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Annexure 2 Account Modification Request Form

Form Bank Example

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267 views3 pages

Annexure 2 Account Modification Request Form

Form Bank Example

Uploaded by

meampcnopma
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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ACCOUNT MODIFICATION REQUEST FORM

Application Date: _________________


Service Req No: _________________
Branch Code: _________________
CUSTOMER ACCOUNT TYPE:

Re Resident Individual Non Individual Non Resident

PERSONAL DETAILS
NAME (as pre Banking Records) ___________________________________________

Customer ID: _______________________; Account Number: ___________________________________

CHANGE OF ADDRESS/ CONTACT DETAILS:


(Kindly provide proof of the new mailing address along with this form. If address needs to change mention new
address alone / if contact details and email id need to change mention contact details alone/ if both mention both
address and contact details for modification)

MAILING ADDRESS: _____________________________________________________________________

_____________________________________________________________________________________
(If permanent address is same as the mailing, address need not mention again) Same as Above

PERMANENT ADDRESS: _________________________________________________________________

_____________________________________________________________________________________

Mobile Number: _________________________________


Tel phone Number: STD _____________________
Email ID: ___________________________________________________________

Signature of Customer

INSTA ALERT REGISTRATION:


I wish to apply for Insta alerts through
MOBILE NUMBER: _____________________________
E-Mail ID: ____________________________________

INSTA ALERT DE-REGISTRATION:

Kindly De- Activate Insta alert registration linked to my Account number: ______________________.
PRINT NOMINEE NAME* Yes No
*Depending upon the option selected here, nominee name will get printed / not printed on statements, passbooks, etc.

NAME CHANGE REQUEST:

Change of Name Reason for name change: __________________________________

Present Name: _____________________________________________

New Name: _____________________________________________

PAN NUMBER UPDATION: (Attach pan card copy with self-attestation)


I wish to update my PAN number in my Account Number: ________________________________

PAN Number: _______________________.

MODE OF OPERATION CHANGE:

Kindly change the mode of operation in my account number: _____________________;


________________________; ____________________ as

Single Either/Survivor Jointly Anyone / survivor

UPDATE CORRECT DATE OF BIRTH:

Request to change Date of Birth (provide a valid age proof) _____________________ (dd/mm/yyyy).

DECALRATION:
I agree that the Bank may debit my account for service charges as applicable from time to time.
(for Insta alert charges). I confirm that all details provided on the form are correct.

Signature of the Account Holder Signature of the Account Holder

IMPORTANT NOTES :

1. For Individual - at Account level changes, all the account holders need to sign whereas at Cust ID level changes,
respective Cust ID holder has to sign for Non-Individual, signatures as per MOP required.
2.Change requested above would be effected in the Bank’s within a period of 4 to 5 working days from the date of
receipt at the branch and the said changes would be effective in the system from that date only.

3.To be accompanied by a copy of the gazette notification along with updated PAN Card. If the change of name is on
account of marriage, an attested copy of the marriage certificate along with updated PAN Card must be submitted
(Applicable for CASA accounts only).

4.For change in address, please provide proof (self-attested) of the new address by submitting a copy of Passport /
Driving License / Election Card / Aadhaar Card.

5. For updating PAN Number, kindly provide a self-attested copy of PAN Card and produce the original for
verification.
6. For change in Mobile / E-mail Id, please provide an ID proof.
7.For Date of Birth change, please provide valid DOB proof like, PAN CARD/ ELECTION CARD/AADHAAR
CARD/DRIVING LICENSE.
8.In case, where operating instruction have been changed from singly or Either or Survivor to joint operation, the
ATM/ Debit cards would be hot listed/ discontinued automatically. Only view access will be provided in Net banking
for joint MOP

FOR BANK USE:

Sourcing Branch name & code: ____________________


Account level verification done by:
_______________________ (Name)
_______________________ (Signature)
_______________________ (Emp ID)
_______________________ (Date)
Approved by Sign:
_______________________________
Name of the Approver: ________________________

…………………………………………………………………………………………………………………………………………………………………………………..
Customer Acknowledgement:
We acknowledge the receipt of Customer Modification instruction from Mr. /Mrs. / Ms. ______________ relating
to Account number/ Cust ID: _______________________________ under service request number:
___________________.

Date: _________________

Bank Official (Sign and stamp)


For Equitas Small Finance Bank LTD.

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