CORPORATE INTERNET BANKING
ACCESS REQUEST FORM
Date: D D M M Y Y Y Y Branch Code: Relationship Manager ID:
Branch Name: CIB SR No.
Customer Type*
New Existing
Details Of Corporate*
Corporate Name: ..................................................................................................................................................................................................................................
....................................................................................................................................................................................................................................................................
PAN No: CRN:
Customer Id (To be filled by the branch):
Segment/Type : Sole Proprietor HUF Partnership Company/LLP Trust/Society Bank Government Bodies
Industry:
Automobiles Agriculture Cables Cement Chemicals
Construction/Real Estate Consumer Durables Education Engineering FMCG
Fertilizers/Seeds/Pesticides Gems & Jewellery Healthcare Hotel IT/ITES
Leather Logistics Metals Mining Media & Entertainment
Oil & Gas Pharmaceuticals Power Retail Shipping
Telecom Textiles Tobacco Travel & Tourism eCommerce
Doctor CA/CS/Lawyer Trade Pawnshop Electronics
Money Service/Exchange Investment Management Money Management Transport
Central Government Department/Organizations/Bodies/Boards Personal Investment Company
Central / State PSU (Including JV/Public Private Partnerships/SPVs) Central Government Scheme/Grant
State Government Department/Organizations/Bodies/Boards State Government Scheme / Grant
Autonomous Bodies under administrative control of Central/State government
Urban Local Bodies - Municipal Corporations/Urban Development Authorities
Local Governments - Gram Panchayat/Taluk Panchayat
Details of Corporate Internet Banking
Group Id( for existing corporate access) Preferred Group Id( for new corporate access)
CIN No.
Additional OTP Security required on Corporate Level*: Yes No
User Details
User 1 User 2 User 3
Request Type* New User Modification New User Modification New User Modification
Deletion Deletion Deletion
Mobile No./Email ID Updation Mobile No./Email ID Updation Mobile No./Email ID Updation
Name of the User*
Employee ID
Designation
City*
Login ID (For Existing Users)
Mobile Number*
Official Email ID*
*For more than 3 users take another form
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CORPORATE INTERNET BANKING
ACCESS REQUEST FORM
User Roles/Rights Details
Role/Rights Type User 1 User 2 User 3
Viewer
Maker
Checker Authoriser Approver Authoriser Approver Authoriser Approver
(One approver is mandatory if corporate
is opting for checker rights) Both Both Both
Both (Maker & Checker)
*Tick only One box for each user
Limit Details for User
User 1 User 2 User 3
Limit Frequency * Per Transaction Limit
Limit Amount( In figures)*
Limit Amount( In words)*
Unlimited
*Provide the limit details for each user and the amount against it.
Transaction Details for Users*
User 1 User 2 User 3
Own Account
Third Party Account
Both
* Tick only One transaction type against each user
Account Linking / Delinking Details for User
User 1 User 2 User 3
Accounts Numbers
* Provide the account number against each user for which the user will have the access rights. As per bank, user with no account filled
will get access to all the accounts mentioned in this CIB form.
User Validity
User 1 User 2 User 3
User Validity End Date
*Please write a specific date against every user. Write NA for not prescribing validity end date for users.
Seal & Signature of Authorised Signatory Seal & Signature of Authorised Signatory
Name : Name :
Place : Date: Place : Date:
Seal & Signature of Authorised Signatory Seal & Signature of Authorised Signatory
Name : Name :
Place : Date: Place : Date:
* To be sealed and signed by authorised signatory as per board resolution
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CORPORATE INTERNET BANKING
ACCESS REQUEST FORM
Declaration By Authorised Signatory
I/We declare that all the particular and information given/filled in this form are true, correct and up to date in all respects and I/we have not withheld any
information. I/We are aware of the fact that the Corporate Internet Banking facility is granted solely at our request and that the bank shall in no way be
responsible for any kind of hacking and/ or phishing attacks and/ or cyber related crime, which may take place or happen in the account during the
operation of the account and which may result in a loss due to the transfer of the funds from my / our account to the third party’s account. I/We are also
aware of the fact that while bank has taken all necessary available precautions, the chances of such attacks by third parties cannot be ruled out in any view
of the matter the bank shall stand indemnified from any such claims from our side.
