AEPS - Customer Request Form

Annexure-I

Aadhaar Enabled Payment System (AEPS) Business Correspondent Channel Customer Request Form

Account No	:
Customer name	:
Branch name	:
Date	:

I hereby provide my explicit consent for Registration/Modification/de-registration of AEPS (debit transactions) facility in above savings account: (Kindly tick the boxes against the request opted for)
Permissible limit:   ONUS transactions Minimum ₹ 50/- Maximum ₹ 30000/-
                           OFFUS transactions Minimum ₹ 50/- Maximum ₹ 10000/-

✓ A. New Registration (Please tick appropriate option)

Sr	Registration Type	Please tick	If yes, please mention limit per transaction
1	ONUS transactions only (i.e. transactions allowed at SBI Kiosk Outlets only)	✓Yes ✓No	ONUS Per Txn Max Limit: ₹ 30000 per day ONUS transactions only ONUS Per Txn Max Limit: ₹ 000 per day
2	Both ONUS & OFFUS transactions (i.e. transactions allowed at Other Bank Kiosk Outlets also)	✓Yes ✓No	ONUS Per Txn Max Limit: ₹ 30000 per day OFFUS Per Txn Max Limit: ₹ 10000 per day ONUS Per Txn Max Limit: ₹ 30000 per day OFFUS Per Txn Max Limit: ₹ 50 per day ONUS Per Txn Max Limit: ₹ 000 per day OFFUS Per Txn Max Limit: ₹ 000 per day

✓ B. Modification of Registration status & limit

Sr	Registration Type	Please tick	If yes, please mention limit per transaction
1	ONUS transactions only (i.e. transactions allowed at SBI Kiosk Outlets only)	✓Yes ✓No	ONUS Per Txn Max Limit: ₹ 00 per day ONUS transactions only ONUS Per Txn Max Limit: ₹ 000 per day
2	Both ONUS & OFFUS transactions (i.e. transactions allowed at Other Bank Kiosk Outlets also)	✓Yes ✓No	ONUS Per Txn Max Limit: ₹ 00 per day OFFUS Per Txn Max Limit: ₹ 00 per day ONUS Per Txn Max Limit: ₹ 00 per day OFFUS Per Txn Max Limit: ₹ 00 per day ONUS Per Txn Max Limit: ₹ 000 per day OFFUS Per Txn Max Limit: ₹ 000 per day

✓ C. De-Registration: Kindly de-register for AEPS transaction facility

I have read, understood and agree to the terms of availing AEPS (Debit Transactions) facility. I also agree to voluntarily provide my Aadhaar details for AEPS Registration. Bank may debit service charges plus taxes to my account, wherever applicable.
I am aware that the transaction limits and other guidelines are subject to change from time to time as per Bank/RBI/NPCI/GOI guidelines.

(Signature of Account holder)

(Signature of Branch Official)
(S.S. Number)

SL 1 e Click korle SL 2 = 000, SL 2 e Click korle SL 1 = 000 - Full Page A4