CUSTOMER SERVICE REQUEST FORM
To, SERVICE HARGES
The Branch Manager, Duplicale ATM Card + S.Tax
TE BANK INDIA REPIN
S.Tax
Dupllcate Pass Book S.Tax
Photograph Attestation STax
Signature Verfication S.Tax
Stop Payment-PSEG +S.Tax
Stop Payment-SMS Seg + S.Tax
Date
Slalement of Account + S.Tax
Name Reissue- Intemet kit +S.Tax
Account No:
Phone No. Mobile No.:
PLEASE TICK THE APPOPRIATE BOX
ACCOUNT CLOSURE/TRANSFER REQUEST (Please debit the charges if any to my Alc.)
1
DPlease close my Ac. .and Transfer the balance to
Alc. No. Jpay by Cash
.Branch
OTransfer the account to your
My New AddresS.
DUnused Cheque leaves Cheque No to Surrendered
DSurrendered Debit Card No.
2
CHANGE OF MAILING ADDRESS / NEW ADDRESS: (Please enclosed Proof of New Address)
Pin Code.
City
Tel. No. ..Mobile. .E-mail ID.
3. CHEQUE BOOK REQUEST
D
Not received for New Alc.
Cheque Book Requisition slip lost. Please issue New Cheque Book.
4. INCORRECT DATA IN PASS BOOK
(The correct dala as per Alc. opening form is as under.)
O
Name wrongly splet to appear as.
OWrong address Joint Aplicant's Name not included
5. STATEMENT (Please debit charges if any to my Alc)
to ..Statement not received Us
O Statement required from date.
o .Statement send to my Email ID
OStatement required from dale
IssUE OF DUPLICATE PASS BOOK (LATEST PHOTOGRAPH REQUIRED)
DMisplaced DContinuatíon Pass Book
JLost
7
DUPDATE KYC /UPDATE PAN CARD
8.UP DATE
Mobile NumberEmail.ID
9.STOP PAYMENT REQUEST
D
Cheque No.. No. of Leaves.
ODrawee Bank. Payee's Name.
10.. SMS ALERTS
Please give SMS Alerts to my Mobile No.
11. NTERNET BANKING
DTransaction Rights DUser ID not enabled OForgot passwords Reset my Profle Password
12 ATM / DEBIT CARD (Please debit the charges if any. to my alc)
(Please fill up debil card request form for duplicate debit card)
Debit Card not received Hot Lisiting No.
U Debit Card Lost / Misplaced ATM Card Damaged, kindly re-issue the same
UPleasee block (hot) the card an re
issue the same
13. L ATM CARD N O . U
n Pin Number not Received JForgot the Pin Number, Please issue New Pin Number
14. USIGNATURE VERIFICATION/ PHOTo GRAPHATTESTATION CHARGES
DPlease debit lo my Alc.
15. DD / BC
CANCELLATION:
DD/BC No
Date. Amount Rs
FVG
16. TDS PAN No. rs****
DForm 15H/ 15 G SubmittedD
17.
Please refund TDS Recovered
PLEASE CONVERT MY A/c No.
.in to joint Alc
by Adding the Name of Smt. / sri.
Mode of operation.
18, LMOBILE BANKING.
19. U OTHER (Please mention
here)
20. PLEASE ALLOT me a locker, l am maitaining a SBI CAc No..
..with your Branch
21. My "AADHAR Card No. .my please be entered in my CIF details
*Signature of Customer FOR OFFICE USE ONLY
(Name) Collected Rs
Address:
Phone No 'Specimen Signature
Venfied CASHIER / PASSING OFFICER
Date:.
STATE BANK OF INDIA Acoount No
Commission Alc.
CREDIT.
RUPEES.
Alc NO
Purpose.
Rs
Signature of Remitter BRANCH MANGER
