FINCARE SMALL FINANCE BANK LIMITED

CUSTOMER SERVICE REQUEST FORM

SR NO :______________________________ Date:______________________________

Personal Details

Name

Mobile No. CIF E-mail ID

Please tick in the appropriate box

1. KYC UPDATION
a) Kindly update my PAN / AADHAAR ___________________________________________________________________________________________________

b) Kindly link my Aadhaar No. __________________________________________________________________________________________________________

2. CHEQUE STOP PAYMENT REQUEST ( DID YOU KNOW YOU CAN DO THIS IN MOBILE BANKING, WHATSAPP BANKING & INTERNET BANKING)

a) I / We have lost the cheque book containing leaves from ________________ to ________________ Please do stop payment of the same.

b) I / We have issued a cheque no __________dated __________________ for __________________ favouring ______________________________________

Please do stop payment of the cheque.

3. CHEQUE BOOK REQUEST ( DID YOU KNOW YOU CAN DO THIS IN MOBILE BANKING, WHATSAPP BANKING & INTERNET BANKING)

a) Please issue new cheque book of ___________________________________________________ leaves because

1) I / We have not received cheque book for my / our new account.

2) I / We have not received our personalized cheque book.

4. CHANGE OF ADDRESS
a) Please update the contact information (Permanent/ Communication) in your records. I/ We am/ are enclosing proof of my/ our new address.

My / Our new address is ____________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________

_____________________________________________________City___________________________________________________ Pin__________________

5. DEBIT CARD ( DID YOU KNOW YOU CAN DO THIS IN MOBILE BANKING, WHATSAPP BANKING & INTERNET BANKING)

a) Please issue a new debit card. Tick appropriate reason listed below:

1) Debit Card not received. Please reissue

2) Lost Card/ Damaged Card. The 16-digit Card no is _________________________________________________________________________________
3) Card Expired.

b) My debit card is blocked, kindly unblock.

c) I have lost / forgot my debit card PIN, kindly re-issue. ( YOU CAN CREATE/CHANGE PIN USING MOBILE BANKING)

6. FIXED DEPOSIT/ RECURRING DEPOSIT ( YOU CAN GENERATE FD ADVISE USING INTERNET BANKING)

a) Kindly Issue Fixed Deposit Advice as initial FDA not received.

b) Kindly dispatch FD Advice to Branch.

c) Tenure of Deposit wrongly captured. Correct Tenure_______________ years _______________ month______________ days

d) Rate of Interest not correctly captured. Correct Rate of Interest_______________%

e) Periodical FD interest not credited to account.

f) Kindly register / cancel/ modify nomination as requested.

CURRENT
Through sweepin / out
@ facility @ @

*T&C Apply 7% 3% 6.5%

 7. TAX DEDUCTED AT SOURCE ( YOU CAN GENERATE TDS & SUBMIT FORM 15G/H STATEMENT USING INTERNET BANKING)

a) TDS Certificate Request for the FY_____________________________

b) Interest Certificate request for the FY__________________________

c) TDS Certificate not received for the FY__________________________

d) FORM 15G/H submitted at branch on __________________ but tax has been deducted.

e) Request for FORM 15G/H updation.

f) Mismatch in Tax deducted and Tax remitted. Please verify.

8. ACCOUNT MODIFICATION
a) Please complete my Full KYC/ ReKYC, (Documents enclosed).

b) Please convert my account from Minor to Major. (Documents enclosed).

c) Addition/ Deletion of Joint Account Holder.

d) Changes in MOP. Self Either or Survivor Jointly Others, please specify under point 12.

e) Pay out account change request.

f) Upload Customer Photo / signature.

g) Account Closure (Including FD pre-closure).
h) Statement of Account (E-statement/ Physical Statement) Period______________________
i) Updation of Email id/ Mobile Number _________________________________

9. INTERNET BANKING/ MOBILE BANKING (STRIKE OUT WHICHEVER NOT APPLICABLE)

a) My User Profile is Blocked. Please unlock.

10. LOAN RELATED

a) Loan status b) Interest related/EMI related/CIBIL/Principal c) Foreclosure/prepayment c) Death/insurance claim

11. POSITIVE PAY SYSTEM

a) Cheque No: _________________________________ b) Cheque date:_________________________________

c) Cheque Amount: _________________________________ d) Beneficiary: ________________________________________________

12. OTHERS (Please Specify)

________________________________________________________________________________________________

________________________________________________________________________________________________

Dear Sir / Madam,

I/We request you to provide me the service/s ticked in the form above. I/We authorize Fincare SFB to debit charges as applicable to
my/our account.

Signature of the Primary Holder Signature of the 2nd A/c Holder Signature of the 3rd A/c Holder

We confirm that all the requests of the customer/s are addressed

Signature and Emp. No. of the Maker Signature and Emp. No. of the Checker

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Acknowledgement Slip (Only For Official Use)
We acknowledge the receipt of Request / Complaint Instruc on from Mr. / Mrs./ Ms._____________________________________________
______________rela ng to CIF number ________________ under service request no_______________ dated _________________________

For Charges and Fees, please refer our schedule of charges (SOC). Terms and conditions apply.