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To
Branch/chief Manager
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STATE BANK OF INDIA
Name :.,., .....,....... ,.................. .'......... .
Dear Sir/Madam, Ale No :.............................................
Mob No.:,..,,.,., ... ,,.,.,., .. ,,,,,, ...............
................................... CUSTOMER SERVICE REQUEST FORM
KINDLY ACCEPT MY REQUEST
Date : ............................... .
(TICK THE REQUIRED SERVICE ONLY)
1 0 !osr,cl5$AUCe of Cheq~• Book : _Please issue 20/50/ 100/1000-leaf ORDER/BEARER Cheque Book for my/our
I C & debit charges(1f any) fonn my/our account.
2 0 For Cheque Book Facility : Please provide Cheque Book facil ity in my/our SB/CA/CC account.
3 0 For Transfer of Account : Please transfer my/our A/C to Branch Name _ _ _ _ _ _ _ _ (Code: _ _ __,

40 Fc,r Closure of Deposit Account: Please close my/our SB/RD/STDR/fDR A/C

-----------
and credit the amount in my/our CA/SB/CC/OD/A/C _ _ _ _ _ _ or pay in Cash (lfpennitted).
so For Issue of Duplicate Passbook : Please issue a duplicate Passbook(Copy of FIR/GD enclosed) & debit
charges (if any ) from my account.

6 □ 1-'or Change of Mc,bile No : Please update my new mobile no in my A/C. New Mobile No:
-------
7 □ For SMS Alert: Please Provide/ Stop SMS Alert Facility on my/ our Account. Mobile No: - - - - - - - -
8 □
For Issue of ATM Card : Please issue ATM Card on my/Our Account.

9 □ charges (if any) from my account.

For ATM PIN Regeneration : Please regenerate ATM Pin (Card No
- - -----~----' & debit

10 □ For ATM Card Replacement : Please issue another ATM Card & debit charges (if any) From my account. OIJ
card has been blocked by me. (ticket No _ _ ___,__ _ _ _ _ __,

11 □
For standing Instruction : Please transfer Rs. _ _ _ _ _ _(per month) Starting on / / _ _ From my/our
SB/CAOD/CC AC to RD/PPF/OD/SB/CA/CC/Loan AC _ _ _ _& debit charges (if any) form my account.
12 □ For Cancellation of DD/BC : Please cancel the DD/BC No. _ _ _ _ _ _ issued on _ _/_ /_ _ in favor of

- - - - - - - - - - - - - as it no longer needed by me Debit charges if any and pay me the

rema inin g amount in Cash or by Transfer to A/C No _ _ _ _ _ _ __
For C~ange of e-mail Id : Please Change/update my e-mail id to_ _ _ _ _ _ _ _ _ _ _ _ _in my CIF.
130 /

For Internet banking Registration : Please register me for Intemert Banking with/without transaction rights.
140
lS O For Mobile Banking Registration : User ID_ _ _ _ _ _ _ Mobile No:_ _ _ _ _ _ __

Conversion of Account type : Convert From SB/ Basic/Small A/c to SB/SB plus/SB Premium Al e.
160
Change of name/ Address : Please change my/ our name/ address.
11 □
Old. Name/ Address New Name/ Address
Name: Name:

Address: Address:

otbtr request not mentioned •~ve:

180
, .
190 Statement : From...,..,......,.....,,.................................................10 ............................................................ .
.
Enclosed KYC Documents : Passport, Voter ID CarJ, Aadhar Letter; Df{ving License, Pan CarJ, NREGA carJ.
'

I/we have read and agree to abide by the bank's terms and conditions and rules in f~ce and the changes thereto in terms anJ
conditions fonn T ime to time relating to my/our account as communicated and made available on the bank's website.

Yours FaithfulJy,

(Signature(s) of Customer) Name/Names: Authorised Dank official