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Customer Request Form: Dear Sir, Kindly Execute The Following Request/s Which Are Selected Below

This customer request form allows a bank account holder to request modifications to their contact details, account, or services. It lists options such as changing mobile number, email, address, transferring accounts, requesting cheque books, account statements, blocking debit cards, and changing account schemes or names. The customer must select the applicable requests, provide required details, and sign to authorize the bank to process the requests. Bank staff then verify the form is complete before processing the customer's modifications.

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Ayyanar
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206 views1 page

Customer Request Form: Dear Sir, Kindly Execute The Following Request/s Which Are Selected Below

This customer request form allows a bank account holder to request modifications to their contact details, account, or services. It lists options such as changing mobile number, email, address, transferring accounts, requesting cheque books, account statements, blocking debit cards, and changing account schemes or names. The customer must select the applicable requests, provide required details, and sign to authorize the bank to process the requests. Bank staff then verify the form is complete before processing the customer's modifications.

Uploaded by

Ayyanar
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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C 917

CUSTOMER REQUEST FORM


(Only for KYC Complied Accounts)

From
Name:…………………………………………………………………. Account No:
To
Cust ID:
The Manager
Br. ……………………………………………………………………….
Dear Sir,
Kindly execute the following request/s which are selected below
(Please tick whichever is applicable)
CONTACT DETAILS MODIFICATION REQUESTS
Mobile Number E-mail ID
Communication Address

City/District State
Country Pin

(Please tick whichever is applicable)


GENERAL MODIFICATION REQUESTS
1. Account Sol Change:
Kindly transfer my account to the Branch:………………………………………………..………………………………. (Sol ID :……………..)
Reason for transferring the account: ______________________________________________________
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. Change of Name: Kindly change my name as Mr./Mrs_________________________________________(Proof Enclosed)

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. 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 Verified by
SP No: SP No:
(If applicable)

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