ࡱ> PSO[  *bjbj 46ΐΐu jj    4A, /mmmmm'''///////$1+4`*/]'Z$.'''*/mm /T,T,T,'.mm/T,'/T,T,X.^.mMf 'p../0/x.4(t4.4.pT,'''*/*/*+*'''/''''4'''''''''j s: 9 To, The AGM / Br Head PRIME CO-OP BANK LTD. Branch_________________ Date:___________ Name of A/c._____________________________________________________ Account No. Phone no. Mobile: Email address  PLEASE TICK [ ] THE Appropriate Box 1. CHANGE OF MAILING ADDRESS AS BELOW : (Please enclose proof of new address)   City Pin Code E-mail ID  Phone No Mobile : 2. STATEMENT (please Debit the charge to my a/c. if any)  Account Statement require from date : / / to / / Statement not received by us. 3. CHEQUE BOOK REQUEST Not received for New A/c. Request for reissue but not received Cheque book requisition Slip Lost. Please Issue. 4. INTERNET BANKING Branch Name :___________Account No.________________ Type of A/c : Current - Over Draft - Cash Credit - Saving - Loan _____________ Forgot Password Password Not Received 5. STOP PAYMENT REQUEST (please Debit the charge to my A/c) Cheque No : From ________________ TO _______________ No. of leaves _____________ Payee Name : __________________ Reason of Stop Payment ____________ ______________________________________________________________________ ______________________________________________________________________ 6. ACCOUNT CLOSEER REQUEST: (please Debit the charge to m y A/c. if any ) Unused Cheque cheques bearing No Form _____________to ____________ are surrendered herewith. Reason for A/c Close: ____________________________________________________ 7. SIGNATURE VERIFICATION CHARGES: please Debit the charge to my A/c. 8. PASS BOOK: I/we request you to issue me/us a duplicate passbook in lieu of the one lost/spoiled. Requisite bank charges may be debited to my/our a/c. I undertake to advise the Bank as soon as the original pass book is found to avoid its misuse. 9. MOBILE BANKING:  /5FHMX\  ޻ym[OChMCJOJQJ^Jh}^CJOJQJ^J"jh}^U_HGmHnHtH uhCJOJQJ^Jh^OCJOJQJ^JhKxCJOJQJ^Jh8?hKx5OJQJ\^Jh5OJQJ\^Jh^OhOJQJ^J&hhKx5CJOJQJ\^JaJh5CJOJQJ^JaJhKx5CJOJQJ^JaJhKxOJQJ^JjhKxU/H  0 t D  ^` gdd     0 2 4 8    N 澲u``YLhKx5OJQJ\^J hKx5\(hKx5CJOJQJ\^JmHnHsHhKx5>*CJOJQJ\^JhKx5CJOJQJ\^JhKx5CJOJQJ\^JhKx5CJOJQJ\^JhKxCJOJQJ^JhKxOJQJ^JhKxOJQJhKx"hKxCJOJQJ^JmHnHsHjhKxU"jhMU_HGmHnHtH uN p D F H DFHJ:NPRrtvRX|ΧzzphO$OJQJ^JhO$>*OJQJ\^J"jhU_HGmHnHtH uhO$hKx5OJQJ^JhhKxOJQJ\^JhKx5OJQJ\^JhKxCJOJQJ^JhKxCJ OJQJ^JhKxCJ OJQJjhKxUhKxOJQJ^Jh` OJQJ^J,:$,sd"<#($$ gdY* "^`"gdY* "^`"gd2~ gdV- |^`|gdDK* N3^ gdd  +st%Icd+45<"""$"&"("z""""""<#>#&$($췭쭡셹xh2~5OJQJ\^J"jh}^U_HGmHnHtH uhY*OJQJ^JhKxCJ OJQJ^JhKxCJ OJQJUh2~OJQJ^JhDK*OJQJ^JhKx5OJQJ\^JjhKxUhO$OJQJ^JhKxOJQJ^JhV-OJQJ^J/ Please Activate Please Deactivate. Mobile No. _________________ 10. NAME ADDITION : I/we request you to add the name of Mr/Ms/Mrs.______________________  _________________________to my/our SB/SBDA. As per the KYC norms, the required documents should be deposit to bank. 11. NAME DELETION : I/we request you to DELETE the name of Mr/Ms/Mrs._________________ _____________________from our SB/SBDA account. 12. OTHER (Please Mention here)____________________________________________ _____________________________________________________________________ Signature of A/c. holder(s)    CUSTOMER REQUEST FORM FOR OFFICE USE Application Received By : Relevant Charges - Date : Remark if Any: Debit ` ________ Sub Officer / Officer / Manager Branch Head / Senior Manager / AGM ($0$L$8%:%<%>%B%x%b&|&&&&&&&&&&&&('*'H'd(׿רמ~u`Qh` 5CJOJQJ^JaJ)h2~h` 5>*CJOJQJ\^JaJh` h` CJh` CJOJQJ^Jh` hUCh` 5CJOJQJ^JhO$OJQJ^Jh0OJQJ^Jh2~5OJQJ\^JhKx5OJQJ\^JhKx5OJQJ^JhKxOJQJ^JjhKxUhY*5OJQJ\^JhY*OJQJ^J$8%%`&&&&&&&&&&&&&&&&&&&&&&Ff $$G$Ifa$gdUC   gdY*&&&&&&&&&&&&&&&&&&&&('*'H''(B)F))$a$Ffe$G$Ifd(f())** *hO$OJQJ^JhKxh` h` CJOJQJ^JaJh` 5CJOJQJ^JaJh+th` 5OJQJ^JaJ))***** * 21h:p. 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