ALTERNATIVE CHANNELS FORM
CUSTOMER INFORMATION
INDIVIDUAL
I/We wish to register as a user of, BANK OF AFRICA Digital Banking Service.
Applicant details:
Middle Name
First Name
Phone No:
Surname
E-mail:
COMPANY/ENTITIES
Name/Title of the Company/Partnership/Sole Proprietorship:_______________________________________________________
Physical Address:
Postal Address:
Postal Code:
Office Tel No:
Fax No:
Email:
Website:
Contact Person: Mr/Ms/Mrs.
Mobile Tel:
ACCOUNT(S) TO BE INCLUDED
Account No.
Account Description (Account Title)
Type of Account
1.
2.
3.
4.
Currency
(
)
(
)
(
)
(
)
SERVICES
Internet Banking (BOA Web)
B-Mobile
Swahiba
SMS Alert
eStatements
New User
Sim/Device/phone No swap reactivation
Amendments/Addition/Alteration
Password reset
Deactivation
eStatements Frequency:
Daily
Weekly
Monthly
Quarterly
Semi Annually
BOA Web DETAILS
User
Rights
Full Name
Access
Option
Signing Option
Transaction Limit
Email
DETAILS ON AMENDMENTS/
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
CUSTOMER DECLARATION
All account owners or authorized signatories must sign below.
I/We understand that submission of this form only constitutes application for enrollment in the Services. I/We have read the Bank of Africa BOA Web Online Banking Terms and
Conditions on Internet Banking Service and the terms are acceptable to me/us. I/We understand that the Bank may, at its sole discretion, request for additional documentation
from me/us to complete this enrollment process.
SIGNATURES: By signing below, I/We authorize The bank to issue temporary (login and/or transaction) passwords on my/our behalf which I/We will be forced to change to new
private passwords the first time I/We log in to the system.
Name
Signature
Date
Thumbprint
Name
Signature
Date
Thumbprint
Name
Signature
Date
Thumbprint
FOR BANK USE ONLY
Summary following the analysis of the customer
Relationship Officer / Inputter
(Name, signature and date)
Customer Service Manager
(Name, signature and date)
NOTES
Branch Manager
(Name, signature and date)