Customer Request Form

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Branch Name KHARGHAR (NAVI MUMBAI) SOL ID 4 8 9 SR. No.
Customer Information
*
Customer ID 8 3 6 1 9 0 2 5 8
*
Customer Name P R A V E E N
1 Name Updation
(please provide last
2 DOB/DOI 3 Aadhaar Number 4 digits of Aadhaar)

4 PAN Number 5 Nationality I N D I A N

(please update passport/VISA
6 Passport No. no. as per attached copy) 7 VISA No.

8 LEI code (Applicable for Non Individual only)

9 LEI code expiry date LEI code -I/We authorize Axis Bank to update expiry date of LEI code,unless otherwise instructed writing.

I wish to update below contact information in

Individual Segment Non-Individual Segment

Please select below if you wish to update in selective accounts only.

All Linked Accounts Also update at Cust ID level for CA
✓ All Relationships Savings & FD Loan A/cs
Only in A/c no 9 2 2 0 1 0 0 6 1 0 9 0 6 8 4
Current A/cs Credit Cards

Contact Information
(Applicable only for
10 Mobile No. & Alert Registration + 8 2 9 1 7 4 3 4 1 9 Transaction Alert EOD Alert Current Account)

Joint account holders will receive One Time Password(OTP) and transaction SMS alerts for their transactions on ATM, Internet Banking and Mobile Banking.
Monthly charge 5/- for savings A/c except NRI customer. To unsubscribe from value added alerts please tick (box)
11 Landline Number Tel(R)
Tel(O)

12 Email ID P R A V E E N B A N U 0 8 @ G M A I L . C O M
(for e-mail statement registration, Physical statements will be discontinued once E-statements are activated)
13 Address (A) Communication i) Residence ii) Office (B) Permanent / Registered address
(Note - Please leave space between two words, In case of joint Holders, each holder is required to fill separate form.)
ADD 1
ADD 2

ADD 3
Landmark

City State

Pin Code/Zip Code/PO Box Country

Please attach address proof document (For deemed OVD, OVD with updated address to be submitted within 3 months, not applicable for NRI, credit cards and loan products

Terms & Conditions: I have read, and understood and agree to be bound by the Terms & Conditions related to UIDAI guideline, sharing of Information with agencies/service provide on need to know basis, regarding various
Products & Services / Fees & Charges including SMS Banking, E-Statement, & Internet Banking, including Terms & Conditions related to sharing of relevant information under foreign tax law like FATCA as displayed on
www.axisbank.com. SMS alert charges are applicable (Only for Non Mandatory SMS) as mentioned on Bank website: www.axisbank.com under Fees and Charges section.
Mobile No. may be updated in the bank records for sending any communication related to my above account, as well as transaction advice. I also authorise the bank to contact me on the above said number for doing
verification, call backs or checks to confirm the veracity of any transaction, as deemed fit by the bank. I confirm that the mobile number is held by me and is not used by any third party and I undertake that I shall duly and
promptly inform the bank, if and when my mobile number changes.
Address Updation - Please note the communication address will be updated at account level and Registered address at Customer ID level (For Current Account)
E-Aadhaar declaration - There is no change in the Aadhaar Detail after the date of download of e-Aadhaar submitted to the Bank.

Date 1 6 0 8 2 0 2 4 Place KHARGHAR (NAVI MUMBAI)

For Individual accounts, in case of joint holder mobile number updation, signatures of only joint holder is required.
For non-individual accounts, signatures as per mode of operation are required for mobile number updation.

Signature Signature Signature Signature

For office use only

Certified that this Request Letter is complete in all aspect & all relevant documents are obtained & verified for mode of operations and signature of the A/c holder. The request may please be processed. The
CRF has been personally submitted by the Customer. I have satisfied myself about the identity of the customer by verifying his / her Debit Card / KYC documents & also his / her signature in Bank's record. I
have done proper due diligence for updating the records of the customer on his / her request at non -home branch.
E-aadhaar Declaration :E-Aadhaar downloaded in my presence (applicable for cases where Aadhaar downloaded in front of the customer in the branch)

Bank induced request Request received date 1 6 0 8 2 0 2 4 Request processed date

Request accepted by
Request certified by
Employee Number (Employee Number)
3 5 2 4 3 2 Signature Signature

Acknowledgement To Customer
Customer Name PRAVEEN
Customer Id 8 3 6 1 9 0 2 5 8 Date Of Request 1 6 0 8 2 0 2 4

Request No.

Name of the Branch Official

Please Note: Your request will be processed within 2 working days. Delivery of kits / cheque books / statement etc. to your address will take between 5 - 11 working
days if dispatched through courier and 15-18 working days if dispatched through speed post (depending on location) Branch Official Signature