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QR Code

QR Code application format

Uploaded by

CS Mohammed Slatewala
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31 views1 page

QR Code

QR Code application format

Uploaded by

CS Mohammed Slatewala
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
Download as pdf or txt
Download as pdf or txt
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Merchant Services Request Form

(For Bank Use Only) SR/CRM No. Date: D D M M Y Y Y Y


Please use block letters (Tick & Sign as applicable):-

Client Details
Cust Id RBL Bank Account No

Account Name

Business Solutions

QR Code

MERCHANT ESTABLISHMENT DETAILS

Shop/Office No. &


Building Name/No.

Road/Street Name/No.

* Landmark * City

* State * Country * Pin Code

* Nature of Business C O D E (MCC Description)

( Please refer to MCC Codes list and relevant description) ( Please refer to MCC Codes list and relevant description)

* Contact Person Name


* Contact No:
* Email Address:
( QR code & VPA will be sent to registered email address only )

Declaration: 1. I/We, hereby acknowledge that QR Code is provided on an ‘as is’ basis with no representation, warranty, guarantee of any kind as to their
functionality and under no circumstances will the Bank and its respective officers, employees and agents be liable to me/us or any other person for any
loss of profit or any special, indirect, incidental, consequential or punitive loss or damages (whether or not they were foreseeable or likely to occur).
2. I/We, understand that to the extent permitted by law, RBL Bank shall grant to me/us a limited, non-exclusive, non-transferable, non-sub licensable right
to access and make personal and non-commercial use of such services with charges and taxes (as applicable).
3. I/We, understand that while the Bank makes commercially reasonable efforts to provide QR code, the Bank is under no obligation to provide such QR
code or shall be liable for any delay thereto.
4. I/We, hereby undertake to visit the nearest RBL Bank branch for any modification to my present email address or mobile number and update the records
of the Bank accordingly.
5. I/We, understand that the Bank has the right to refuse to accept/process any transaction through QR code for any purposes at any time without giving
any reason or explanation.
6.I/We, declare that the information furnished by me/us is true and correct.
7.I/We, understand that the Bank may at its sole discretion discontinue any of the services completely or partially without any notice to me/us

Authorised Signatory 1 Authorised Signatory 2

Authorised Signatory 3 Authorised Signatory 4

FOR BANK USE ONLY

Branch Code: Branch Name:

I hereby certify that the customer’s signatures have been verified with the Bank’s records and is as per the operating mandate.

Verified by: EMP No. EMP Name: EMP Designation:

Approved by: BM/SDM EMP no. BM/SDM Name: BM/SDM EMP Designation:

ACKNOWLEDGEMENT D D M M Y Y Y Y
Date:

Customer ID/Account No. Service Request No.


Customer Name:

Request related to: Branch Stamp & Signature of Official

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