Acknowledgement to Customer
Please Note: Your request will be processed within 2 working days. Delivery of kits /cheque books / statement etc. to your address will take
between 5-11 working days if dispatched through courier and 15-18 working days if dispatched through speed post (depending on locaon)
Branch Official Signature
Customer Name
Customer ID
Name of the Branch Official
Date of request
For office use only
Cerfied that this Request Leer is complete in all aspect & all relevant documents are obtained & verified for mode of operaons and signature of the A/c holder. The request may
please be processed. The CRF has been personally submied by the Customer. I have sasfied myself about the identy of the customer by verifying his / her Debit Card/ KYC
document & also his / her signature in Bank's record. I have done proper due dilligence for updang the records of the customer on his/her request at non-home branch.
For Scheme Code Conversion Only - I hereby confirm that I have explained the customer all the Terms & Condions, details of Features & Charges, Average Minimum Balance (AMB)/
Total Relaonship Value (TRV) requirement, Debit card and any other condions as applicable to the product subscribed by the customer. The customer has agreed to abide by all the
above-menoned condions which is also available at the Bank’s official website.
Bank induced request
Request received date
Request processed date
Request accepted by
Employee number
Request cerfied by
(Employee number)
Signature
Signature & S.S.No.
Signature
Signature
Signature
Signature
For Individual accounts, signatures of all account holders are required for Account Transfer, Account Acvaon & Scheme Code Conversion.
For non-individual accounts, signatures as per mode of operaon are required.
Date
Place
Address Updaon - Please note the communicaon address will be updated at account level and Registered address at Customer ID level (For Current Account).
Please note address shall be captured as per OVD submied in case of any discrepancy observed in the details submied on CRF vis a vis OVD.
Scheme code conversion - Please note that the new scheme code will be applicable from the next charge cycle.
Account Transfer - Bank reserves the rights of recovery in case of any future debits accruing on this account as a result of any claims or transacons. All old cheques issued
shall be honoured, if otherwise in order. The remaining channel facilies (debit card, internet banking & telebanking) shall remain the same. Also all the standing
instrucons and ECS mandates given would be honoured, if otherwise in order. The flexi linked FD's will connue to remain in the old branch, the new flexi linked FD's
will be opened in the new branch and any cheques issued shall be honoured by withdrawal from the flexi linked deposits only. You can connue to use exisng cheque
book for transacons purpose ,however in case you wish to request for new cheque book , you can visit any of our banking channels. I have read and understood the
above terms and cerfy that the details provided on the form are correct.
Account Acvaon - As per customer eligibility decided by Axis Bank from me to me.
Terms & Condions
RL/CRF/Jul2020/VER.1
Branch Name
From Date
No. of books
*Reason for not operang the Account
Exisng scheme code New scheme code
Passbook
Print Nominee Name
To D a t e
Account Number*
Duplicate Statement
New Cheque book
Reversal of charges
Scheme code conversion
Label Code
Account Transfer
From Branch
Reason for Transfer of Account
Stop Payment Request
will be charged as applicable)
To Branch
Payee Name :
Cheque Number(s):
Reason for Stop Payment :
Debit Card Debit Card Number
Deacvaon
Any other
(Please specify)
Request received at (me)
Date of Cheque (s):
Amount
OR From Sol ID To Sol ID
1) ` debited on
2) ` debited on
SOL ID
SR. No.
Banking Requests
This page is required to be filled only if there are requests numbered 14 to 24
(Will be changed as applicable)
I agree to henceforth maintain Average Monthly/QuarterIy/Half Yearly Balance as per requirement (applicable (or cases where Average Balance Non-Maintenance is charged)
(Nominee name will get printed
on statement, passbook, etc)
(Please aach necessary supporng document)
(Menon label code for conversion to salary account)
14
15
16 17
18
19
20
21
22
23
24
Please acvate my account. (For Individual A/c, kindly aach KYC document of all account holders. For Non-Individual A/c, aach KYC document of the enty)
Account acvaon
Name change if any to be requested on pg1
18
E-aadhaar Declaraon: There is no change in the Aadhaar Detail aer the date of download of e-Aadhaar submied to the Bank.
I confirm that I have understood the Terms & Condions, details of Features & Charges related to the requested scheme variant by vising Axis Bank website and agreeable to all the Terms and Condions including Average
Minimum Balance (AMB) / Total Relaonship Value (TRV) / Debit card / Any other condions, as per relevant MID available on www.axisbank.com/download-forms/accounts. Also, the same was explained to me in detail by
the Bank Official taking this request. I agree to convert my scheme to the variant as selected above and will maintain account balance as per requirement of new scheme code. I will not dispute or raise any legal acon
against Axis Bank if any benefits associated with the variant are withdrawn at the sole discreon of Axis Bank and / or charges (including applicable GST) levied if I am unable to fulfil the criteria associated with the product
E-aadhaar Declaraon: E-Aadhaar downloaded in my presence (applicable for cases where Aadhaar downloaded in front of the customer in the branch)
D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y D D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y YD D M M Y Y Y Y
D D M M Y Y Y Y
D D M M Y Y Y Y
i) *Please confirm if you would like to proceed with the REKYC along with the acvaon YES NO
(*if none of the above menoned is been selected bank shall not be proceeding with the REKYC of the account .)