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Customer Request Form: This form allows customers to request statements, cheque books, and updates to their mailing addresses, including acknowledgment and authorization sections.
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Date: i
‘We understand your world
The Manager
HOFC Bank Ltd
Branch:
Dear Sir/Madam,
Ref: Customer ID__ _____JAccount No. PEE
A) Please tick the relevant box for which request is to be made:
Statement of the period to,
(Reason for the request
Interest Certificate CASA/FD Account number given above for the year to
a
a
1 Balance Confirmation for Alc no given above
1 Current FD balance(s) booked under my customer id
DFO confirmation for FD no, | Which I have not received by post
1 Form 46Ain respect of Tax deducted under my customer id for the Financial Year
Signature Verification required on the enclosed forms. (Reason
Provide status of Cheque Number
Oo
You are requested to:
1 Kindly dispatch the document to my mailing address, OR
1 I shall personelly collect the document from the Branclvhandover the same to the person whose
signature is attested below
Please provide mailing address
Tel No
Please Note:
In case the address provided does not match with the Bank's record, please provide address change request. For
address change cases, customer needs to collect the doouments from the branch,
agree to the charges applicable for my above request to be debited to my account as given above.
Yours truly,
Signature of Customer/Authorized Signatory(s) Signature of the Bearer who will collect the Documents
‘Acknowledgement for receipt of request documents: __
‘Customer's Acknowledgement Copy
, CustomerID. . Ale Number
‘We acknowiedge receipt of instruction(s) as below (tick v)
D Statement Request Ci Interest Certificate Cl Balance Confirmation CFD Balance Form 164
Duplicate FD Advice Request CG Signature Verfcation Gl Pass Book Issuance LI Permature payment of Term Deposit
Branch
Date Name of Bank Offical Signature of Bank Official Branch Stamp,
Signature of Customer/Authorized Signatory(s) / person who is authorized by the customer ta collact the sama
Valued clients may please note that the delivery ofthe requested documents, Certficates, confirmations stall be made after business hours
