Please complete all fields of this Form in CAPITAL LETTERS and countersign any corrections / overwriting
on the form. Please strike out all blank sections in the form prior to submission.
Branch Name : Branch/SOL id : Date : D D M M Y Y Y Y
*CIF ID OR *Account No.:
Name PREFIX FIRST MIDDLE LAST
(As per bank record)
I request you to please update the following details (Please þ tick as applicable)
1-Contact Details
I request the bank to update my contact details given below against my aforementioned Account
Mobile Country Code Residence Country Code Area Code
Office Country Code Area Code
Email ID
2-ID Details
I request the bank to update my Identification details given below against my aforementioned Account
PAN Card OR Form-60 (If PAN not available, please attach Form-60)
Passport Details Number Date of issue D D M M Y Y Y Y Expiry Date D D M M Y Y Y Y
Country of issue
Date of Expiry
Visa/OCI/NRIC/ Number D D M M Y Y Y Y D D M M Y Y Y Y
issue Date
Resident Permit
Details Country of issue
Driving License DL Expiry Date D D M M Y Y Y Y
Voter’s ID Card NREGA Job Card
UID (Aadhaar)
Others Identification Number
(Any document notified by the central government)
3-Address Change / Updation (Please tick appropriate box)
I request the bank to change / update my address details given below against my aforementioned Account
Current Residential
Address
Landmark City Pin Code
State Country
Permanent /
Overseas Address
Landmark City Pin Code
State Country
Office / Business
Address
(India / Overseas)
Landmark City Pin Code
State Country
Mailing Address Current Residence Permanent Office / Business Address
4-Name Change Request
I request you to update my changed name as per below in your records
Name PREFIX First
Middle
Last
I am submitting the supporting ID proofs along with the request
Date : D D M M Y Y Y Y
*Customer Name : FIRST MIDDLE LAST
Request related to :
Name of Bank Official : Bank Official (sign and Stamp) :
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5-Signature Change Request
Old Signature New Signature
I/We hereby declare that the change in Signature would supersede our existing clause in the account with effect from __________________ (date).
I/We shall indemnify and keep the Bank fully indemnified on demand form and against all actions, proceedings, suits, loses, damages, claims, demands, liabilities, expenses (legal and otherwise), interests, costs and
charges whatsoever which may be bought against or suffered or incurred by the Bank howsoever arising from or in connection with the Bank’s acceptance or acting upon this request and/or from other reasons or causes
whatever in connection with this request.
Bank Use Section : I hereby confirm that the above signature is captured in my presence :
Name of Staff/RM: Signature of the Staff: Emp. No.
6-KYC Self Declaration
I ________________________________________________________________________ (Account Holder) have Banking relationship with your
above branch and here-by confirm the details provided below are correct. I/We also attach the necessary Identity Documents and Address proof
documents* along with recent passport size photograph as per your requirement. Please update the details in your records if it is different.
Paste photograph
only for Re-KYC
and Sign across
photograph
*Please submit self-attested photocopy of KYC proofs (whenever required) as per RBI guidelines applicable from time to time.
7-Others
I request you to please update the DOB in the bank records D D M M Y Y Y Y
Other requests: Type of request :
Type of Documents submitted for :
Document Number :
IDENTITY DOCUMENTS
ID proof submitted along with the form : Passport Driving Voter’s ID NREGA UID (Aadhar) Others
License Card Job Card (please specify)
TERMS & CONDITIONS
Terms & Conditions:
I confirm having read and understood the terms and conditions governing accounts and respective services linked to my Account and hereby agree to be bound by the terms and conditions and amendments governing the accounts or
changes thereof and further amendments made by the Bank from time to time. The copy of terms and conditions is available on the Bank's website www.dbsbank.com/in and is also available at the Bank’s branch. I have read and understood
the terms and conditions and agree to keep the Bank indemnified against all liabilities, claims, proceedings, actions and damages in relation to or arising out of the Bank accepting my / our request and transmitting information through
electronic means. All the details and information provided herein are correct and Bank shall not be held responsible for any loss that I/we may suffer due to incorrect mobile number/email address/ mailing address furnished by me / us and
non-delivery / delays of all correspondence / alerts due to any other technical reasons. In consideration of your having acted on my above said instructions for name and or honouring my modified signature, I hereby irrevocably and
unconditionally undertake to indemnify DBS Bank India Limited, (“Bank”) and save it harmless against all costs, expenses, charges, claims (including all attorney’s fees) for defending a claim or claims, that the Bank may suffer or incur in
consequence of or arising from the Bank acting on my modified signature as said above. Please issue new cheque book, debit card (debit Card form attached) and Statement in my changed name and mail the same to my mailing address.
I confirm that the above mentioned information with respect to my bank accounts held with your bank is true & correct. I am aware of charges applicable for various services offered and I accept and agree to be bound by the said Terms &
Conditions. I am aware of charges applicable for various services offered and I accept and agree to be bound by the below mentioned Terms & Conditions. I understand 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 systems from that date only. Deliverables, if any, will be sent to the mailing / communication address as per the latest records
available with the Bank.
Customer Signature (as per bank records) :
FOR BANK USE
Certified that this Request Form is complete in all respects, all relevant documents have been checked and obtained.
Date : D D M M Y Y Y Y
Please process this request.
Branch Checklist : Request received through: Walk-in: Self Bearer Relationship Manager / Staff Mail-Courier
Passport Driving License Others
ID proof submitted along with the from: PAN Aadhar (Please specify)
Attending Officer’s: Name Signature Employee ID
Call back done on contact number: Country Contact Number : Date & Time :
Code :
Call back done by officer’s Name & Signature: Signature Employee ID
Name
Customer Signature verified by:
Name Signature Employee ID
Customer Care (24x7): India Helpline (Toll number) : 1860 267 1234
International Helpline : +91 44 6685 4555
From Singapore (only) : 800 852 6186
Email: customercareindia@dbs.com | Visit us at: www.dbsbank.in
2 SBA_CPU/002/NOV 22
