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Dear Sir I wish to register as a user of LVBiNET The Lakshmi Vilas Bank s Internet Banking Facility. Registration form for Internet Banking Facility LVBiNet Retail Banking The Branch Manager The Lakshmi Vilas Bank Ltd Branch. Customer Name Use block letters Prefix/Salutation Mr. Mrs. Ms. Dr. Account Number Full 16 digit prefixed with zero Customer ID to be filled by branch Address City State Pin Telephone Mobile Email Options to be enabled Non Financial only I confirm that the information given above is correct. I have read and accept the terms and conditions set out by the bank for offering Internet Banking services. I agree that transactions executed over Internet Banking Services under my User Name and Password will be binding on me. For Branch use Customer Signature Date DDMMYYYY For Internet Banking Cell use It is confirmed that Application received on Information provided by the applicant is verified and found correct with records available in CBS* Signature of the applicant is verified* The Customer ID has been intimated to the applicant. In case of address modification Address details are modified in CBS as per the KYC norms. User has been created on PIN mailers sent on Remarks Note User ID will not be created for applicant if the details are not tallied with records available in CBS* PIN mailers will be sent to applicant s address as per the records available in CBS. Customer Name Use block letters Prefix/Salutation Mr. Mrs. Ms. Dr. Account Number Full 16 digit prefixed with zero Customer ID to be filled by branch Address City State Pin Telephone Mobile Email Options to be enabled Non Financial only I confirm that the information given above is correct. I have read and accept the terms and conditions set out by the bank for offering Internet Banking services. I have read and accept the terms and conditions set out by the bank for offering Internet Banking services. I agree that transactions executed over Internet Banking Services under my User Name and Password will be binding on me. I agree that transactions executed over Internet Banking Services under my User Name and Password will be binding on me. For Branch use Customer Signature Date DDMMYYYY For Internet Banking Cell use It is confirmed that Application received on Information provided by the applicant is verified and found correct with records available in CBS* Signature of the applicant is verified* The Customer ID has been intimated to the applicant. For Branch use Customer Signature Date DDMMYYYY For Internet Banking Cell use It is confirmed that Application received on Information provided by the applicant is verified and found correct with records available in CBS* Signature of the applicant is verified* The Customer ID has been intimated to the applicant. In case of address modification Address details are modified in CBS as per the KYC norms. User has been created on PIN mailers sent on Remarks Note User ID will not be created for applicant if the details are not tallied with records available in CBS* PIN mailers will be sent to applicant s address as per the records available in CBS.

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