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Annexure -5

a
APPLICATION FOR RE-GENERATION OF PIN MAILER FOR
PASSWORD LOST / LOCKED / FORGOTTEN
(Tick the applicable boxes)
To
Branch Manager Date:
Indian Bank,
……………………………………………..Branch

Dear Sir,

Request for ‰ issue of new login password


‰ issue of new transaction password
I am an account holder in your branch with CIF Number:

‰ I have lost/forgotten/misplaced the password / ‰ my pass word has been locked for the Internet Banking
for the above CIF.
‰ I request you to issue me new login password;
‰ I request you to issue me new transaction password
(Please tick the applicable box / boxes)
The necessary charges may be recovered from my primary account number ……………………………

Yours faithfully,

1.Signature & 2.Signature & 3.Signature & 4. Signature & 5.Signature &
Name Name Name Name Name

(to be signed by all in case of joint accounts and all partners in case of partnerships)

FOR BRANCH USE

Verified the signature/s. Informed Project Office through IP message on …………………………… and MIS
sheet sent.

Other Comments/Noting:

Date: Officer In Charge Branch Manager/Assistant Branch Manager

Disclaimer: Customer is advised to check/verify the Information furnished above before submitting, Indian Bank cannot be held liable
in case any harm, damages, loss caused due to incorrect information provided by the customer.

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