Andhra Bank Comp No: _ _ _ _ _ _ _ _

Branch Code _ _ _ _ _ Name _ _ _ _ _ _ _ _ _ _ _ _ _

Application for AB INFI-net Internet Banking Service
(For Individuals and Proprietory Concerns)
Details of the applicant:-
Name of the applicant*
(See Note below)
Constitution Individual
Joint account
Proprietory Concern

Name of proprietory concern
(For Proprietory Concerns)
Unique Customer Number of
the applicant
Address of the applicant

Town/City: PIN:
Email-ID
Phone: Office Residence Mobile
Place of Birth Wedding anniversary date
Note: *Name of the applicant is the name of the single individual account holder or the name of the first
individual in the case of joint accounts or the name of the Proprietor in the case of a Proprietory Concern.
Details of accounts for which Internet Banking Service is sought:-
S No Branch Branch Name Account details Name(s) of account Mode of
Code Type Sub Number holder(s) Operation (for
Type joint accounts)

Note: 1) Enclose the list of accounts if the space provided is not sufficient.
2) In case any account is a joint account, a letter in the prescribed format should be submitted by
the joint holders other than the applicant (i.e. other than the first joint holder). For each joint
account a separate letter should be submitted.
Declaration:-
I Declare that I have the knowledge of the use and functionality of Internet. I do not use cyber cafes to
access the AB INFI-net Internet Banking Service. I am aware that the usage of AB INFI-net Internet Banking
Service is governed by the terms and condition, which are displayed on the site www.andhrabank.in
maintained by Andhra Bank. I have read the terms and condition applicable to the bank accounts as
displayed on the bank's website and I agree to abide by the same. I also agree that I would be deemed to be
aware of the conditions and that all my rights and liabilities would be governed by the said terms and
conditions by my act of access in on www.andhrabank.in. Any future changes made by the Bank in respect
of Terms and Conditions which are on website is acceptable to me and I shall abide by the same and the
bank need not give me a separate notice in this regard. I also agree that this application shall be treated as
an authenticated request for generating UserID and PIN/Passwords for my use. The UserID and
PIN/Password mailers can be mailed to my address provided in the bank's records at my risk and
responsibility.

Place: _________________
Date: __________________ Signature of the Applicant
 For office use
Verification:-

I have verified the application form and the records and confirm that the applicant is a single
individual and is the sole holder of the account / all the accounts indicated in the application
form.
I have verified the signature of the applicant with his specimen signature available on
records and found in order.

I have verified the application form and the records and confirm that the applicant is the
First Joint Holder of the joint account / of all the joint accounts indicated in the application
form and that the other joint holder(s) of the account(s) has/have submitted the prescribed
letter separately for each such account giving his/their consent.
I have verified the signature of the applicant and the signatures of other joint holders with
their respective specimen signatures available on records and found in order.

I have verified the application form and the records and confirm that the applicant is the
sole proprietor and the holder of the account / all the accounts indicated in the application
form.
I have verified the signature of the applicant with his specimen signature available on
records and found in order.

I have verified and I hereby confirm that KYC Norms are fulfilled completely for the account(s)
mentioned in the application form.

Date: ________________ Signature of the verifying officer

------------------------------------------------------------------------
Decision of the Branch Manager:-

Permitted to Register the Application Form for availing AB INFI-net Internet Banking Service.

Not permitted for the reason: _________________________________________________.

Date: ________________ Signature of the Branch Manager

------------------------------------------------------------------------
Action taken:-

The Application Form is registered on _ _ _ _ _ _ _ _ _ under Registration No _ _ _ _ _ _ _ _

and communicated to DIT.

Advised the applicant about non-acceptance of the request.

Date: ________________ Signature of the officer

------------------------------------------------------------------------
For Head Office Use
Signature
UserID is generated and despatched on: ____________
Name:
Signature:
PIN Mailer is generated and despatched on: _________
Name:

*****
 Comp No: _ _ _ _ _ _ _ _ _ _ _

Letter of consent from the joint account holders other than the First Joint Holder
(For Individual joint account holders)
To Place:
________________
The Manager/Chief Manager Date :
________________
Andhra Bank
____________________ Branch

Dear Sir,
Sub:- Application for AB INFI-net Internet Banking Service submitted to you by
Mr/Ms _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

I/We the undersigned declare that I/We am/are holding the following account(s) with your bank
jointly with Mr/Ms _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ who is the
First Joint Holder for the accounts
S Account details With branch Names of account holder(s) Mode of
No Type Sub Type Number Branch Branch Name including the First Joint operation
Code Holder
1.
2.
3.
1.
2.
3.
(Enclose a separate list of accounts if the place provided is not sufficient)

I/We understand that the said First Joint Holder has submitted an Application for availing AB INFI-
net Internet Banking Service from your bank in respect of the above mentioned account(s).
I/We herby give consent for the said Application and also authorize the said First Joint Holder to
view/access and to conduct operations in the said account(s) individually through AB INFI-net
Internet Banking Service offered by your bank.
I/We affirm, confirm and undertake that I/We have read and understood the Terms and Conditions
for usage of the AB INFI-net Internet Banking Service which are displayed on the website
www.andhrabank.in and that I/We agree to abided by the said Terms and conditions.
I/We hereby state that should I/We wish to revoke the above authorization, I/We shall issue a letter
of revocation to Andhra Bank, _________________________ Branch in this regard. I/We hereby
agree that until ten days after receipt of such revocation letter by the bank, the aforesaid
authorization shall hold good.
Names of Joint Holders other that the First Holder:

1. 1.

2. 2.

3. 3.

(Signatures)