form-d-plus-loan-customer-request-form-june22

Form D+ : Loan Customer Request Form
(For RBL Bank use only)
Service Request No. ____________________________ Date of Request :
Note: Please Use Block Letters And Attach Self-Attested Document Proofs As Per Bank Kyc Policy. Tick () & Sign As Applicable.
Borrower Name :
Registered Mobile No.: Customer ID.:
Co-Borrower Name :
Registered Mobile No.: Customer ID.:
*Loan Account No: Field Mark (*) is mandatory
Service Request Type

Statement of Account Repayment Schedule Balance Confirmation Modification in Interest Rate
(Period from ___________ to ____________)
List of Documents (LOD) Rate Change Letter Loan Agreement Copy Copy of Property Documents
Inquiry for Full Prepayment (statement/payoff)* Original Property Papers (applicable Insurance Policy Related
*Reason for Loan Closure ________________________________________________ for closed Secured Loan accounts)
Welcome letter Interest certificate For Financial year ____________________ Loan closed - NOC Related
(Provisional/Final)
UDYAM Number Updation: _____________________ Refund of Excess EMI Other refunds* (please specify) GST Updation
(Please mandatorily submit copy of UDYAM certificate) collected (* Mandatory provide GST registration
_______________________ Certficate)
Refunds (if any) Bank ________________________________________________________________ Branch: _______________________________________

A/c No: IFSC Code: Note: Please attach copy of cancelled cheque
Photo and Signature updation Other request if any (please specify) ______________________________________________
(For Financial Inclusion customers only)
Part Payment Request (as applicable for the product)

I/We wish to make a part payment to reduce my principal outstanding in my loan records, please accept my payment and proceed with rescheduling my loan by
Reducing EMI & Tenor to be kept Constant Reducing Tenor and EMI to be kept constant
Mode of Payment (tick whichever applicable)
Cheque No :___________________ Bank Name : ___________________________________ Amount : ___________________ Date : _________________
RTGS / NEFT / IMPS : Amount : ___________________ Transaction Reference no :_________________________ Transaction Date : ________________
Cash : Rs._______________________ (Denomination : Rs.2000 * ____ , Rs.500 * ____ , Rs.200 * ____ , Rs.100 * ____ , Rs.50 * ____ , Rs.10 * ____)
PAN Number :
Note: Acceptance of request for change in terms/re-scheduling of loan is at the sole discretion of RBL Bank and subject to necessary payments made to RBL Bank
towards part payment charges(wherever applicable). The current EMI will continue until the revised repayment terms are effected in RBL Bank’s records. The revised
terms will reflect within 15 working days from the date of receipt of the request form by RBL Bank (Part Payment charges as applicable will be deducted (please visit
RBL Bank’s website for details of service charge & fees).
Change Of Repayment Mode

I/We wish to change the instructions for EMIs payment from my existing mode of repayment to the revised mode as detailed below:
Revised repayment Mode : Post Dated Cheques * Standing Instruction for RBL Bank A/c NACH
Change in Bank A/c ( from ______________________________________ to ________________________________________)
Change in Bank Name (from ___________________________________________________ to ________________________________________________)
*Incase of PDC /SPDC please fill the below details
No. Of Post dated Cheques Bank Name Cheque Number Amount
No. Of Security Cheques Bank Name & City From To
Cheque Dates Bank Account No
EMI amount Acct Type
Swap charges Rs ______________/-paid vide Cash Cheque No. _______________ Drawn on Bank _______________________ Dated _____________
Note: Bank will take ___________ days for activating revised instructions. In case the next installment falls due prior to the said date, the repayment already
lodged with us will be presented for payment.
Customer Copy of Acknowledgment

Date of Request: _____________________________ Service Request Number : _____________________________________________
Loan Account Number : ____________________________________

Type of Service request _____________________________________ Name of the Borrower/ Co-Borrower: _____________________________________
Name of the Branch Official : _______________________________ Signature of Branch Official and Branch Stamp : ________________________ 
Customer Service (24 X 7) : +91 22 61156300 Email us at : customercare@rblbank.com Webiste : www.rblbank.com
Full Pre-Payment
* Details of Payment (applicable for Full Pre-payment/refund related requests)
1. Cheque No :___________________ Bank Name : _____________________________________ Amount : ___________________ Date : ________________
2. Cheque No :___________________ Bank Name : _____________________________________ Amount : ___________________ Date : ________________
* Note: For full pre-payment, RBL Bank will only accept payment by Cheques /DD issued from the Borrower or Co borrower(s) RBL Bank account or payment instruments
of other banks and reserves the right to reject instruments issued by third parties (other than borrower/co-borrower). RBL Bank reserves the right to revise /reject
the amount payable if at any time RBL Bank is of the view that sources and documents submitted is/are incorrect and /or inadequate. RBL Bank shall act upon the
instructions subject to internal approvals and execution of necessary documentation by the borrower/co-borrower.
Customer Confirmation
I/We have voluntarily submitted the ID proofs to RBL Bank for the purpose of fulfilling the above request and infomation given by me in this form are true,
accurate, complete, and upto date in all respects and I have not with-held any infomation. I/ We also authorise Bank’s representative to contact us to seek
further clarity on the service request. (service request do not require DND signoff).
Customer Signature :_________________________________________ 

Name of the Signatory :___________________________________________________________________________ (Individual/Proprietor /Partner/ Director)
(For Office Use Only)

I hereby certify that the customer/Authorised signatory/Bearer has signed in my presence and the copy of KYC Proof has been verfied from the original
KYC Document.
Type of ID proof ______________________________________ ID No. _________________________________________
Customer Request received by (Branch Official Name and Emp Code) _______________________________________________________________________
Branch Official Signature ___________________________________________ 

Date of Receipt __________________________
Customer Service (24 X 7) : +91 22 61156300 Email us at : customercare@rblbank.com Webiste : www.rblbank.com

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Form D+ : Loan Customer Request Form

(For RBL Bank use only)

Service Request No. ____________________________ Date of Request :

Service Request Type

Refunds (if any) Bank __________________________ Branch: _

Part Payment Request (as applicable for the product)

Change Of Repayment Mode

Customer Copy of Acknowledgment

Customer Signature :_________________________________________ 

(For Office Use Only)

Branch Official Signature ___________________________________________ 

Customer Service (24 X 7) : +91 22 61156300 Email us at : customercare@rblbank.com Webiste : www.rblbank.com

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