STATIC DATA CHANGE FORM

Branch/Krishi Branch:_____________________ Date: ______________________

DD-MM-YYYY
Account Holder Information

Account Title:____________________________________________________________________________________________

Account Number:

Date of Birth: _____________________________ Mothers Name: ________________________________________

Please update my/our static data with you as per bellow information.

Address Change (Please mention the Flat/Floor no, Building Name if applicable)

□ Residence □ Office □ Permanent

New Address: __________________________________________________________________________________________

___________________________________Post Code __________Nearest Land Mark __________________________________

Contact Number Change

□ Residence Phone Number: ________________________________ □ Mobile Phone Number: ___________________________

□ Office Phone Number: ___________________EXT: ___________ □ Fax Number: ____________________________________

□ E-mail Address: _________________________________________________________________________________________

Special Instruction (If Any)

________________________________________________________________________________________________________

Authorization (I/We have declare that, the above mention information(s) provided by me/us is correct)

st nd
1 Accountholder’s Signature 2 Accountholder’s Signature

For Branch/Krishi Branch use only (All Account Holders are required to sign regardless the mode of operation.)
Physical presence(s) confirmed Signature verified Proof of Address Received

CIF No:

Received by with seal Approved by with seal

For Operations use only:

Proof of Address matched

Data inputted by with seal/PIN Approved by with seal/PIN

** Seal is mandatory for Business Account

All blank fields must be marked as “N/A” Process Management, Operational Risk Management, Risk Management Division’2012