UOB 121 PHONE BANKING & PERSONAL INTERNET BANKING SERVICE                                                                                                              Application Form
MY PARTICULARS
      Name (as in NRIC/Passport)
      NRIC No. (new/old) / Passport No.                                               —              —                     /
      My Mailing Address
      (Select One only)
               Per Account No.
               Credit Card No.                                                   [Last 4 digits only]
               New Account To Be Opened
      My Security Password (Mother's Maiden Name)
MY REQUEST
      I would like to apply for [Please tick (√)]
            UOB 121 Phone Banking Service                                                                                      UOB Personal Internet Banking Service
REGISTERING MY MOBILE PHONE - TWO FACTOR AUTHENTICATION CODE SERVICE (TAC) FOR UOB PERSONAL INTERNET BANKING
      For added security, a Transaction Authorisation Code (TAC) may be required to perform certain transactions, in addition to your User ID and Password.
      The TAC will be delivered to your designated mobile phone via SMS upon request through UOB Personal Internet Banking.
          Please register my mobile phone number for TAC*
      My mobile* phone number is
                                                (Country Code)               (Mobile Phone Number)
      * This mobile phone number will be used for the purpose of TAC only.
DECLARATION
      By signing below, I
  -
      confirm that I have received a copy of the UOB 121 Phone Banking Terms & Conditions / Terms & Conditions for UOB Internet Banking
      (hereinafter called "Terms and Conditions") and I have read the same and confirm I fully understand the contents and effects thereof;
  -   signify my concurrence to accept, adopt and be bound by all the provisions under the Terms and Conditions, including any changes made thereto
      by the United Overseas Bank(Malaysia) Bhd [UOB] from time to time at its sole discretion;
  -   consent to the linking of all my account(s) held with UOB and instructions given for Bill Payment service (if applicable) to the
      UOB 121 Phone Banking / UOB Personal Internet Banking service;
  -   acknowledge that all my account(s) held with UOB shall be automatically registered for UOB 121 Phone Banking Service / UOB Personal
      Internet Banking Service unless I instruct you otherwise.
      Customer's Signature                                                                                          Date
FOR BANK USE
ACTION BY BRANCH                                                                               ACTION BY UOB 121 - FULFILLMENT
Checklist:
          MyKad Verified                                                                      PBK Access ID
                                                                                              PIB Access ID
          Signature Verified
Verified/Accepted by                                  Approved By                              Verified /Input by                               Approved By
Name :                                                Name :                                   Name :                                           Name :
Date :                                                Date :                                   Date :                                           Date :
United Overseas Bank (Malaysia) Bhd (271809K)                                                                                                                  UOB121-14 (12/08)