fu-o-n il@ jfr, cunu.
a Bank
CUSTOMER REQUEST LETTER
IFor Savings & Current A/c - (Proprietorship) customers onty]
From : To:
The Branch Manager,
Branch
Dear Sir/Madam,
l/we request you to provide me the service/s as ticked in the box betow. You can debit charges as appticabte to my account.
MvA/c No. Customer lD:
Phone / lobite No. _ E-mait lD :
Kindty update my Permanent Account Number in your records : PAN (enctose proof of PAN)
Please tick M in the appropriate box :
I. E CHEQUE STOP PAYIAENT REQUEST:
a.El/wehaVeto5tthechequebookcontaining[eavesfrom- to Ptease stop
payment for the same and issue new cheque book.
b. E l/we have'issued a cheque no dated for {
favoring , Ptease stop the cheque payment.
2.tr CHEQUE BOOK REqUEST -
a. fl l/we have not received cheque book for my / our new account. Ptease issue the cheque book.
b. E l/we have not received Personatized Cheque Book.
b. E l/we have tost the cheque book requistion stip. Ptease issued a cheque book.
3.tr OEPOSIT OF CASH / CLEARING CHEQUE - -
/ OUTSTATION CHEQUE / TRANSFER OF FUNDS
a. T.1 l/We have remitted cash amountins to t at branch for credit of
A/c No. Amount not ciedited/short credited. Please verify.
b. fl l/We have deposited the Cheque No Amount { Date of Deposit
- Drawee Bank and Branch
- Credit not received in my/our account. Ptease verify and credit.
- Returned cheque not received: Please verify and return the cheque.
c.E An amount of t remitted on
-
(date) through RTGS/
NEFT not credited to beneficiary's account. Ptease verify.
d. E An amount of t remitted on (date) through RTGS/ NEFT
by bank/branch for credit of my/our a/c no.
. not credited. Ptease verify and credit.
e. E Detaits of transaction required -
Debit : Date Amount <- Payee/Ch
Credit : Date Amoiint t (Cash/transfer entry)
f. fl Charges - Amount t Date Wrongty debited. Ptease verify.
9. ! Fottowing Transaction through lnternet Banking not effected :
:
Nature of Transaction Date Amount t-
Beneficiarv Name A/c No.
4. E PASSBOOK / PASS SHEET:
a. EI Passbook - l/we have not received Passbook for my new account. Ptease issue pass book.
b. E Duplicate passbook - l/we have tost the Passbook. Ptease issue a duplicate passbook with entries
from to
c. El Pass Sheet - l/we have not received Pass Sheet for my/our,account. Please issue Pass Sheet
from to
d. E Dupticate Pess Sheet - Pteasa issue Dupticate Pass Shdet from to
e. E PteaIe register my e-mail address and send the pass sheet - Periodicity -;Uonthty / Bi-monthly / quarterty /
Hatf-yearty / annuatty.
t
F E ^X[::t fr"1l1tnt"'.0",".-, information (Residence/office) in. your records. I / we am / are enctosing proof of
my/our new address. My/our new address is-City
PIN TelNo. A{obite No. Emait lD-
b. T-l Chanqe of address intimated on (datei not yet effected r'n the system.
-
4
6. E DEBTT CARD / CREDTT CARD
(Strikd our which is not applicable)
b.trtr
a. I have filted up the form but not receiyed
the Card. please check and issue the
Lost card . ,yly Debit / Credit Card card
is lost. The 16 d igit Debit/Card No.
PI ease Hot List the card. (ptease is
fitl up separate appt ication form for obtaining
c. E
Card expired. New Card not received n ew card.)
d. E
ATM . Cash not dispensed / partly
dispensed - ATM tD
Amount t .
Transaction Date :
(Ptease attach Transaction stip)
7. tr
INTERNET BANKING / MOBIL. BANKING
/ TELE BAN KING (Strike out which is not appticabte)
a. El
I have fiu.ed up the form but not yet received
the User lD for tnternet Ba nking/Mobite
Ptease issue. Banking/Tetebanking
b. ,tly UserE profite is Btocked. ptease untock.
c. E I have forgotten my user lD and-Password
for lnternet Banking
8.tr FrxED DEpostr / KA ,TADHENU
DEpostr / Rr.r..,rd-,iirii"i,"=
,/ ,Mobite Banking / Tete Banking. please issue
a. It1nt llTb"t date of Deposrts :
b. the Deposit wrongty mentioned. Correct
c. E
Lr ]::ure-gf
Kare of rnterest
Tenure
not correctty applied. / preferentiat
:
months/years.
,."ti notli*rr......--
d. E Periodicat FD interest not credited ,o ...orn, ) pJV
e. fl Nomination not registered / not cancetted , ,.ri",i""-.,
"r0".'r"i'."*.*.
e.tr TAX DEDUCTED AT SOURCE : Lq,i"steo not effected.
a. E TDs Certificate Request for the Fy
b. trr nterest Certificate reguest for the Fy
c. E TDS Certi ficate not received for the Fy
d. tl Form 15 H / 15G submitted at branch
on but tax deducted.
ff_ i,tismatch in Tax deducted t , ."ritt"a.JGi!l ii,.
10.tr PENSIONERS' GRIEVANCES : "na
El pension not credited ff Life Certificate not updated
E Commutation not restored
- E Pension / DA arrears not paid.
11. E STANDTNG |NSTRUCfloNS fl PPO Copy not received
E Famity pension not reteased.
Fottowing standing instructions not
executed
lnstructions date:
From :
A/c No.
Amount t Periodicity
of
To :A/c No.
ol
12. E ACCOUNT l^oDtFtcATtoN :
a.
b. : No:
c. submitted on
d. made.
e.
f.
ntioned in the A/c opening form.
13.tr
Date :
SIGNATURE OF THE CUSTOMER/S
For Branch Use : Please affix date & time seal here.
We confi rm that att the requests
of the
customer/s are addressed_ Verified
Signature of the attending Officer
,/ l an ager Signature of Branch-in-charge / Sr llan ager / ,{anager
cut here
We acknowtedge having received
custor", ,"or"r, ,L.I)'?#EDGEMENT
(fullname)A/c
requesting for point no.
Sl No.
Please affix date seal Mth $me Signature of the Officer.
