UBL Wallet VISA Internet Activation Form Title of Account: _________________________________ Date: ___________ Account Number CNIC Number: Supplementary Card Holder CNIC (If applicable): Primary UBL Wallet card No: Supplementary UBL Wallet card No (If applicable): I the primary account holder, ___________________________________ hereby authorize UBL (United Bank Limited) to activate the Internet facility on my UBL Wallet card (supplementary or primary as applicable), whereby I/ the supplementary cardholder) will be able to use the Card/supplementary card on the Internet to pay for goods/services within the time period – sessions stipulated by me. Also in consideration of the Bank providing this facility I fully acknowledge, understand and accept the following: 1. I, the Cardholder agree to indemnify and keep the Bank indemnified from and against all actions, claims, demands, proceedings losses, damages, personal inquiry, costs, charges and expenses whatsoever which the Bank may at any time incur, sustain, suffer as a consequence of providing the cardholder/supplementary cardholder the facility of the Card/supplementary card or by any reason of the Bank acting in good faith and taking or refusing to take any action on the Cardholder’s instructions or otherwise by providing the Services or if the Card is lost, misused/mislaid or stolen in the event of a breach of these Terms and Conditions by the Cardholder. 2. The Bank shall not be liable for any loss or damage resulting from any misuse of the Card/supplementary card and/or from the refusal of any Merchant’s Service Outlet (s) or to accept the card/supplementary card. These terms and conditions herein shall be without prejudice to and supplemental to the terms and conditions governing the issue of and use of the card/supplementary card and shall be applicable to all the internet transactions undertake through such card/supplementary card. If at any time, dispute arises in connection with any of the internet transactions or above mentioned terms and conditions, the Bank’s decision in connection with the same shall be final and binding __________________________ Primary Cardholder’s Signature ________________________________ Supplementary Cardholder’s Signature (If Applicable) Note: Please fill this form and email us the signed scanned copy at: wallet.internet@ubl.com.pk OR Fax to 02199201632 OR mail by post at the Customer Services 2nd Floor, UBL Warehouse Building, Plot # 1 & 2 “C” Group, Mai Kolachi Road, Karachi – Pakistan