Annexure I

(Specimen of Declqrolion to be obloined for proof of lhe moiling oddress)

Dote:

To
The ASC HeOd
Bronch
Axis Bonk Limited

Deor Sir/Modom,

Ideclore ond confirm thot for opening on loon occount with your Bronch of Axis Bonk, my locol
oddress, which is to be recorded os my moiling oddress in the occount is os follows: -

(pleose mention the House No./Flot No./Rood No./Streei No./Floor No./Deportment ond
Londmork, os opplicoble)

City Stote (lndio), PIN Code

Contoct Detoils Telephone Number (Office / Locol / Residence)

Mobile No. EmoilAddress

My permonenl oddress ls
ond lowords proof of some, lom enclosing documenl

Iouthorize the Bonk to send oll conespondence. including oll deliverobles io me of ihe oforesoid
moiling oddress.

I underloke to immedlotely Inform the Bonk in cose there is ony chonge in my reglstered
correspondence oddress, but nol loler thon 2 weeks of such chonge.

ln cose the oddress submitted by me os proof, undergoes o chonge, I note to submit the fresh
proof of oddress to the Bronch for updotion of the records. I hereby ogree ond undertoke to
hold hormless ond keep Axis Bonk fully indemnified ogoinst cloims ond domoges, which moy be
mode in respect hereof by reoson of Axis Bonk relying ond octing on this declorotion.

Yours foithfullY,