INTERNET BANKING APPLICATION FORM (CUSTOMERS RESIDENT ABROAD)
Date: ______________
CONTACT DETAILS WHEN ACCOUNT WAS OPENED IN NIGERIA

ACCOUNT NAME: _______________________________________________________________________ ACCOUNT NO: _________________________ TELEPHONE NO._________________________________ CONTACT ADDRESS: ____________________________________________________________________ _______________________________________________________________________________________ EMAIL ADDRESS _______________________________________________________________
CURRENT CONTACT DETAILS ABROAD

CONTACT ADDRESS: ______________________________________________________________________ _________________________________________________________________________________________ TEL. NO HOME _______________________ TEL. NO. WORK ___________________________ Are you changing your email address Yes No Old e-mail: _______________________________New e-mail: ______________________________________

REQUEST Please profile my accounts for the following services (please tick as appropriate):
Pre-registered Transfer
(Kindly request for a pre-registered transfer account form)

Stop Cheque Transfer to other banks Bill Payment Standing Order to other bank Exchange Rate

Draft in Transit Self Service Deposit Rate

Transfer to any GTBank Account Cash in Transit Standing Order to GTBank Account Confirm Cheque Please specify accounts to be profiled:

Current A/C

Savings A/C

Master card A/C

Domiciliary A/C(s)

2."Please issue me a TOKEN to enhance the security of my Internet banking transactions". PICK UP OPTION Courier Delivery Proxy (The customer should send the proxy with a duly signed letter of authorization)
.....................…………………………………………………............................... Account to Debit for the cost and delivery of the token: …………………………………………..........................................
Forms should be filled and mailed to gtconnect@gtbank.com for customers outside Nigeria

Delivery Address (outside Nigeria Only): …………......................…............……………………………………....................

3. Problems Encountered Did not receive User ID/Passcode Account blocked due to several PIN tries

Forgot Secret Question & Answer Forgot Passcode

Authorised Signature: ________________________ Authorised Signature: __________________
Customer Responsibility You agree to take responsibility for protecting and ensuring the safety of your user login