CUSTOMER REQUEST FORM Be2'5 BANK For Branch Office Use Only (Encircle Requested SR/s) | cz | sn Rana | ES | STeceT [ee | roe ® ‘The Bronch Head . ‘Axis Bonk ld. TANGA Branch | SOU Date of Request: |Z Caso: Nae: CLT Customer id: [3S ‘Account Nenber [311% To] Tol) To ‘Loan Account Number | The contact information provided wil be updosed incl te Retail Accounts) (The conte inlrmaton prev wb upaed l e aon Recs Crd Crd Number: (The contac ifometon pond” wi J 1. Nobile Number Updo & lors Raion cue Coury Cae ‘This subsribes tool clrs including Volue Added Ales. Chargeable «57 marth for Saving Accounts Unisscibe hm Value Added Alors (Only Manatory Als willbe sent. For eg. Aller hosed & Inter Barking ronson) Country Code STD Code Contact Number LANDLINE NUMBER UPDATE (Re LANDUNE NUMBER UPDATE (Of): E-MAILID [FOR E-STATEMENT REGISTRATION): In case E-Stotomenis ore activated, physiol sotoments PERMANENT ACCOUNT NUMBER [PAN) DETAILS: <2] Country of Residence 2) Tox Reference No. 6. CHANGE OF ADDRES 1 [_] communication @ [ Resder Otte 8) [_] Permanent (Peat leave space betven two word) naa of ont holdrs, each older needs fil separate Form) tora Se | oy TN Cole Coney? ator DOCUMENT FOR PROOF OF ADDRES (nde or Change in Mang Aden: DOCUMENT DENTFICATION NUMBER: ISSUING AUTHOR ACE OF SUE Issue ONE 1 wan: TolMeyTeT 7 NEW CHEGUE SOOK REQUEST Nonbrl Cinque Book amped) ——— COUNT ACTVATION: PEASE REACTWATE MY ACCOUNT NUMBER S[slSlol lol lolol [eaIsI REASON FOR NOT OPERATING THE ACCOUNT: STAYING ABROAD 3 purucaTesTaTENENT: Sener Eagar From Dote(OTOLMTMP YT VY Le] toooe-[> TOT MM VE VTVLY] wale reper plc Ta nod end verted and ag obs bow by He Tes pnd Conditions yoga produc pd services induding SMS Booking, E-Stepet 8 nna Boning, ning Terre tre Crs ed thong a ler thon sn Rag on He ICA, es pay vv nba clos el he Bark ay cor sos orgs Pat DATE: PLACE: CUSTOMER SIGNATURE: TOR BRANCH OFFICE USE ONLY ert hat is Ru a op inl pc & ert doar ore & eel node of person and pte oh AV. The end moyen Pre he Cbs pony nba he re ‘hve stad myel otteiSety fe Cuscry vr i / pr Oa Cord /KYC ect loi Slgnure nan recard Rowe don proper due lignes or ping fe record che Caster on his he eqs ol towbas bronch, BANK INDUCED REQUEST [REQUEST RECEIVED DATE: DTM[ey]y Forwarnep toa oat: [5 TOT mM yd REQUEST ACCEPTED BY: EMPLOYEE NUMBER: Signature: Roques cored by sgnoture Designation: []OH[]8H S.No. [ACKNOWLEDGEMENT TO CUSTOMER Customer Name Dose ofReques Racened: [DO] MM] eV] Y]¥ Request No. Employee Number rs Nome ofthe Branch Ofc Pleo Note: Yous recuse runes 1-1 hag beks / scent ayo oes ll __ Signature: ne et Zion ore od ere of apse 4 iz doo i bs procead within 2 working out end 15 18 etling Soy dpeched tug sped po dperdg on loco je Cconan 511 working yet Spe auCUSTOMER REQUEST FORM y Ras For Branch Office Use Only (Encircle Requested SR/s wo fu] 23] «fis | wii ie 10, DEBIT CARD DEACTIVATION OF DEBIT CARD NUMBER: REACTIVATION OF CARD NUMBER ISSUE DEBIT CARD DUPLICATE PIN Ti. STOP PAYMENT REGUEST Number of Cheques Payoos Nome: (Cheque Numbers: ieee cia ce Gergen ies hese nt Reason for Stop Payment: ge |: = A] 12, REVERSAL OF CHARGES 1 Bs |i Date of Debit Amount of Debit © Pa I undertoke to keep henceforth an Average Monthy / Querterly / Half Yeorly Balance of & (In case of Average Balance Non Maintenance Charges only) {also acknowledge that all ther applicable charges with regards ta my account have baen communicated to me and will abide bythe same. 13. [_] ISSUANCE OF pAssBOOK ‘V4. MOBILE NUMBER UPDATE & ALERTS REGISTRATION FOR JOINT HOLDERS: (cide Curry Code) \Wharver oie ruber fin occourt holder ore prove, hey wil ese One Time Pxeword {OT} ar ranocon cles on hese nub for rasan ted by emen Aly ern Boning and Melle Bnking cs aphsble Signature of Primary Helder Signore oF Jen Helder Signore oF 2 lint Haldar Signore of 3 Join Helder “Signature of al he holders is equred for updating of mobile rumber/s of joint holders 15, [__] SIGNATURE VERIFICATION 16, PRINT NOMINEE NAME Y N “Depending vpon the option selected here, nominee name will ge printed / not printed on stoements,possbooks, ek 17. ANY OTHER (Please Speciy) Thre read ond upd god ond opine be bpd by fe pe cod Condos aon prod apd waves nding SVS Doking, Ear & ern Baling, acing ergs 8 rca red sing pv chon dr gn lve ac, ody on ew anno ee ht he ak my dab ice herp ls owe: [2I@ [yD] ely PF] race PRETORIA, S:A. customer sicnarune,_“D Adorn TOR BRANCH OFFICE URE ONT erie ht his Rua! ater compee nl epet & all leant documents or casnad & vere mode of open and signer of the A/c The request may lease be fered ha Ce ates prc nid y te Cason Thongs pal ees ay fe Corry rg Yt St Crd / RVC Scone 8c Be orignal n Ban's rears | ave done proper ds dignc for updos he record oe Custom his/her equa nob branch BANK INDUCED REQUEST REQUEST RECEIVED DATE: C Y FORWARDED TO ClH DATE: PPT REQUEST ACCEPTED BY: EMPLOYEE NUMBER. Signature: Request cored by signotwe: Designation: [JOH []8H SS. No. ‘ACKNOWLEDGEMENT TO CUSTOMER Customer Nome: Dote of Request Received Roques No Employee Number Name of the Branch Offi: —_ —___Signatio ‘lease Note: Your request [equetruriers 1-14 wl be procested wihin 2 working days. Addition oft halen and change of ight will oke upto 45 working days. Ocvery of kis / hogan becls/ scaoents Oe e yor aches wl che rer 5-11 meng doy dace rough cue nd 15:18 working oye dpsed rough send pot pending o aon