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The Country Head & CEO

State Bank of India


Male’
Date / /20

Dear Sir,

With reference to the below mentioned account( s ) I/We authorize Mr./Ms.


…………………… (ID/WP Card no.) …………………. to collect my
A T M / P I N / I N B , whose specimen signature is attested here below.

Account number USD/MRF

  / 
  / 
2. I/We understand the risk associated with getting my ATM/PIN/INB delivered to a third
party. I/We absolve the bank of any liability that may arise due to misuse of the PIN
delivered to the person authorized by me.

3. Specimen signature of Mr./Ms. ………………………… is hereby attested:

Documents to be attached:
ID copy of Account Holder(s)
Passport copy of Account Holder(s)
(Signature of Bearer) ID Copy of Bearer

Yours faithfully,

Signature of the Authorized Signatory Signature of the Second Authorized Signatory


Name: Name:

For Office Use


Account holder(s) signature(s) verified ATM Pin delivered &
Please issue the ATM pin to the bearer entered on ___ _____

Officer In‐Charge Assistant

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