COMPLETE ONLINE BANKING APPLICATION FORM

Branch: ☐ W/F ☐ Bridge Street ☐ Gros-Islet ☐ Soufriere ☐ Vieux Fort

PERSONAL INFORMATION
Customer
Click or tap here to enter text. Home Phone:
Click or tap here to enter text.
Name:
Click or tap here to enter text. Work Phone:
Click or tap here to enter text.

Mailing Click or tap here to enter text. Mobile Click or tap here to enter text.
Address: Phone:
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E-Mail Click or tap here to enter text.
Address:
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Residential Click or tap here to enter text.

Address:
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Internet Banking Basic Service Options

Standard Features: Optional Features:

View Account Balances Bill Payment

View and Print Cheque and voucher Images Internal Transfers
Secure E-mail Loan Payments
Statements viewing and download Stop Payments
Transaction viewing and download Wire Transfers

COB 1
 GENERAL ACCOUNT ACCESS RIGHTS FOR USER (Login ID is Assigned by Bank)
INDIVIDUAL ACCOUNTS
CIF #:
USER ID #:
VIEW ONLY TRANSFER IN ONLY TRANSFER IN & OUT
ACCOUNT View balances and Cannot access any account Transfer funds in and out.
statements/cannot information/
# perform any transactions. deposit funds only.
1 Click or tap here to enter text. ●

2 Click or tap here to enter text. ●

3 Click or tap here to enter text. ●

4 Click or tap here to enter text. ●

5 Click or tap here to enter text. ●

6 Click or tap here to enter text. ●

7 Click or tap here to enter text. ●

8 Click or tap here to enter text. ●

9 Click or tap here to enter text. ●

10 Click or tap here to enter text. ●

GENERAL ACCOUNT ACCESS RIGHTS FOR USER (Login ID is Assigned by Bank)

JOINT ACCOUNTS
CIF #/s:

ACCOUNT/s # Access Rights Signing Priviledges

IN IN & Any Any
1 Click or tap here to enter text. VIEW
ONLY
●
OUT
●
One Two
Both

IN IN & Any Any

2 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

3 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

4 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

5 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

6 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

7 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

8 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

9 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

IN IN & Any Any

10 Click or tap here to enter text. VIEW
ONLY
●
OUT One Two
● Both

COMPLETE ON-LINE BANKING APPLICATION FORM

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By signing below, I hereby authorize you and your agents to attach the above Joint Accounts with the stated Access Right
to the Complete On-Line Banking Account of the applicant. I hereby certify that all statements relating to the above Joint
Accounts are true and complete and are made for the purpose of obtaining the Complete On-Line Banking Service;
authorize you to obtain such information as you may require concerning the statements herein; agree that this application
shall remain your property; and acknowledge my responsibility to inform you of any change in name and address and
account signing Privileges within a reasonable time.

JOINT ACCOUNT SIGNATURE: DATE:

JOINT ACCOUNT SIGNATURE: DATE:

JOINT ACCOUNT SIGNATURE: DATE:

JOINT ACCOUNT SIGNATURE: DATE:

JOINT ACCOUNT SIGNATURE: DATE:

JOINT ACCOUNT SIGNATURE: DATE:

SPECIAL INSTRUCTIONS

Click or tap here to enter text.

REVIEWING MANAGER’S SIGNATURE: DATE:

COMPLETE ON-LINE BANKING APPLICATION FORM

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 BILL PAYMENT DETAILS

UTILITY VENDOR NAME ON ACCOUNT ACCOUNT NUMBER

Click or tap here to enter text. Click or tap here to enter text.
Cable & Wireless Fixed Line
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Cable & Wireless Mobile
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Cable & Wireless Cable Vision Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Digicel Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
EC Global
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
WASCO Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
LUCELEC Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Courts (SLU) Limited Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.
4Cs Credit Card Click or tap here to enter text. Click or tap here to enter text.
Click or tap here to enter text. Click or tap here to enter text.

COMPLETE ON-LINE BANKING APPLICATION FORM

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Authorization and Agreement

By signing below, I hereby apply for Complete On-Line Banking (COB) service (the "Service") and authorize you and
your agents and assigns to provide the Service for the Bank of Saint Lucia Limited (BOSL) (the "Bank") accounts
designated. I understand that the use of the Service is subject to the terms and conditions contained in: (a) the Complete
On-Line Banking Service Agreement ("the Agreement") which I may access when I log onto the Service, (b) your general
disclosure for personal and business accounts which I received when I opened my account(s) and (C) your general
account mandates. I acknowledge and agree that using, or permitting another person to use, the Service confirms the
terms and conditions set forth in the Agreement.

I must indicate that I wish to cancel the Service by written notice. Non-usage of the Service for 120 days may result in
suspension of the Service. I agree that any time after such notice or period of non-use, you may discontinue the Service.
If my Service is discontinued I can request it’s reinstatement by contacting the Bank in writing or via telephone.

I hereby certify that all statements in this application are true and complete and are made for the purpose of obtaining the
Service; authorize you to obtain such information as you may require concerning the statements herein; agree that this
application shall remain your property; and acknowledge my responsibility to inform you of any change in name and
address within a reasonable time.

LOADING OFFICER’S SIGNATURE:

COB APPLICANT’S SIGNATURE: DATE: DATE:

LOADING OFFICER’S NAME:

FOR BANK USE ONLY

ACCOUNT MANDATE REVIEWED NAME: DATE:
AND VERIFIED BY:
SIGNATURE:

COB ACCOUNT SETUP REVIEWED NAME: DATE:

BY:

SIGNATURE:

COMPLETE ON-LINE BANKING APPLICATION FORM

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