CUSTOMER REQUEST FORM
(Only for KYC Complied Accounts)
From
RAFEEQ PATHIYANAVALAPPIL ABDULKADER Account No:
Name:…………………………………………………………………. 1 6 4 5 2 2 0 0 0 0 0 2 3 5
To
PERUMPILAVU Cust ID:
The Manager, Br. ………………………………………………..
Dear Sir,
Kindly execute the following request/s which are selected below
CONTACT DETAILS MODIFICATION REQUESTS (Please tick whichever is applicable)
Mobile Number 00966590233681 E-mail ID [email protected]
Communication Address pathiyanavalappil house , karikkad post
City/District trissoor State kerala
Country india Pin 680519
GENERAL MODIFICATION REQUESTS (Please tick whichever is applicable)
1. Account Sol Change:
Kindly transfer my account to the Branch: _____________________________________________(Sol ID :__________)
Reason for transferring the account: __________________________________________________________________
DP account linked to transferee account Yes No (If Yes, kindly provide application form for change in bank details)
2. Cheque Book Request: Number of leaves required 10 X 20 50 X
Point of delivery X Branch Communication address
3. Account statement/Interest Certificate: Date From Date To
4. Issue duplicate passbook
5. Block / Hot Mark Debit card Number
6. Activation of SMS Alert/Email alert: X SMS Alert X Email Alert
X
I/We request you to enable SMS alert facility/Email alert facility in my/our account ______________________________
7. Change Account Scheme: Convert my account from to
8. Stop Payment: Cheque No. From______________ No. of Cheque(s): ______ Payee Name: _______________________
Cheque date: ____ /____ /_______ Reason: _____________________________________Amount:________________
9. Change of name (as per proof attached): _______________________________________________________________
Please use this EMAIL ID from now on "
[email protected]"
10. Any other request: _________________________________________________________________________________
X
_________________________________________________________________________________________________
Declaration:
I have read, understood the terms and conditions to various products and services. I accept and agree to be bounded by the Terms
and Conditions as displayed in your website. I agree that the Bank may debit service charges plus taxes to my account wherever
applicable. I hereby declare that the above details are correct. In case of Indian mobile number updation in Non-Resident Customer
IDs, I/ we understand that it is a temporary facility allowed for enabling banking transactions and receipt of alerts. I/ we am/are
solely responsible for updating an active overseas number in due course.
Total number of requests:
Date: 02/June/2025
Place: Saudi Arebia Signature of applicant Signature of joint holder(s)
FOR BRANCH USE ONLY
Certified that this request form is complete in all respects & all the relevant documents are obtained. Verified the Mode of
operation and signature(s) of the account. The request may be processed.
Entered by Verified by
SP No: SP No:
(If applicable)
C 917
