NF 993/1L(50)/2013-06/Arjun
CUSTOMER REQUEST LETTER
[For Savings & Current A/c (Proprietorship) customers only]
From : To:
_____________________________________________ The Branch Manager
__________________________________________ _______________________________________
_____________________________________________ ________________________________BRANCH
Dear Sir/Madam,
I/We request you to provide me the service/s ticked in the box below. You can debit charges as applicable to my account.
My A/c No. ___________________________________________ Customer Id : ________________________________________
Phone / Mobile No. ____________________________________ E-mail Id. _____________________________________________
Kindly update my Permanent Account Number in your records : PAN (enclose proof of PAN)
Please tick in the appropriate box.
1. CHEQUE STOP PAYMENT REQUEST:
a. I/We have lost the cheque book containing leaves from__________________to______________ Please stop
payment of the same and issue new cheque book.
b. I/We have issued a cheque no.___________________dated _______________ for `________________________
favouring _____________________________________________________ . Please stop payment of the cheque.
2. CHEQUE BOOK REQUEST:
a. I/We have not received cheque book for my/our new account. Please issue cheque book.
b. I/We have not received Personalized Cheque Book.
c. I/We have lost the cheque book requisition slip. Please issue a cheque book.
3. DEPOSIT OF CASH /CLEARING CHEQUE / OUTSTATION CHEQUE / TRANSFER OF FUNDS
a. I/We have remitted cash amounting to `______________________ at ___________________ branch for credit of
A/c No. _____________________________. Amount not credited/short credited. Please verify.
b. I/We have deposited the Cheque No. ____________________ Amount `___________________Date of Deposit
___________________Drawee Bank and Branch ___________________________________________
- Credit not received in my/our account. Please verify and credit.
- Returned cheque not received. Please verify and return the cheque.
c. An amount of ` ________________________remitted on __________________________ (date) through RTGS/
NEFT not credited to beneficiary's account. Please verify.
d. An amount of ____________________________remitted on________________________(date) through RTGS/NEFT
by_____________________bank/branch for credit of my/our a/c.no.______________________________________
not credited. Please verify and credit.
e. Details of transaction required –
Debit: Date________________________Amount ` _________________________ Payee/Charges____________________
Credit: Date _______________________ Amount `___________________________(cash/transfer entry)
f. Charges – Amount ` ___________________ Date _____________________________Wrongly debited. Please verify.
g. Following Transaction through Internet Banking not effected:
Nature of Transaction:____________________________________ Date__________________Amount `_____________
Beneficiary Name _______________________________________ A/c No. _______________________________________
4. PASS BOOK/PASS SHEET:
a. Pass Book– I/We have not received Passbook for new account. Please issue pass book.
b. Duplicate Pass Book – I/We have lost the pass book. Please issue duplicate pass book with entries
from_______________________ to ________________________.
c. Pass Sheet - I/We have not received the pass sheet for my/our account. Please issue pass sheet
from________________________to _______________________.
d. Duplicate Pass Sheet – Please issue duplicate pass sheet from_________________to____________________.
e. Please register my e-mail address and send the pass sheet – Periodicity – Monthly / Bi-monthly / quarterly/
Half-yearly /annually.
5. CHANGE OF ADDRESS:
a. Please update the contact information (residence/office) in your records. I/We am/are enclosing proof of
my/our new address. My/Our new address is_____________________________________________City ____________
PIN_______________Tel No.________________Mobile No.__________________E-mail Id _________________________
b. Change of address intimated on _______________________(date) not yet effected in the system.
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6. DEBIT CARD / CREDIT CARD (strike out which is not applicable)
a. I have filled up the form but not received the Card. Please check and issue the Card.
b. Lost Card – My Debit/Credit Card is lost. The 16 digit Card No. is _________________________________.
Please Hot List the Card. (please fill up separate appln. form for obtaining new Card).
c. Card expired. New Card not received.
d. ATM – Cash not dispensed/partly dispensed - ATM ID ______________________Transaction Date: ______________
Amount `__________________.(Please attach Transaction Slip)
7. INTERNET BANKING/MOBILE BANKING/TELE BANKING(strike out which is not applicable)
a. I have filled up the form but not yet received the User ID for Internet Banking/Mobile Banking / Tele Banking. Please issue.
b. My User Profile is Blocked. Please unlock.
c. I have forgotten my User ID and Password for Internet Banking / Mobile Banking / Tele Banking. Please reissue.
8. FIXED DEPOSIT / KAMADHENU DEPOSIT / RECURRING DEPOSITS:
Account Number_________________________________date of Deposit: ____________________
a. Deposit Receipt not received.
b. Tenure of the Deposit wrongly mentioned. Correct Tenure: ________________months/years.
c. Rate of Interest not correctly applied. / Preferential rate not given.
d. Periodical FD interest not credited to account / pay order not received.
e. Nomination not registered / not cancelled / variation as requested not effected.
9. TAX DEDUCTED AT SOURCE:
a. TDS Certificate Request for the FY ___________________________________
b. Interest Certificate request for the FY _______________________________
c. TDS Certificate not received for the FY ______________________________
d. Form 15H/15G submitted at branch on _______________but tax deducted.
e. Mismatch in Tax deducted and Tax remitted. Please verify.
10. PENSIONERS' GRIEVANCES:
Pension not credited Life Certificate not updated Pension/DA arrears not paid
Commutation not restored PPO Copy not received Family pension not released
11. STANDING INSTRUCTIONS
Following standing instructions not executed:
Instructions date:_______________________Amount : ` _______________________ Periodicity : ____________________
From : A/c No.____________________________ of ______________________________
To : A/c No.____________________________of _______________________________
12. ACCOUNT MODIFICATION:
Account Number: _______________________________ Name : ________________________________________________
a) Documents submitted for KYC Compliance. KYC details not updated.
b) Date of Birth not updated though proof of Date of Birth submitted on________________.
c) Conversion of individual account into joint account not made.
d) Status of account not changed from Minor to Major.
e) Addition / Deletion of Joint Account holder not made.
f) Mode of Operation wrongly mentioned from the one mentioned in the a/c opening form.
g) Sweep-in/Sweep-out instructions not executed.
13. OTHERS (Please specify): _________________________________________________________________________________
______________________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Date:___________________
SIGNATURE OF THE CUSTOMER/S
For Branch Use: Please affix Date Seal with time here
We confirm that all the requests of the Verified
customer/s are addressed
Signature of the attending Officer/Manager Signature of Branch-in-charge/Sr Manager /manager
___________________________________________________ cut here ___________________________________________________
ACKNOWLEDGEMENT
We acknowledge having received customer request letter from ________________________________________________
___________(full name) A/c No. _________________________________________________requesting for point no._________
Sl.No. _______ Plese affix date seal with time Signature of the Officer
