iB 6: DBS iBANKINGMulti-purpose Form (DBS d2pay INDIVIDUAL)

DBS Bank LtdSimpang Bedok Post OfficePO Box 216Singapore (914 808)

(Submit by mail only)Tel: 1800 111 1111From overseas, please call (+65) 6327 2265

PERSONAL PARTICULARS

SERVICE PARTICULARS

DBS Bank Ltd Aug13Co. Reg. No. 196800306E

Mr Mrs Miss Mdm Dr

*NRIC / Passport Number

Full name as in NRIC / Passport

Mobile Phone(Mobile no. supplied may be used in SMS communication)

Please where applicable:

Account No. (Please Include hyphens)A/C Type: *DBS Autosave/Current/Savings or POSBank Current/Savings

I wish to *apply / reactivate for DBS d2pay Service. (Please complete 2 and 3)

I wish to *set / revise my DBS d2pay Daily E-Commerce Limit. I acknowledge that the limit will be applicableto E-commerce sites and electronic channels that accept DBS d2pay.

My Daily E-Commerce Limit: *$100 / $200 / $300 / $400 / $500 / $1,000 / $1,500 / $2,000 / Above $3,000, please specify:

1.

2.

(Maximum $25,000)

I wish to *set / change my designated debiting account for DBS d2pay:

Account No. (Please include hyphens):

A/C Type: *DBS Autosave/Current/Savings or POSBank Current/Savings

I wish to deactivate my DBS d2pay4.

3.

Note:Upon activation of service(s), notification (if applicable) will be sent to your designated Primary Account address

* Delete accordingly

I agree to abide by the Terms and Conditions Governing Electronic Services (copies available at www.dbs.com/sg and all Branches)

Applicant’s Signature / ThumbprintPlease sign according to bank records

Date

(For thumbprint, call at any branch with proof of identification to have your thumbprint verified by a branch staff.)

For Bank UseVerified by / Date:

Approved by:

Issuance Authorised by:

Keyed by:

Checked by: