J, B3fif,n"Customer Request Form

Please stfike offthe tieldswhich are notappticabte

ly'i/e (Gatome/s Name)

CFID

reqoest you lo process the reques(s) select€d b€lor,/ peftiining to rny/o|la accounE

Aa(ounl Numben

1, l'lobll€ R.bt dA!.rts Mobile AlelE Registration

Ihb subs.ribes lo eU Alerts Indding Value Add€d Alerts, OErgeaue @ l5/mo$ for atl SavingsA.loonts

Z li{obfr/Dhona o'(brEa R.qu.6!

Motile Al€rts Deregistrelion

a) L.ndtin€ No. updare (Rer.t f*'o tro *0"0, !!fI[b) L.ndtine No. update (om1 1*r,r' sm coa"r), [l-X-I!d Moblle No. : 9 ,l

f Attatt tO lfor e*utomcnt Rag&tradonh In c.s€ E StaLernenls are activat€d, physi(at stetehenB witl b€ dis.bl€d

EmaillD

d PAN lJpd.t.r

6, dEq.otAddr.s I fl cornmunkation:(PLas€ h.\,! . !p.c! b.twe.n two-wordr)

tlec,Mdress

5. AADHAAR Card o,Upd.t r

i0 office e ! e",r*n"nt

tindnark

cftr PIN Code:

Dooment for Mdress Proof (Mandalory for 6an9e in Maiting Add.ess):

u"uon,.,!!

lssuing AuboriB,:

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Dat€:

Plece:

DccL.atbnI ha\& .ead, understood and agre€ to lhe lerms and condltlons to the various paoducts and 5e.vlc6 | agree that the gank mey deblt seNke darg€5 plus taxes !o rny account

wherever aDpllcabte.

lEmmE!For Sardr Usc Onbf

Cetiffed that this Request L€tter 'E complete in all resped and all relevant doaurnenE are obtalned and €dfied tie mode of opeEtjon and signatur€5 of the ry'c holdeE lhe

requ6t may please be prcess€d The cRF has been personatly submited by e €ustomer. UE\€ satiafled ml's€lf €bout the ldentl'ty of the 6rstorn€r by t/eriring hlVher Debit

cad^Yc documenB and elso hlther signature in BanLsre<ords. I have done profEr due dlllgence to BFdate the records of the Grsiomer on hlv her requGt at noDbase bEndlmmmRequest R€ceiving Date:

Request Accepted By

Emplo!'er No.:

Designadon:

Document ldenuf ication Number:

Custome/s Sign6ture

'Sign.ture ot the Bank Off icial

Acknowl.dgement (Io be returned to the Cusrcm€rj

Custome/s Nemei

R€questReceiving Datel

Name ofthe arandt Offloi..t

Employ€e tlumbei

ForBandhanBank

Signature otthe Bank Official

o"d,nlEfll Tlffi e."o,- e"*hc"a.nl-fTl

7. Ihpli€tast t ne|* R.qu.it

stalement Required From Date:

& D.b& C.d/A$, C.d rrbt d

D.blt o.d/arM c.d l{a:

mmlmn roD.h

I lDebltCard/ATMCardReplacementRequ6t

Name as\ /DUtd appearon the Cad:{For Cdrd Replacehent requiremen0

dft Grq/ATM Grd PIN R€is$affe I o"U, c"ralur* o,t *oUro:ns

I-Tl**'*oeque rssuine oae: [Tl m Inntr

StoD Payrncit ReCt rat

PayEe's Nafiret

:,

Reason For Slopping Payment:

10. lrs,!nc. of th. Pa55 Eoolc

11. ClEtlgc of tadnc

Rea$n For name dEnging:

Exisling A(colnt Name

(Reaserttad tlr apporting dudtrnt)

12. A,f, Oth.f (Pte.s.3Fdfyt

I have read, und€Elood and agrce to th€ terma end condltlons to th€ varlous producb and s€Mc6 | agrce that the Bank may debit s€Niae dEag€6 plus tax€s to .rry account

whereverappli(.ble.

Oate: N.

CusLome/s Signafure

For aaanch t se Only

C€ttified that dtls Reqjeat Lrtter b comp{€te Ina[ resp€d.rd a[ rel6/ant doormenE a.e obtalned and ',€rfl€d dE mode ofopeEtion and signabrrts o6dl€ Iy'c holdeG TfE

'€q!€!i mO/ pte6e be p.oce6s€d T€ CRF hd been personatly $bmnted U dE Cl6to€r. t ha€ gtiS€d rnysef about dE identhr of 6e Custo.rFr bi raiF/irE tinher Deht

,GfdArdoCUrr€ntsanda|sohivlErsj'JrEhjEinBanksr€co.d5.tha!,edon€prop€rduedIlgencetoupdatedErecordsofdFc!sto.n€ronhlvherr€qt|e5t.tnonbi5e.

Custome/s Name:

Reqwst ReceMng Date

Name of the Br.nch Offidat

EmployeeNumbec

ForBandhanBank

Signalure of lhe Bank Otficiat

Request Acepted q/:

Employer No.:

Designation: