BankGSM Application Form

Mobile Banking Service Application Form

Bank: Emirates Islamic Bank

Date:

Note: Please complete in BLOCK Letters and sign in the appropriate space after reading the mandate and agreement which forms an integral part of the application.

All fields marked by a (*) are mandatory.

New application Modification request (This will overwrite your previous message settings on the specified account)

Dear Sir, I/We request you to provide me/us EIB Mobile banking service, subject to the terms and conditions. I/ We hereby further authorize the bank to debit my/ our account on a monthly basis for service charges for EIB Mobile banking service as per the bank's schedule of charges.

Application Details

* First Name:

Middle Name:

* Last Name:

Account Number

- -

2^nd Account Number

- -

3^rd Account Number

- -

Note: If you want to subscribe more accounts to EIB Mobile banking service, please use another application form and attach it to this form.

* Mobile Number:

Mobile Code Mobile Number

Preferred Language for Push Service

English Arabic

English will be default language, if not selected

Note
To subscribe additional mobile numbers to the service, please fill a separate form and attach with this application.

Email Address:

Emirates Islamic Bank Charge / Credit card Number:

- - -

2^nd Emirates Islamic Bank Charge / Credit card Number:

- - -

3^rd Emirates Islamic Bank Charge / Credit card Number:

- - -

4^th Emirates Islamic Bank Charge / Credit card Number:

- - -

Note: If you want to subscribe more EIB Charge / Credit Cards to EIB Mobile banking service, please use another application form and attach it to this form.

Sign me up for the PUSH request function. (for charge / credit cards)

EIB-MOBILE Alert Functions (for charge / credit cards)

Cash Withdrawal

Utility Bill Payments

Purchases

How would you like to receive your EIB-MOBILE message?

English Arabic

English will be default language, if not selected

SMS will be sent for all purchases which are AED 200 or more for above selected transaction.

EIB Mobile banking service Alert Functions Required (for accounts only)

Choose functions	1st account	2nd account	3rd account

ATM Card Transactions
Salary Credit
Internet Banking Transactions
Standing Order
Manager's cheque
Telegraphic transfers
Charge card payment
Cash deposit machine transactions
Phone banking Transactions
Cheque Deposit
Cheque Return
Cheque Debit
Inward Remittance
Installments
Term Deal Maturity
** Available Balance

** Available Balance requires you to choose the frequency (date/time).

Frequency for Available Balance

Please select how often you want to receive your available balance. (only one mode of subscription possible)

Monthly

Twice a month

Weekly

Daily

Which day of the month:	What time:
* If you select one of these options and they don't exist in a month (like 31 in April or February, 29 in non leap year's February etc), last day of those months will be effective instead.

Which day of the month:	What time:
Which day of the month:	What time:
* If you select one of these options and they don't exist in a month (like 31 in April or February, 29 in non leap year's February etc), last day of those months will be effective instead.

Which day of the week:

What time:

Note
Frequency selected will be applicable to all accounts for which available balance alert is ticked. To select a different frequency for each account, please fill a separate form and attach with this application.

EIB Mobile banking service Pull Function (for accounts and charge / credit cards)

Note: If selected, you will be automatically subscribed to the pull functions for all your accounts and charge cards subscribed for EIB Mobile banking service.

Sign me up for the PULL request function. (for accounts and charge / credit cards)

Customer Signature

I/we have read and fully understand the EIB Mobile banking service terms and conditions of service agreement and agree to its contents

Power of Attorney (for corporate users): YES NO

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