PROFILE CHANGE REQUEST FOR MOBILE/ INTERNET BANKING

D D M M Y Y Y Y
Date/ ldlt M 27 09 2 0 2 3
To,
The Branch Manager/ zfvf k|aGws
…………………
Panipokhari Branch/ zfvf

Dear Sir/ Madam,

I/We would like to request you to provide/ make changes in the following facility/ service being availed/ to be
availed by me/ us:

Cancel SMS Banking service

Unblock SMS Banking service
Regeneration of password
Link the SMS Banking service to new Account Number……………………………
Add account to be linked ……………………………………………………………
Remove linked account number……………………………………………………..
Change mobile number to……………………………………………………………
Edit Profile……………………………………………………………………………
Others…………………………………………………………………………………

I/We hereby authorize you to debit my/our below mentioned account for necessary charges for the same.
(I/We also understand and fully agree that the Terms and Conditions shall as per original application form of
Global IME Internet/Mobile Banking Service)

______________________________
Authorized Signature
Account Name: Darshan Tikhatari Pariyar
Account Number: 03309015001089
Mobile Number: 9987590601

(For Bank’s Use Only)

✔ Customer is self-present
✔ Customer verification is doe through valid ID

Signature Verified by: Approved by:

Staff ID: Staff ID:
Date: Date: