Annexure-A Combined request for dormant account activation
and updation of Re-KYC (Resident Individual A/cs)
PART A Dormant Account activation:
Date : D D / M M / Y Y Y Y Account Number:
Dear Sir / Madam,
I / We, holders of above-mentioned Account with your Bank, request you to activate my / our Account, which is in
Dormant status. The Reason for no operations in the account: ___________________________________________________
I/We enclose herewith Self-attested copy of Officially Valid Identity proof document for all the account holders AND
(Select anyone option) :
Transaction request (Cash Deposit / Cash Withdrawal / Funds Transfer / RTGS / NEFT) to be executed from my / our
account for activation.
Consent to Debit & credit my / our account for Re. 1/- for account activation.
I/We further confirm that (Select anyone option):
Address & KYC information in bank records are correct & hence no need of any change / update KYC information.
For Re-KYC, I / We shall provide information as per bank policy in future.
Or
Address / KYC information need to be updated & hence have provided additional documents as per Section B
(RE-KYC information) & request bank to update information as per Section B.
I/ We understand that a financial transaction is mandatory to maintain the active status of the account. In case I / We fail
to carry out any financial transaction on the date of account activation, Bank will change the status of my / our account to
Dormant, restricting transactions and channel access.
Customer Signature: _____________________________ _____________________________
(Customer Name) (Customer Name)
PART B Re-KYC (updation of KYC information):
Details for Account Holder-1
Section A Personal:
CRN: Latest photograph
(Optional)
Customer Name: F I R S T N A M E M I D D L E N A M E S U R N A M E
Section B Occupation & Income:
Occupation Salaried Self Employed Student Housewife Politician
Others please specify ______________________
Annual income (Rs.) Name of organization & designation (if salaried) Nature of business activity (if self- employed)
Section C Address & contact details:
There is no change in my contact details / mailing address. Attached herewith are the KYC documents for the
purpose of Re-KYC updation.
I wish to change my mailing address / contact details in the bank records. Attached herewith are the KYC
documents matching with the new details for the purpose of Re-KYC.
Section D To be filled ONLY IF THERE IS A CHANGE in the mailing address or contact details:
Please update the following information in your records. I have provided identity / address proof for the same.
For updating New Address (provide Address Proof Document)
Address:
City: Pin-code:
State: Country:
KMBL/Oct-2022/V 1.05
For updating New Mobile Number / Email id (provide Identity Proof Document)
Mobile No.: I S D –
Email ID
Details for Account Holder-2
Section A Personal:
CRN: Latest photograph
(Optional)
Customer Name: F I R S T N A M E M I D D L E N A M E S U R N A M E
Section B Occupation & Income:
Occupation Salaried Self Employed Student Housewife Politician
Others please specify ___________________
Annual income (Rs.) Name of organization & designation (if salaried) Nature of business activity (if self- employed)
Section C Address & contact details:
There is no change in my contact details/mailing address. Attached herewith are the KYC documents for the purpose
of Re-KYC updation.
I wish to change my mailing address/contact details in the bank records. Attached herewith are the KYC documents
matching with the new details for the purpose of Re-KYC.
Section D To be filled ONLY IF THERE IS A CHANGE in the mailing address or contact details:
Please update the following information in your records. I have provided identity / address proof for the same.
For updating New Address (provide Address Proof Document)
Address:
City: Pin-code:
State: Country:
For updating New Mobile Number / Email id (provide Identity Proof Document)
Mobile No.: I S D -
Email ID
I / We, do hereby solemnly declare, that the information provided above with respect to my / our account is true, correct
and complete and the said details may be updated in the Bank records.
Signature of the First Holder Signature of the Second Holder
Name: Name:
*Note: In case of more than 2 holders, please attach additional form.
KMBL/Oct-2022/V 1.05
Customer Acknowledgement Copy: (Applicable if submitted at the branch)
Service Request No: Acknowledgement date: D D / M M / Y Y Y Y
Signature of the Bank Official:
KMBL/Oct-2022/V 1.05
