Corporate Internet Banking

Registration form for 2-Factor Authentication* (Netsecure) for Corporate Internet Banking

Corporate Name: __________________________________________________________

Corporate ID : ___________________________ Customer ID: _______________________

Please provide the below mentioned details for all the corporate internet banking users

Sl.No. User ID Mobile Number Email ID

1 + 9 1

2 + 9 1

3 + 9 1

4 + 9 1

5 + 9 1

6 + 9 1

7 + 9 1

8 + 9 1

9 + 9 1

10 + 9 1

If there are more ID’s to be added to the list, please fill in the form available in Annexure A

*2-Factor Authentication – It is an additional security provided for online transactions. It will be mandatory to have 2-Factor

authentication to do financial transactions through Axis internet banking from 15th January, 2012..

I/We hereby request AXIS Bank Limited ("Bank") to activate the 2-Factor authentication offered by the Bank to carry out

transactions using Corproate iConnect in my/our account stated above to the stated Mobile Number of Authorized official.

I/We certify that the details furnished in this Application are correct and I/we give my/our consent to receive such information

on the said Mobile numbers of the authorized user. I/We shall advise the Bank immediately in case of any change in the above

details including the addition and deletion of user and the information given in the Application form. I/We agree to provide any

further information required and demanded by the Bank, from time-to-time, for providing this 2FA facility.

_____________________ ______________________ _____________________

Signature of Authorised Person 1 Signature of Authorised Person 2 Signature of Authorised Person 3

1. For Individuals, signature of account holder. 2. For Sole proprietorship account, signature of the Sole proprietor. 3. For Partnership firm account, signature of All Partners. 4. For Companies, signature of all Authorized Signatory as per the account opening document* For 2,3 and 4 Organization seal along with the signature of the authorized person is must

Annexure A

Sl.No. User ID Mobile Number Email ID

1 + 9 1

2 + 9 1

3 + 9 1

4 + 9 1

5 + 9 1

6 + 9 1

7 + 9 1

8 + 9 1

9 + 9 1

10 + 9 1

11 + 9 1

12 + 9 1

13 + 9 1

14 + 9 1

15 + 9 1

16 + 9 1

17 + 9 1

18 + 9 1

19 + 9 1

20 + 9 1

21 + 9 1

22 + 9 1

23 + 9 1

24 + 9 1

25 + 9 1

___________________ ______________________ _____________________

Signature of Authorised Person 1 Signature of Authorised Person 2 Signature of Authorised Person 3

1. For Individuals, signature of account holder. 2. For Sole proprietorship account, signature of the Sole proprietor. 3. For Partnership firm account, signature of All Partners. 4. For Companies, signature of all Authorized Signatory as per the account opening document*

For 2, 3 and 4 Organization seal along with the signature of the authorized person is must