24 X 7 Banking Registration Form (For Retail Customers Only)

_______________________ Branch

Date: _______________

Customer Name: Mr. /Mrs. /Ms. _______________________________________________________________________________________

Customer ID:

_________________

Mobile Number: _________________

Email ID:

Savings Account Number: ___________________________________

Telephone No:

_____________

_____________________

_________________________________________________________________________________________

CHANGE OF ADDRESS:
NEW MAILING ADDRESS:

______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
City: _______________________

PIN: ___ ___ ___ ___ ___ ___

Document for proof of address: * ____________________________________________________________________

Please update the above address in the following accounts also Savings Account Number ______________________________________________________________
MOBILE ALERTS
Please register the following accounts for Mobile alertsSavings Account Number: _____________________________________________
Savings Account Number: _____________________________________________
This service is currently offered on Mobile Numbers registered in India.

I-CONNECT

Yes, I wish to apply for I-Connect (Internet Banking)

(Internet Banking)

Please activate Fund Transfer facility

Customers Signature

IPIN (Internet Banking Password) will be mailed to the mailing address available with us. Please use the same to access the I-Connect.

E-STATEMENT REGISTRATION (Signature of Primary Holder is required)

Please activate E-statements in the accounts listed belowSavings Account Number: ___________________________________
Savings Account Number: ___________________________________
In case E-statements are activated, physical statements will be disabled.

DECLARATION
I have read, understood and agree to the Terms and Conditions relating to various services including Mobile Banking, E-statements and
Internet Banking. I accept and agree to be bound by the Terms and Conditions as displayed on www.axisbank.com. I agree that the bank
may debit service charges to my account wherever applicable.
Date: ___ / ___ / __________
Place: ___________________

Customers Signature

Signature of both holders is required in case modus-operandi is either or survivor/joint

FOR BANK USE ONLY

Field Verification

Certification

I confirm having visited the place of residence /

Office of the customer and verified the same with
the details mentioned on this form.

Certified that this Request Letter is complete in all respect and all relevant documents are
obtained and verified. Mode of operation and signatures in the A/c have been verified from
Finacle and found in order. The request may please be processed
For Axis Bank Ltd.

Name:

_____________________________________

Employee No: ___________________

Form Sourced by:

Designation: _______________________________
Date of visit: _____/_____/_________

Employee ID: ____________

Name: ____________________________________

Signature of Employee

Signature of Br Head/Auth Signatory

Name:
Designation:
S.S.No.