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PrimePay Setup Form
User Information
Operator Information
Signature
1. Full User Name
Date of Birth
Mobile Number
Email Address (Domain)
2. Full User Name
Date of Birth
Mobile Number
Email Address (Domain)
Signature
Checker Information
1. Full User Name
Date of Birth
Mobile Number
Email Address (Domain)
2. Full User Name
Date of Birth
Mobile Number
Email Address (Domain)
Signature
Signature
Authorizer Information
Signature
1. Full User Name
Date of Birth
Mobile Number
Email Address (Domain)
OTP
2. Full User Name
Date of Birth
Mobile Number
Email Address (Domain)
OTP
Signature
Version: 2.0 | Next Review Date: 01-January-2022 I Transaction Banking
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signatures of the authorizers will be printed on the cheques in case of cheques printed through Prime Cheque Management Solution )
Please find the signature(s) of our Authorized Signatory (as per ‘Authorizer Information’ of this form and our board Resolution on Operational
Mandate for banking accounts) & would request you to convert the said specimen signature into a Mechanical Signature or delete the said in
PrimePay. Operational mandate of the authorized signatory shall be given separately. I/We hereby undertake that we shall intimate you through
this form whenever any change of signatory (for any of the above role) is required into PrimePay. I/We further confirm that above users have
the authority to perform roles and functions designated in the setup form.
Authorized Signatory of Client Authorized Signatory of PBL
Authorized Signatory(s) Authorized Signatory(s) Authorized Signatory(s) Authorized Signatory(s)
Email SMS
Email SMS
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Masataka Irie Kogoro Osumi
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