That the users are authorised by the Company / Organisation’s Resolution dated _________________ to avail the Corporate Internet Banking (CIB) facility
to the existing account with Jana Small Finance Bank and agree to the terms and conditions of CIB in addition to the terms of the Account maintained with
Jana Small Finance Bank.
I/We have read and agree to abide by the terms and conditions governing Corporate Internet Banking and understand that any changes to the terms and
conditions will be available on the website www.janabank.com only. I/we acknowledge the enclosed Corporate Internet Baking prevailing terms and
conditions.
I/We hereby request Jana Small Finance Bank Limited (“Bank”) to activate safety net offered by the bank to carry out transactions using Corporate Internet
Banking in my/ our account stated above to the stated Mobile Number of Authorised official. I/We give my/our consent to receive such information/OTP
on the said mobile numbers of the authorised user. I/We agree to provide any further information required and demanded by the bank, from time-to time,
for providing this safety net facility. For every user mandatorily OTP for transaction will be implemented by the bank.
I/We agree to provide duly filled and signed CIB Access form every time for any modification/addition/deletion request for any of the parameters present in
the CIB Access form, after the CIB on-boarding.
I/We shall not hold bank responsible for any damages or losses caused by bulk file upload transactions and bank shall not be liable to validate any beneficiary
for bulk file upload transactions by the corporate.
I/We shall advise the bank immediately in case of any change in the above details including the addition and deletion of user and the information given in
the Application form.
I/we agree that the transactions and requests executed in the above mentioned account/s through ‘Corporate Internet Banking under the User IDs and
Password will be legally binding on the Company/Concern/Firm/us/me.
I/We agree to all the Terms and Conditions of Corporate Internet Banking of Jana Small Finance Bank Limited.
Seal & Signature of Authorised Signatory Seal & Signature of Authorised Signatory
Name : Name :
Place : Date: Place : Date:
Seal & Signature of Authorised Signatory Seal & Signature of Authorised Signatory
Name : Name :
Place : Date: Place : Date:
For Office Use Only
CIB access to be provided for (select only one):
Current Account Savings Account HUF Trust Account Vostro Overdraft
Cash Credit Rural Lending (Agri)
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CORPORATE INTERNET BANKING
ACCESS REQUEST FORM
Certification by Verifying Authority
I hear by confirm that the mode of operation of the account(s) and signature(s) of the client are verified and limits assigned to each user for
transacting through Corporate Internet Banking are in conformity with the board resolution for operating the account(s).
Date: ...................................................... Branch Code: ...................................................... Branch Name: ......................................................
Name : Name :
Employee ID : Employee ID :
Designation : Designation :
Guidelines to Fill the Form
This form can be used for following requests:
1. New GROUP ID/ LOGIN ID creation.
2. Existing CIB user rights modification viz. Limits, Profile, Account Linking etc.
3. Mobile Number/ Email Id Registration/ Modification.
4. Linking/ Delinking of Accounts.
5. All * marked fields are mandatory for new CIB requests.
6. For modification request fill only the relevant field that needs to be modified.
7. Strike out / or fill NA to all the fields kept blank to avoid any type of confusion or miscommunication.
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Acknowledgement
We acknowledge the form and documents submitted for CIB access request for account nos._________________________________________
_______________________________________________ . The same will be processed within 3 bank working days. For any queries refer to CIB
terms & Conditions in Jana Bank website (www.janabank.com) or contact to Jana customer care at 18002080 or customercare@janabank.com.
Branch Executive Name :
Branch Executive Signature : ____________________________________
Date : D D M M Y Y Y Y
V_001/30.08.2019
