CUSTOMER REQUEST FORM
(Only for KYC Complied Accounts)
From
Name:………………………………………………………………….
To
The Manager, Br. ………………………………………………..
Account No:
Cust ID:
Dear Sir,
Kindly execute the following request/s which are selected below
CONTACT DETAILS MODIFICATION REQUESTS
(Please tick whichever is applicable)
Mobile Number
E-mail ID
Communication Address
City/District State
Country Pin
GENERAL MODIFICATION REQUESTS
(Please tick whichever is applicable)
1.
Account Sol Change:
Kindly transfer my account to the Branch: _____________________________________________(Sol ID :__________)
Reason for transferring the account: __________________________________________________________________
DP account linked to transferee account Yes No (If Yes, kindly provide application form for change in bank details)
2.
Cheque Book Request: Number of leaves required 10 20 50
Point of delivery Branch Communication address
3.
Account statement/Interest Certificate: Date From Date To
4.
Issue duplicate passbook
5.
Block / Hot Mark Debit card
Number
6.
Activation of SMS Alert/Email alert: SMS Alert Email Alert
I/We request you to enable SMS alert facility/Email alert facility in my/our account ______________________________
7.
Change Account Scheme: Convert my account from to
8.
Stop Payment: Cheque No. From______________ No. of Cheque(s): ______ Payee Name: _______________________
Cheque date: ____ /____ /_______ Reason: _____________________________________Amount:________________
9.
Change of name (as per proof attached): _______________________________________________________________
10.
Any other request: _________________________________________________________________________________
_________________________________________________________________________________________________
Declaration:
I have read, understood the terms and conditions to various products and services. I accept and agree to be bounded by the Terms
and Conditions as displayed in your website. I agree that the Bank may debit service charges plus taxes to my account wherever
applicable. I hereby declare that the above details are correct. In case of Indian mobile number updation in Non-Resident Customer
IDs, I/ we understand that it is a temporary facility allowed for enabling banking transactions and receipt of alerts. I/ we am/are
solely responsible for updating an active overseas number in due course.
Total number of requests:
Date:
Place: Signature of applicant Signature of joint holder(s)
FOR BRANCH USE ONLY
Certified that this request form is complete in all respects & all the relevant documents are obtained. Verified the Mode of
operation and signature(s) of the account. The request may be processed.
Entered by
SP No:
(If applicable)
Verified by
SP No:
C 917
