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UOB 121 PHONE BANKING & PERSONAL INTERNET BANKING SERVICE Application Form

MY PARTICULARS

Name (as in NRIC/Passport)

NRIC No. (new/old) / Passport No. — — /


My Mailing Address

(Select One only)


Per Account No.

Credit Card No. [Last 4 digits only]

New Account To Be Opened

My Security Password (Mother's Maiden Name)

MY REQUEST

I would like to apply for [Please tick (√)]

UOB 121 Phone Banking Service UOB Personal Internet Banking Service

REGISTERING MY MOBILE PHONE - TWO FACTOR AUTHENTICATION CODE SERVICE (TAC) FOR UOB PERSONAL INTERNET BANKING
For added security, a Transaction Authorisation Code (TAC) may be required to perform certain transactions, in addition to your User ID and Password.
The TAC will be delivered to your designated mobile phone via SMS upon request through UOB Personal Internet Banking.

Please register my mobile phone number for TAC*


My mobile* phone number is
(Country Code) (Mobile Phone Number)

* This mobile phone number will be used for the purpose of TAC only.

DECLARATION

By signing below, I
-
confirm that I have received a copy of the UOB 121 Phone Banking Terms & Conditions / Terms & Conditions for UOB Internet Banking
(hereinafter called "Terms and Conditions") and I have read the same and confirm I fully understand the contents and effects thereof;
- signify my concurrence to accept, adopt and be bound by all the provisions under the Terms and Conditions, including any changes made thereto
by the United Overseas Bank(Malaysia) Bhd [UOB] from time to time at its sole discretion;
- consent to the linking of all my account(s) held with UOB and instructions given for Bill Payment service (if applicable) to the
UOB 121 Phone Banking / UOB Personal Internet Banking service;
- acknowledge that all my account(s) held with UOB shall be automatically registered for UOB 121 Phone Banking Service / UOB Personal
Internet Banking Service unless I instruct you otherwise.

Customer's Signature Date

FOR BANK USE

ACTION BY BRANCH ACTION BY UOB 121 - FULFILLMENT


Checklist:

MyKad Verified PBK Access ID

PIB Access ID
Signature Verified

Verified/Accepted by Approved By Verified /Input by Approved By


Name : Name : Name : Name :
Date : Date : Date : Date :

United Overseas Bank (Malaysia) Bhd (271809K) UOB121-14 (12/08)

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