Customer Request : Form B

The term “RBL Bank” or “the Bank” shall mean The Ratnakar Bank Limited.
(For Bank Use Only) Branch Branch Code Date D D MM Y Y Y Y
PLEASE USE BLOCK LETTERS AND ATTACH SELF-ATTESTED DOCUMENT PROOFS AS PER REQUIREMENT.
TICK & SIGN AS APPLICABLE AND STRIKE OUT THE IRRELEVANT PORTIONS
Customer Name T A H E R B H A I A L I B H A I R A J K O T WA L A T R U S T
Cust Id 2 0 7 9 4 0 Account Number 3 0 9 0 0 0 7 2 1 4 8 0
CHEQUE RELATED
Stop Payment of Cheque:
Cheque Number Cheque Date Reason for Stop Payment
1 DD MM Y Y Y Y
2 DD MM Y Y Y Y
3 DD MM Y Y Y Y

Re-issuance of Cheque Book: Number of ChequeBooks to be reissued:

(Savings accounts consists of 20 leaves per cheque book,
Current Accounts consists of 50 leaves per cheque book)
RE-GENERATION OF STATEMENT AND PASSBOOK RELATED
Duplicate Passbook Statement required: from D D MM Y Y Y Y to D D MM Y Y Y Y
FIXED DEPOSIT (FD) ADVICE RELATED
Advice copy requested for FD account number/s:
FD a/c: FD a/c:
BALANCE CONFIRMATION CERTIFICATE AND DEBIT/CREDIT ADVICE RELATED
Balance Confirmation Certificate for the above mentioned account as on
DD MM Y Y Y Y
Debit Advice Credit Advice for the above mentioned account: Date: D D MM Y Y Y Y Amount
ACTIVATION OF DORMANT / INACTIVE ACCOUNTS
1. Activation Of Dormant / Inactive Accounts : ID Proof(Self-Attested)
Reason for a/c being dormant/ inactive: Out of station Residence Shifted Other reason
2. Unfreeze above account for which KYC documents have been submitted as under
ID Proof (Self-Attested) Address Proof (Self-Attested) Other Proofs(Self-Attested)
*Note: In case of address change, please submit Form A with valid address proof.
I/ We, the undersigned, being customer of RBL Bank hereby confirm that I/We have read, understood and agree to abide and be bound by all the provisions of the terms & conditions as displayed on the website:
www.rblbank.com. I agree that the Bank may debit my account as applicable for above requests and for service charges as applicable from time to time. The information and data furnished by me/us to the bank
are true and correct and I/We undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am/we are aware
that I/We may be held liable for it.These terms and condition shall be in addition to any other terms as stipulated by the Bank from time to time in respect of other services availed by me/us. Changes requested
would be effected in the Bank's records by the Bank within the committed period from the date of receipt at the Branch and the said changes would be effective in the system from that date only. Deliverables, if
any, will be sent to the prefered maling address as per the latest records available with the Bank.

Date: D D MM Y Y Y Y
Ver : SCGS/August/2013

Place:
(For Branch Use Only) - I hereby certify that the customer has signed in my presence and the signature has been verified from Bank's records

Verified By (Name & Sign): Approved By (Name & Sign):

Customer Name T A H E R B H A I A L I B H A I R A J K O T W A L A Date 1 0 1 2 2 0 1 9

Request related to: Cheque related Regeneration of statement and passbook
Fixed Deposit Related Balance Confirmation Certificate /Debit/ Credit advice
Account Freeze Removal Dormant /Inactive Account Activation

Name of Bank Official: Signature of Bank Official:

customercare@rblbank.com

www.rblbank.com