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Customer Request Form - Axis Bank

This document is a customer request form for Axis Bank. It allows customers to request various services including: updating contact information like mobile number, email, and address; requesting new account services like alerts, internet banking, debit cards; changing account details like PAN, Aadhar numbers; and miscellaneous requests like new cheque books, stop payments, signature verification. The customer fills out the applicable fields, provides necessary documents for verification, and signs to agree to the bank's terms and conditions for services.

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Dhinakaran
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8K views2 pages

Customer Request Form - Axis Bank

This document is a customer request form for Axis Bank. It allows customers to request various services including: updating contact information like mobile number, email, and address; requesting new account services like alerts, internet banking, debit cards; changing account details like PAN, Aadhar numbers; and miscellaneous requests like new cheque books, stop payments, signature verification. The customer fills out the applicable fields, provides necessary documents for verification, and signs to agree to the bank's terms and conditions for services.

Uploaded by

Dhinakaran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BANK

CUSTOMER REQUEST FORM


Please strike off the fields which are not applicable
Ao"'t
For Branch Office Use Only (Encircle Requested SR/s)

The Branch Head


Axis Bank Ltd. Branch | 5ol lD: Date of Request:

Customer Name:

Customer ld: Account Number:

1. MoBILE NUMBER UPDATE/REGISTRATION :

Avail following Services - Transaction Alerts (Tick on the "Subscribe" Option Below), Get Balance & Last 3 txns through SMS,
financial txns on internet banking, Duplicate Debit Card/ Pin Request.
ALERTS: | | Subscribe | | Unsubscribe
(All alerts will be sent. Charges applicable @Rs S/month) (Only Mandatory Alerts will be sent. For e.g. All card based &
Internet Banking transa(
2. LANDLINE NUMBER UPDATE (Res):

LANDLINE NUMBER UPDATE (Off):


3. EMAIL ID (FOR E-STATEMENT REGISTRAT1ON): ln case E-Statements are activated, physical statements will be disabled

4. PERMANENT ACCOUNT NUMBER (PAN) DETAILS:

5. AADHAR NUMBER :

6. CHANGE OF MAILING ADDRESS (ln case of joint holders, each holder needs to fill a separate form)

Landm'arkr: STATE* :

City*: Pin Coder:

DOCUMENT FOR PROOF OF ADDRESS (Mandatory for change in Mailing Address):

DOCUMENT IDENTIFICATION NUMBER:

ISSUING AUTHORITY: PLACE OF ISSUE:

ISSUE DATE VALID TILL

7. NEW CHEQUE BOOK REQUEST: Number of Cheque Book/s Required:

8. ACCOUNT ACTIVATION: PLEASE REACTIVATE MY ACCOUNT NUMBER

REASON FOR NOT OPERATING THE ACCOUNT:

9. OTHERS

I have read, understood and agree tothe terms and conditionsto various products and seruices including SMS Banking, E-Statement and lnternet Banking. I accept and agree

to be bounded bythe Terms and Conditions as displayed on ww.axisbank.coBl agreethat the bank may debit service charges plustaxesto my account wherever applicable.

DATE: PLACE:' CUSTOMER SIGNATURE:

FOR BRANCH OFFICE USE ONLY


Certi{ied that this Request Letter is complete in all respect & all relevant documents are obtained & verifieil mode of operation and signatures ofthe Vc. lhe
request may please be processed.

| | BANK TNDUCED REg


REQUEST RECEIVED DATE: FORWARDEDTO CLH DATE:

REQUEST ACCEPTED BY: EMPLOYEE NUIVIBER: <,IGNATURE:

Request Certified By Signature


r.aaaaarlartrrrr-llaaaar.aartrrrrtrr.artaaaaarattr....raaaaaaDrttttr]ar.alrratDt
Designation: f] ot E tt ,.rro,l-T-l-T-l*l
ACKNOWLEDGEMENT TO CUSTOMER
Customer Name:
Date of Request Received:
Name of Branch Official:
- Sigiature:
AXIS BANK
CUSTOMER REqUEST FORM
Please strike off the fields which are not applicable

10. DUPTICATESTATEMENT
Statement Required From Date: To Date;

11. DEBIT CARD

I oelcrrveloN oF DEBtr cARD NUMBER:

! RelcrrvnroN oF CARD NUMBER: o


r=
f] rssuE DEBrr cARD DUPLIcATE PtN z u.
VG

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12. STOP PAYMENTREQUEST uo
Number of Cheques:
EU
Payees Name: Or
aO
6u
Cheque Number(s): tr

Date of Cheque: Reason for Stop Payment:

Amount:

13. REVERSATOFCHARGES

Date of Debit: Amount of Debit: Rs

I undertake to keep henceforth an Average Monthly / Quarterly / Half Yearly Balance of Rs. (ln case of Average Balance
Non-Maintenance Charges only):

14. [ ssuANcEoF PAssBooK

rs. I srGNAruRE vERrFrcATroN

16. ANY OTHER (Please Specify)

I have read, understood and agree to fhe terms and conditions to various products and services. I accept and agree to be
bounded by the Terms and Conditions as displayed on www.axisbank.com. I agree that the bank may debit service charges plus
taxes to my account wherever applicable.

DATE: PIACE: CUSTOMER SIGNATURE:

FOR BRANCH OFFICE USE ONTY


Certified that this Request Letter is complete in all respect & all relevant documents are obtained & verified mode of operation and
signatures of the A/c. The request may please be processed.

I I BANK TNDUCED REQUEST


REQUEST RECEIVED DATE: FORWARDED TO CLH DATE:

REQUEST ACCEPTED BY: EMPLOYEE NUMBER:

Request Certified By Signature Desisnarion:[] o, r,, ,.r*o,lTI-TTl


ACKNOWTEDGEMENT TO CUSTOMER
Customer Name:

Date of Request Received:


Name of Branch Official:
Signature:

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