CUSTOMER REQUEST FORM MISCELLANEOUS (Annexure-P)

To,
The Branch Head
Bandhan Bank Branch | Branch Code Date

Customer Name

CIF No. Account No. 1.

2.

Please Tick whichever is applicable

1. Cheque Book Request

A. New Cheque Book Activation Request
B. Cheque Book Issue Request
Number of Cheque Leafs Required
(* Approval as per approval matrix to be attached)

2. Debit Card Request VISA Rupay MasterCard

Name to be printed on the Debit Card _________________________________________________

3. Issuance of Passbook in Current Account Yes No

4. Group ID and DSC ID Updation

A. Existing Group ID New Group ID
B. Existing DSC ID New DSC ID
Declaration
I have read, understood and agree to be bound by the terms and conditions to the various products and services including SMS
Banking, E-statement & Internet Banking, including Terms and Conditions related to sharing of relevant information.
I/We hereby declare that the information furnished above is true and correct to the best of my/our knowledge.
I/We hereby confirm having read and understood all the terms and conditions applicable for the request initiated by me/us.
I/We agree that Bank may debit my account for service charges plus taxes as applicable from time to time.

Date:
Place: Customer’s Signature

For Branch Use Only

Certified that this Request Letter is complete in all respect & all relevant documents are obtained & verified. The CRF has been
personally submitted by the Customer and the customer has signed the form and all associated documents in my presence . I have satisfied
myself about the identify of Customer by verifying his/her KYC document & also his/her signature in Bank’s records. I have done
proper due diligence for updating the records of the Customer on his/her request at non-base branch/base branch.

Name of Employee Signature

Employee Code Designation
Branch Code
Date Approved by (BH/ABH)
(With Stamp & Employee ID)