Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

ANNEXURE-11

Application for availing SyndProtect RSA SecurID Hardware/Software Token for Internet Banking Services
[Please read the terms & conditions carefully before filling up this form]
The Head of the Branch
SyndicateBank
_____________________ (Branch)
_____________________ (City)
Dear Sir,
I wish to avail the SyndProtect Facility using RSA SecurID Hardware/Software Token for Internet Banking Services offered
by the Bank for all the active accounts covered by the customer ID given below.
Login ID * (Customer ID)
Name in full* (Mr/ Ms/ M/s)
Mobile Number *
E-mail ID *
Savings/Current/OD (flagged accounts)

Category*

Individual

Term Deposit accounts

Loan Accounts

RSA SecurID Token-Type *

Device Serial No.


(For Hardware Tokens- to be filled by branch)

RSA SecurID Device-Type


(For Software Tokens)
Mobile
Desktop

Hardware
Software
*

Proprietorship

Partnership

Others

This information is mandatory

DECLARATION
RSA SecurID Token: I/We agree to receive RSA token which generates passcode for me/each individual authorized signatory(s) as given
above for the purpose of transacting my/our accounts through internet banking.. I/We agree and authorize the bank to debit my/our primary
account with the bank at the rate applicable from time to time for the issuance of duplicate RSA token if any, for the specific facility (which
is non- refundable) to be issued to me/individually to each of the authorized signatory(s). I agree to surrender the token to the branch as soon
as possible in case my relationship with the Bank is terminated for any reason.
I/We confirm that the information given above is correct. I/We have read and agree to abide by the above additional terms and conditions
governing Internet Banking facility of Syndicate Bank provided to me/us which shall constitute an agreement between me/us and the Bank.
I/We have read and understood the rules governing the above channel services and agree to abide by the same. I/We have read and I/We
accept the Terms & Conditions set out by the Bank for offering the SyndProtect RSA SecurID Token for Internet Banking.

Place:
Date:

Signature of Applicant/s

For use by the branch:


Customer ID
It is confirmed that:
The information provided by the applicant is verified and found correct.
Email ID and mobile number is updated in customer master
RSA SecurID Token hardware token has been handed-over to the Customer.
Customer has been informed that RSA Software Token Activation Code (in case of Desktop Device-Type only) will be
sent by SMS on registered mob no as available in telex field in customer master.
We have provided the customer with the detailed write-up as per the type of token opted for by the customer
Internet Banking facility is flagged positive in the Account Master for all accounts opted for by the applicant.
Asst. General Manager / Chief Manager / Sr.Branch Manager

Acknowledgement of Receipt of RSA SecurID Hardware Token


Customer ID
Customer Name
I/We confirm that have received the hardware token with the serial number as mentioned above in good condition

Signature of Applicant/s

You might also like