mobile Number Sl. 1 2 3 4 5 Branch Name A/c Type

_______________________ A/c Number Fund Transfer Required Outward Inward

* Only those accounts can be registered for IMPS which are already linked to your mobile.

Do you want to transfer fund through IMPS only to registered beneficiaries Enter the Beneficiary Details (only if the value of above is Y) Sl. Beneficiary Mobile No Beneficiary MMID Beneficiary Name

Y/N

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I agree to the following terms and conditions

1. Money can be remitted through IMPS using SMS/Mobile Banking PIN only and therefore Account Holder shall be solely responsible for the transactions made using his SMS/Mobile Banking PIN. 2. Account Holder shall keep his SMS/Mobile Banking PIN secret and not disclose it to anyone. 3. Transaction request of the Account Holder shall be processed solely based on information provided by the Account Holder, i.e. Mobile Number and MMID. Account Holder shall solely responsible for wrong credit due to wrong information provided by the Account Holder. 4. The Bank shall not be responsible for non-execution/delay in execution of Account Holders request for transaction caused due to system/communication failure or due to any other reason beyond the control of the Bank. 5. The Bank may levy charges for IMPS service and Account Holder shall bear the charges as levied by the Bank from time to time for this service. The charges as and when levied/modified shall be displayed on the Banks website and it shall be the responsibility of the Account Holder to visit the Banks site from time to time. 6. Remittance transactions made through IMPS are real time transactions and therefore once initiated, cant be stopped. 7. The Bank may put a cap on amount of transaction allowed through IMPS which may be changed from time to time. 8. Apart from the above, Account Holder shall also be guided by Terms and Conditions of Mobile Banking as mentioned at the Banks website.

Signature of the Account Holder

For Office Use

1. Please verify the signature of the Account Holder 2. Please check that the Account Holder is registered for SMS/Mobile Banking 3. Please check if mobile number of the Account Holder is same as mentioned above

Verified By (Name and E-No): Signature of official:

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