ENGLISH_Customer Request form_final_LEI CODE UPDATE

Branch Name

Customer ID*

Customer Name*

Name Updaon

DOB/DOI

Aadhaar number

Savings & FD

Current A/cs

Loan A/cs

Credit Cards

All Linked Accounts

Only in A/c no

Also update at Cust ID level for CA

LEI code - I/We authorize Axis Bank to update expiry date of LEI code, unless otherwise instructed in wring

PAN number

Naonality

Mobile No. & Alert Registraon

E-mail ID

State

Country

Please aach address proof document

Bank induced request

Request accepted by

Employee number

Request received date

Request processed date

Request cerﬁed by

(Employee number)

D D M M Y Y Y Y

ADD 1

ADD 2

ADD 3

Landmark

City

Pin Code/Zip Code/PO Box

VISA No.

(Please Provide last

4 digits of Aadhaar)

Please select below if you wish to update in selecve accounts only.

(for e-mail statement registraon. Physical statements will be disconnued once E-statements are acvated)

(Note - Please leave space between two words. In case of joint Holders, each holder is required to ﬁll separate form.)

(For deemed OVD, OVD with updated address to be submied within 3 months,

not applicable for NRI, Current A/c, Credit cards and loan products)

Country Code

Mobile Number

I S D S T D N U M B E R

I S D S T D N U M B E R E X T N

Transacon Alert EOD Alert

(Please update Passport /VISA

no. as per aached copy)

(Applicable for Non Individual only)

Passport No.

LEI code

SOL ID

SR. No.

Customer Informaon

Contact Informaon

For oﬃce use only

Acknowledgement to Customer

Individual Segment

All Relaonships

Non-Individual Segment

I wish to update below contact informaon in

(Applicable only for

Current Account)

Joint account holders will receive One Time Password (OTP) and transacon SMS alerts for their transacons on ATM, Internet Banking and Mobile Banking.

Monthly charge ` 5/- for Savings A/c except NRI customer. To unsubscribe from value added alerts please ck

Landline number

Tel (R)

Tel (O)

Cerﬁed that this Request Leer is complete in all aspect & all relevant documents are obtained & veriﬁed for mode of operaons and signature of the A/c holder. The request may

please be processed. The CRF has been personally submied by the Customer. I have sasﬁed myself about the identy of the customer by verifying his / her Debit Card/ KYC

document & also his / her signature in Bank’s record. I have done proper due dilligence for updang the records of the customer on his/her request at non-home branch.

E-aadhaar Declaraon : E-Aadhaar downloaded in my presence (applicable for cases where Aadhaar downloaded in front of the customer in the branch)

Please Note: Your request will be processed within 2 working days. Delivery of kits /cheque books / statement etc. to your address will take

between 5-11 working days if dispatched through courier and 15-18 working days if dispatched through speed post (depending on locaon)

Signature

Signature & S.S.No.

Branch Oﬃcial Signature

D D M M Y Y Y Y

For Individual accounts, in case of joint holder mobile number updaon, signature of only joint holder is required.

For non-individual accounts, signatures as per mode of operaon are required for mobile number updaon.

Date

Signature

Place

Signature

Customer Name

Customer ID

Name of the Branch Oﬃcial

Date of request

Customer Request Form

E-aadhaar Declaraon -There is no change in the Aadhaar Detail aer the date of download of e-Aadhaar submied to the Bank.

LEI code expiry date

(B) Permanent /Registered address

Terms & Condions: I have read, and understood and agree to be bound by the Terms & condions related to UIDAI guideline, sharing of Informaon with agencies/service provide

on need to know basis, regarding various Products & Services / Fees & Charges including SMS Banking, E-Statement, & Internet Banking, including Terms & Condions related to sharing

of relevant informaon under foreign tax law like FATCA as displayed on www.axisbank.com. SMS alert charges are applicable (Only for Non Mandatory SMS) as menoned on Bank

website: www.axisbank.com under Fees and Charges secon.

Mobile No. may be updated in the bank records for sending any communicaon related to my above account, as well as transacon advice. I also authorise the bank to contact me on the

above said number for doing veriﬁcaon, call backs or checks to conﬁrm the veracity of any transacon, as deemed ﬁt by the bank. I conﬁrm that the mobile number is held by me and

is not used by any third party and I undertake that I shall duly and promptly inform the bank, if and when my mobile number changes.

Address Updaon - Please note the communicaon address will be updated at account level and Registered address at Customer ID level (For Current Account)

D D M M Y Y Y Y D D M M Y Y Y Y

D D M M Y Y Y Y

Address

(A) Communicaon

i) Residence ii) Oﬃce

Acknowledgement to Customer

Please Note: Your request will be processed within 2 working days. Delivery of kits /cheque books / statement etc. to your address will take

between 5-11 working days if dispatched through courier and 15-18 working days if dispatched through speed post (depending on locaon)

Branch Oﬃcial Signature

Customer Name

Customer ID

Name of the Branch Oﬃcial

Date of request

For oﬃce use only

Cerﬁed that this Request Leer is complete in all aspect & all relevant documents are obtained & veriﬁed for mode of operaons and signature of the A/c holder. The request may

please be processed. The CRF has been personally submied by the Customer. I have sasﬁed myself about the identy of the customer by verifying his / her Debit Card/ KYC

document & also his / her signature in Bank's record. I have done proper due dilligence for updang the records of the customer on his/her request at non-home branch.

