Branch:_________________________
Date: _____________
1st Applicant's Name*: _______________________________________________________________________
2nd Applicant's Name*: _______________________________________________________________________
Account number: _________________________________ Mobile Number: _____________________________
(Fields marked* are mandatory)
*Kindly fill only those boxes where information is to be added or updated. On submission of form always ask for
acknowledgement* (Kindly tick the boxes against the request opted for)
ADD/UPDATE PERSONAL DETAILS
1. Update KYC ID Type: PAN Aadhar Driving License Passport Voter ID NREGA Card
Document number__________________(Attach self-attested copy of document for verification with original)
Place of Issue____________________________ Issue Date________________ Valid till date: ___________
2. Address Change: Permanent Correspondence Both (Please leave space between two
words/digits)
Address line 1: ___________________________ Address line 1: _______________________________________
Address Line 2____________________________ Address Line 2_______________________________________
Address Line 3: ___________________________ Address Line 3: ______________________________________
Document Type: PAN Aadhar Driving License Passport Voter ID NREGA Card
(Mandatory for Permanent Address Change)
3. Add Father/Mother/Spouse name: ______________________________(strike out whichever is not applicable)
4. Please seed/update my Aadhar Number in the account number mentioned above for DBT purpose: ___
5. Please delete my Aadhar Data from the account Number mentioned above, my Aadhar [Link] _____
6. PAN: ____________________________________________________________
7. Email ID: _________________________________________________________
8. Change my Title to: _________________________________________________
9. Change my Name to: ________________________________________________
(Relevant document e.g. Govt. Gazette Notification / Marriage Certificate to be attached)
10. Change mobile number to: __________________________________________
OTHER ACCOUNT/CIF MODIFICATIONS
11. Transfer Account CIF Both To Branch Name_______________________ Branch Code:__________
12. Change mode of operation in above mentioned account to:
Self Either or Survivor Former or Survivor Jointly As per mandate enclosed
13. Request to activate my inoperative/Dormant account (number mentioned above):
Reason for dormancy: ________________________________________________________________
[Link] my account from Minor to Major as I became Major on ___________________________
15. Change A/c Type to: Salary Package Variant: Corporate/Defence/Others Savings Bank to NRO
Savings Bank
Current Account Variant: Regular/Gold/Diamond/Platinum
16. Change my signature in above mentioned account:
OLD SIGNATURE NEW SIGNATURE
From To
17. I/we request to close above account and pay the balance by: Cash/ Credit to account no.___
FIXED DEPOSIT/PPF ACCOUNT RELATED SERVICES
18. Please change the tenure of my/our Fixed deposit A/C No.___________________ to
19. Reissue Term Deposit advice for A/C number: __________________________________________________
20. Please issue TDS/Interest certificate for Account Number/s: _______________________________________
OTHER ACCOUNT RELATED SERVICES
21. Passbook required: Yes/No [If No, Request for statement of account through e-mail id.
22. Request to Issue Duplicate Passbook for the Account Number:________
23. Request to activate Phone Banking/Mobile Banking services in the above-mentioned account.
24. Standing Instruction: Please transfer Rs. to RD/Loan/SB Account Number: _______________
Starting from date _______________Every alternate Daily/Monthly/End of Month
25. Setup Auto-sweep facility - Saving Plus Threshold amount: Rs.
Sweep time: Weekly/Monthly
Under reverse sweep facility the MOD (Multi-option deposit) to be broken by: Last in First Out/First in Last out
NOMINATION
26. Nomination to be modified in my account mentioned above: New/Change/Delete
(Please fill and attach DA-1 form for new nomination, DA-2 form to delete nomination and DA-3 form to change
nomination)
27. Nomination to be modified: [Add/Modify] in the scheme APY/PMJJBY/PMSBY/PPF
APY RELATED SERVICES
[Link] to update the pension amount for APY from Rs _________ to 1000/2000/3000/4000/5000
I hereby authorize the bank to debit my above mentioned bank account till the age of 60 for making payment
under APY as applicable based on my age and the Pension Amounts elected by me.
CHEQUE RELATED SERVICES
[Link] book facility: Please provide cheque book facility in my account number mentioned above.
[Link] personalized cheque book request: Number of leaflets: 10/20/25/50/100
Name on cheque: ____________________________________________________________
Address to be delivered to: Permanent/Correspondence/New
Address line 1: ______________________________________________________________________
Address line 2: ______________________________________________________________________
Address line 3: ______________________________________________________________________
31. Request to stop (number of cheques) Cheque number listed below/attached
Starting from ______________ ending at ______________ or Cheque number: __________________
Cheque number: _______________ Cheque number: _______________
Cheque number: _______________ Cheque number: _______________
DEBIT CARD SERVICES
32. ATM card issuance (Charges will be deducted as applicable): New/Replace
Address to be delivered to: Permanent/Correspondence
Name on card: ____________________________________________________________________________
33. Block / Unblock debit card number: _____________________________________________________
INTERNET BANKING SERVICES
34. Activate Internet Banking in the above mentioned account.
Kit number (for official use only): _________________________________________________________
35. Request to: Reactivate the username/Re-issue login password/Reset the INB profile password
Date of Birth: ___________
Wish to receive the Pre-Printed Kit (PPK) at address mentioned in my account
36. Internet Banking rights modification : Full Transaction rights/Limited Transaction rights
37. Request to add beneficiary to INB : Reference Number: _______________________________________
Beneficiary name: ______________________________ Beneficiary account No : _____________________
Beneficiary Bank/Branch: ___________________IFS Code: __________________Limit (INR): Rs: _________
PENSION SERVICES
38. I wish to submit Life Certificate for PPO no: _________________________________________________
[Link] issue Pension Certificate/Slip for PPO no: _____________________ for the Month_______Year_____
[Link] issue Form 16 for PPO no: _________________________________________________________
[Link] Grievances (Pension not credited/Life Certificate not updated)
LOCKER SERVICES
[Link] for Allotment of Locker: (Size): Small/Medium/Large/Extra Large
43. Request to add Nomination to Locker number: ______________________________________________
(Duly filled in nomination form is to be attached)
[Link] for Locker Conversion from Single to Joint: Locker No. __________________________________
Name of Joint Holder: ________________________________________________________________________
Account no. of Joint Holder: ___________________________________________________________________
45. Request for closure (Surrender) of Locker No: ________________ Bearing Key No: __________________
46. Request for break open of Locker No: ______________________________________________________
I have read, understood and agree to the Terms and Conditions of various products and services including SMS
alerts, Debit card and Internet Banking. I accept and agree to be bounded by the Terms and Conditions as
displayed on [Link]. I agree that the bank may debit service charges plus taxes to my account whenever
applicable. I wish to seed this account with NPCI mapper to enable me to receive Direct Benefit Transfer (DBT)
including LPG Subsidy from Govt of India (GOI) in this account.
Kindly provide the number of Requests submitted (count and enter number of ticks in the checkboxes)*:
First account holder's Second account holder's Signature of Branch
signature signature Official with SS No.
____ _____ _______ _____ _______ _____ _______ _____ _______ _____ __
ACKNOWLEDGEMENT
Date of Request Received: ______________ Customer Name: ________________________________________
Employee Number: ________________Name of Branch Official: __________________Signature: ___________
Please note: Your request will be processed within 2 working days. Delivery of kits/cheque book etc. to your
address will take between 7-15 working days (depending on delivery location)
