+ Receipt Date: _/_/ Semere © S Bl 3 312 Account Nez 000000 73 Rll flatdr's Name: General Rules: “FOUN SHIP 1. Please tick the appropriate box (es), wherever applicable and give the new details inthe space provided. 2. Ifnew information for field (s) wherever (*) symbol is mentioned, pertains to the USA, then please fill Annexure compulsorily. However, ifthe information sought in Annexure has already been provided by you to the Bank, then please ignore the Annexure, Change of Postal Address® (Please provide relevant proof and it should be attested as per Attestation Requirements“) ‘Change address for ca om: [|] Current (Overseas) Address | _ ] Permanent (Overseas / Indian) Address Address Type: []Residential or Business {Residential [[]Business istered Office [] Unspecified No =O! NES M Al I ity (Town /Distriet__L-An Chi DURAN Stae_TAAUi ADU Country__Iny Di A PIN_ 60904 orient ol [A] [[euiange of Mobile Number» | + 91 9789825)74 {ot oegh Inca Baring eyo oo, Fer chase of ble minh. pase Change of Email Address Feonet overtone aca keer Change of Telephone Number* (tn 1SD~ STO Naber formes) Change of Passport / VISA / Work Permit Details* (Please enclose self-attested copy of relevant pages) Details to De changed for mom [—] Passport [_] VISA/ Work Permit Number Issue Date Place of Issue Nationality* Valid Up to (Wot required: IF VISAT Work Permit Details are tobe changed) Change of Recorded Signature (Old Signature * ‘New Specimen Signature "ifyou are not able to replicate your old signatures, then please submit copy of your Passpon. Your new specimen signatures should be the same ason the Passport. Passport copy needs to be attested as per attestation requirement ® © attestation Requirement: If proof is submited in person in the branch then no third party atestation is required but please cary’ original copy ofthe proof for eross-verification. In all other cases, proof should be duly attested by anyone of the following: 41, Sl Foreign Office (wherever itis permitted) 2. Indian Embassy / High Commission 3. Notary Public Declaration: I request bank to amend the information provided in my account as stated above and confirm that all the details provided herein by me are correct. Oh] 2014 @chennat ae) at Date Place Signature Customer Acknowledgement Copy (Toe returned tthe customer, submiting iin the perso Ale No: Alc Holder Name: ‘Type of request: Change of personal details Date of receipt: __/_/ ignature of authorised official