For Scheme Code Conversion Only - I hereby conﬁrm that I have explained the customer all the Terms & Condions, details of Features & Charges, Average Minimum Balance (AMB)/

Total Relaonship Value (TRV) requirement, Debit card and any other condions as applicable to the product subscribed by the customer. The customer has agreed to abide by all the

above-menoned condions which is also available at the Bank’s oﬃcial website.

Bank induced request

Request received date

Request processed date

Request accepted by

Employee number

Request cerﬁed by

(Employee number)

Signature

Signature & S.S.No.

Signature

For Individual accounts, signatures of all account holders are required for Account Transfer, Account Acvaon & Scheme Code Conversion.

For non-individual accounts, signatures as per mode of operaon are required.

Date

Place

Address Updaon - Please note the communicaon address will be updated at account level and Registered address at Customer ID level (For Current Account).

Please note address shall be captured as per OVD submied in case of any discrepancy observed in the details submied on CRF vis a vis OVD.

Scheme code conversion - Please note that the new scheme code will be applicable from the next charge cycle.

Account Transfer - Bank reserves the rights of recovery in case of any future debits accruing on this account as a result of any claims or transacons. All old cheques issued

shall be honoured, if otherwise in order. The remaining channel facilies (debit card, internet banking & telebanking) shall remain the same. Also all the standing

instrucons and ECS mandates given would be honoured, if otherwise in order. The ﬂexi linked FD's will connue to remain in the old branch, the new ﬂexi linked FD's

will be opened in the new branch and any cheques issued shall be honoured by withdrawal from the ﬂexi linked deposits only. You can connue to use exisng cheque

book for transacons purpose ,however in case you wish to request for new cheque book , you can visit any of our banking channels. I have read and understood the

above terms and cerfy that the details provided on the form are correct.

Account Acvaon - As per customer eligibility decided by Axis Bank from me to me.

Terms & Condions

RL/CRF/Jul2020/VER.1

Branch Name

From Date

No. of books

*Reason for not operang the Account

Exisng scheme code New scheme code

Passbook

Print Nominee Name

To D a t e

Account Number*

Duplicate Statement

New Cheque book

Reversal of charges

Scheme code conversion

Label Code

Account Transfer

From Branch

Reason for Transfer of Account

Stop Payment Request

will be charged as applicable)

To Branch

Payee Name :

Cheque Number(s):

Reason for Stop Payment :

Debit Card Debit Card Number

Deacvaon

Any other

(Please specify)

Request received at (me)

Date of Cheque (s):

Amount

OR From Sol ID To Sol ID

1) ` debited on

2) ` debited on

SOL ID

SR. No.

Banking Requests

This page is required to be ﬁlled only if there are requests numbered 14 to 24

(Will be changed as applicable)

I agree to henceforth maintain Average Monthly/QuarterIy/Half Yearly Balance as per requirement (applicable (or cases where Average Balance Non-Maintenance is charged)

(Nominee name will get printed

on statement, passbook, etc)

(Please aach necessary supporng document)

(Menon label code for conversion to salary account)

16 17

Please acvate my account. (For Individual A/c, kindly aach KYC document of all account holders. For Non-Individual A/c, aach KYC document of the enty)

Account acvaon

Name change if any to be requested on pg1

E-aadhaar Declaraon: There is no change in the Aadhaar Detail aer the date of download of e-Aadhaar submied to the Bank.

I conﬁrm that I have understood the Terms & Condions, details of Features & Charges related to the requested scheme variant by vising Axis Bank website and agreeable to all the Terms and Condions including Average

Minimum Balance (AMB) / Total Relaonship Value (TRV) / Debit card / Any other condions, as per relevant MID available on www.axisbank.com/download-forms/accounts. Also, the same was explained to me in detail by

the Bank Oﬃcial taking this request. I agree to convert my scheme to the variant as selected above and will maintain account balance as per requirement of new scheme code. I will not dispute or raise any legal acon

against Axis Bank if any beneﬁts associated with the variant are withdrawn at the sole discreon of Axis Bank and / or charges (including applicable GST) levied if I am unable to fulﬁl the criteria associated with the product

E-aadhaar Declaraon: E-Aadhaar downloaded in my presence (applicable for cases where Aadhaar downloaded in front of the customer in the branch)

D D M M Y Y Y Y

D D M M Y Y Y Y D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y YD D M M Y Y Y Y

D D M M Y Y Y Y

i) *Please conﬁrm if you would like to proceed with the REKYC along with the acvaon YES NO

(*if none of the above menoned is been selected bank shall not be proceeding with the REKYC of the account .)