Karnataka Gramin Bank

Canara Bank)
(A Scheduled Bank, Estd by Govt.of India, Sponsored by

CUSTOMER REQUEST LETTER

[For Savings &Current A/c (Proprietorship) Custorners only]

From:
The Branch Marae
KarnatakaGrarir Rank
STORAaNAMAYU Brarcr

Dear Sir/Madam
charges as appicatie to
service/s ticked in the box below., You carn debit
I/We request you toprovide me/us the
my account.
tad424919
My A/c No. L9431 0000336|
Custorner 1D

Emil ID
Phone/ Mobile No.
(enciose
in your records: PAN
Kindly update my Permanent account Number
proof of PAN)
Please tickin the appropriate box.
1. LCHEQUE B0OK REQUEST: 'SSUe cheaue 0
for my / our new accoUnt. Pleae
a.I/We have not received Cheque Book
Cheque Book.
LIIWe have not received personalized
requisition slip. Please issue a Cheque BoOk.
I/We have lost the cheque book
C.
2.CHEQUE STOP PAYMENT REQUEST: from to
Please stoo pavent
Book containing leaves
a. LI IWe have lost the Cheque
Cheque Book.
the same and issue new dated for favouring
b. /We have issued a Cheque No. Please stop paymen cf
the rha
FUNDS
CHEQUE/OUTSTANDING CHEQUE/ TRANSFER OF
3. DEPOSIT OF CASH/CLEARING at
to?
a.I/We have remitted cash amOunting Amount not credited/short credited.
Please verify
amount
Date of Deposit
I/We have deposited the Cheque No.
b. LJ
Drawee Bank and Branch
credit.
my/our account. Please verify and cheque.
-Credit not received in Plese verify and return the credited to
Returned cheque not received. (date) through RTGS/NEFT nt
JAn amount of? remitted on
C.
beneficiary'saccount. Please verify.remitted on (date) through RTGS NEFT E re
d. LIAn amount of not cred1ted. Piese vetty a
of my/our A/c No.
Bank/branch for credit
4.PASS BOOK/PASS SHEET: account. Please issue pass book
have not received Pass book for new pass book with entnes from
a. L Pass Book- I/We
I/We have lost the pass book. Please issUe duplicate
Book-
b. LDuplicate Pass
to to
duplicate pass sheet from
Pass Sheet - Please issue to
C.
Duplicate Pass Sheet - Please issue duplicate pass sheet from Weekly/Fortnightly / Periodcity -
Mont
sheet
d
address and send the pass
e. Please register my e-mail
Bi-monthly /quarterty/Half-yearly/annually.
Address Communicaton A tres:
5.JCHANGE OF ADDRESS: O Permanent(residence/office) in your reccrds I we anate ec PIN
information
a. U Please update the contact address is City
) E-mail 1D
new address, My/Our new
Tel No.
(Mobile No.

Cut here
 B0DI POSTT KAMADHENU DE POSIT | RECURRING DEPOSITS:
Account No Date of Deposit :
DepOSIt Recept not received
Tenure of the Deposit wrongly mentioned. Correct Tenure: months/years.
C Rale of Interest not correctly appled / Preferential rate not glven.
d Penodical FD nterest not credted to accOunt / pay order not recelved.
Nomination not registered / not cancelled/varlation as requested not effected in my SB/CA/FD/KD/RD A/C No.
Pernodical FD interest not credited to account / pay order not recelved
TAX DEDUCION AT SOURCE:
TOS Certufcate Request for the FY
Interest Cetfcate request for he FY
C. [ TDS Ceuficate not received for the Fy
Form 15H/15G submitted at branch on but tax deducted.
MIsmatch in Tax deducted and Tax remltted, Please verify.
8.STANDING INSTRUCTIONS:
Following standing instructions not executed:
Amount Perlodicity

ACCOUNl MODIHCATION,
Account No: Name:
a Documents submitted for KYC Compliance. KYC details not updated.
b ODate of Birth not updated though proof of Date of Birth subrmitted on
ConversIon of individual account into joint account not made.
d. Status of account not changed from Minor to Major.
Addtion/ Deletion of Joint AccOunt holder not made.
MOde of operation wrongly mentioned from the one mentioned in the A/c opening form,
DE3IT CARD:
ihave fil:ed up the form but not received the Card. Please check and issue the card
b. Lost Card - My DebIt Card is lost. The 16 digit Card No. is
Please hot List the Card. (Please fill up separate appln.form for obtaining new card).
c. O Card expired. New Card not received.
d. DATM - Cash not dispensed/partly dispensed - ATM ID transaction date Amount
(Please attach Transaction Slip).
11. INTERNET BANKING/MOBILE BANKING (Strike out which is not applicatble)
nave filled up the form but not vet received the User ID for Internet Baning/Mobile Banking. Please issue.
te s Dlocked Please uniock.
. liave iorgten ny Usei iD and Pyord fo ngmet Banking/ Mobile Banking. Please relssue.
SMS REGISTRATION; MOBILE NO
Modification
Addition
c. Deletion.
13. OTHERS (Please specty):
Darch..
DECLARATION
holding the afore-mentioned acCount with Karnataka Gramin
, eety eidre tiat,
and the same may be updated in the bank's records for Mobile Banking,
senduxy drly conmunkaton related to my above accournt, as wellas transaction advises. Iaso authorlse the bank to contact me on the above
mentone number for doing verification call backs or checks to confim the veracity of ary transaction, as deenmed fit by the bank. I conhim that the
sJd obile numter is held by me and is not in use by any other third party and I undertake that I shall duly and promptly inform the bank if and
when my nobile number changes
Inave read and understood the docunent containing theTerns and Conditions" &"Disclaimer Clauses" goveming Kanataka Gramin Bank's Internet
tany servKes vdiatbike n Bank's Internet Banking portal (https nettbankig pragathikr isnabank com) accessed through Bank's oficial wetsite
adlxcept the sane. Further, I also agree that the transaction and the requests exeauted In the above mentioned
sg'e itene! hatkg wer oy uaer lD and paSsword wlltbe legally binding on me and I am responsible for malntenance of secrecy and
o t i e t i e ntanaton Niss OntoTie by the Bank throOugh Internet/ Mobile/Mail/Telephone.
TS t ad a tu te uuNd y the Terns and conditions to vartous products and services incuding ATM Cards, Intemet Barking,
ds dsplayed on . hag dnith h/ avalable at brariches. I ogree that the Bank may debit service charges plus taxes to my account
wherever applkcabke
Plae
Signature of the Account Holder/s
Cut here
ACKNOWLEDGEMENT
(full name) A/c
We ackncowkedge hav1ng receved customer request ietter from The signature is verifled &found correct.
requesting for point No

Piease offix date seal with time Slgnature of the Officer / Manager