Scribd
Upload
20K views2 pages

Axis Bank Customer Request Form

This customer request form allows a customer of Axis Bank to request changes or updates to their account information. The customer can request to update their mobile number, landline numbers, email address, mailing address, request a new cheque book, reactivate their account, or make requests regarding their debit card, stop payments, statement copies, signature verification and more. The form requires the customer's signature and provides spaces for the branch office to accept and process the request.

Uploaded by

Amit Tiwari
Copyright
© Attribution Non-Commercial (BY-NC)
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
20K views2 pages

Axis Bank Customer Request Form

This customer request form allows a customer of Axis Bank to request changes or updates to their account information. The customer can request to update their mobile number, landline numbers, email address, mailing address, request a new cheque book, reactivate their account, or make requests regarding their debit card, stop payments, statement copies, signature verification and more. The form requires the customer's signature and provides spaces for the branch office to accept and process the request.

Uploaded by

Amit Tiwari
Copyright
© Attribution Non-Commercial (BY-NC)
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
You are on page 1/ 2

CUSTOMER REQUEST FORM

Please strike o the elds which are not applicable For Branch Oce Use Only (Encircle Requested SR/s)

1
The Branch Head

4
D

7
Y Y Y

D M M Y

Axis Bank Ltd. _________________ Branch | Sol ID: __________________ Customer Name: Customer Id: Account Number:

Date of Request:

1. MOBILE NUMBER UPDATE(FOR SMS BANKING REGISTRATION):


Avail following Services - Transaction Alerts, Account Balance Requests, Cheque Book Requests, Secured Online Fund Transfers (if opted for Net Secure with SMS), Duplicate Debit Card/ Pin Request.

2. LANDLINE NUMBER UPDATE (Res):


LANDLINE NUMBER UPDATE (O):

3. EMAIL ID (FOR E-STATEMENT REGISTRATION): In case E-Statements are activated, physical statements will be disabled 4. Permanent Account Number (PAN) details:
5. CHANGE OF MAILING ADDRESS (In case of joint holders, each holder needs to ll a separate form)

NEW MAILING ADDRESS (Please leave space between two words)

Landmark*: City*:

STATE* :

Pin Code*:

DOCUMENT FOR PROOF OF ADDRESS (Mandatory for Change in Mailing Address):_________________________________________ DOCUMENT IDENTIFICATION NUMBER: ISSUING AUTHORITY: ________________________________________ 6. 7. PLACE OF ISSUE: ______________________________

NEW CHEQUE BOOK REQUEST: Number of Cheque Book/s Required: ________________ ACCOUNT ACTIVATION: PLEASE REACTIVATE MY ACCOUNT NUMBER REASON FOR NOT OPERATING THE ACCOUNT: _____________________________________________________________

I have read, understood and agree to the terms and conditions to various products and services including SMS Banking, EStatement and Internet Banking. 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:________________________ PLACE: _______________________ CUSTOMER SIGNATURE:____________________________ FOR BRANCH OFFICE USE ONLY
REQUEST RECEIVED DATE: FORWARDED TO CLH DATE: REQUEST ACCEPTED BY:_______________________________ EMPLOYEE NUMBER: _________________________________ SIGNATURE:_________________________________________ Certied that this Request Letter is complete in all respect & all relevant documents are obtained & veried mode of operation and signatures of the A/c. The request may please be processed. For AXIS BANK LTD. Signature: ___________________________________________ Designation: ___________________ S.S. No: _______________

ACKNOWLEDGEMENT TO CUSTOMER
Customer Name: Date of Request Received: Name of Branch Ocial: Employee Number of Branch Ocial: Request Option No.: Signature:

CUSTOMER REQUEST FORM


Please strike o the elds which are not applicable

8.

DUPLICATE STATEMENT Statement Required From Date: To Date:

9. DEBIT CARD DEACTIVATION OF DEBIT CARD NUMBER:


_________

REACTIVATION OF CARD NUMBER: ISSUE DEBIT CARD DUPLICATE PIN 10. STOP PAYMENT REQUEST Number of Cheques: Cheque Number(s): Date of Cheque: Amount: Reason for Stop Payment:

Payees Name:

11. REVERSAL OF CHARGES Date of Debit: Amount of Debit: Rs.

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

12.

ISSUANCE OF PASSBOOK

13.

SIGNATURE VERIFICATION

14. ANY OTHER (Please Specify) ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ I have read, understood and agree to the 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:________________________ PLACE: _______________________ CUSTOMER SIGNATURE:____________________________ FOR BRANCH OFFICE USE ONLY
REQUEST RECEIVED DATE: FORWARDED TO CLH DATE: REQUEST ACCEPTED BY:_______________________________ EMPLOYEE NUMBER: _________________________________ SIGNATURE:_________________________________________ Signature: ___________________________________________ Designation: ___________________ S.S No: ________________ Certied that this Request Letter is complete in all respect & all relevant documents are obtained & veried mode of operation and signatures of the A/c. The request may please be processed. For AXIS BANK LTD.

ACKNOWLEDGEMENT TO CUSTOMER
Customer Name: Date of Request Received: Name of Branch Ocial: Employee Number of Branch Ocial: Request Option No.: Signature:

FOR OFFICE USE ONLY:TIME OF REQUEST RECEIVED

You might also like