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    Customer Request Form

    Uploaded by

    Shree Ganesha
    The document is a customer request form for a loan account. It collects information such as the customer's name, address, contact details, and loan account number. The customer can request services like loan statements, documents, pre-closure details, and bank account or address changes. It outlines the process for refunds, part payments, and EMI changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Customer Request Form

    Uploaded by

    Shree Ganesha
    12 views2 pages
    The document is a customer request form for a loan account. It collects information such as the customer's name, address, contact details, and loan account number. The customer can request services like loan statements, documents, pre-closure details, and bank account or address changes. It outlines the process for refunds, part payments, and EMI changes.

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    CustomerRequestForm

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    The document is a customer request form for a loan account. It collects information such as the customer's name, address, contact details, and loan account number. The customer can request services like loan statements, documents, pre-closure details, and bank account or address changes. It outlines the process for refunds, part payments, and EMI changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    12 views2 pages

    Customer Request Form

    Uploaded by

    Shree Ganesha
    The document is a customer request form for a loan account. It collects information such as the customer's name, address, contact details, and loan account number. The customer can request services like loan statements, documents, pre-closure details, and bank account or address changes. It outlines the process for refunds, part payments, and EMI changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Customer Request Form

    Please fill in BLOCK le�ers

    Loan Account No: Date: DD/MM/YYYY


    Name of Borrower / Co-borrower / or authorized person on behalf of borrower:

    Correspondence Address:
    Contact No: E-mail Address:
    I / we request you to provide me / us with the following service(s). I am / we are aware of the charges to be paid for the requested service, wherever applicable.

    Deliverables:
    1.Welcome Kit 2.Repayment Schedule 3.Statement of Account 4.Original Document
    5.Interest Statement a) Provisional b) Final 6.List of Documents 7.Loan pre-closure Statement
    8.Closure NOC 9.Rate Change Le�er 10.PDC Request 11.Insurance related Please specify

    12.Copy of Documents Please specify 13.Others

    Financial:
    1.Pre-closure Payment Would you like to con�nue with the Life Insurance policy? Yes No

    2.Part Payment with effect on i) Tenure ii) EMI (Please indicate below source of funds in case of pre-closure payment or part payment)

    a) Salary / Business Income b) Proceeds from investments c) Sale of immovable property d) Sale of movable property such as jewellery, vehicle etc
    eg. FD, insurance, mutual funds, shares, debentures etc

    e) Loan / contribution from family and relatives f) Transfer of loan to other bank / FI g) Other Sources

    3.Refund Related a) PF Refund b) Refund of Excess EMI Collected c) Other Refund

    4.Bank Account Swap 5.ROI Conversion with effect on i) Tenure ii) EMI
    6.EMI Related a) Payment/ EMI Not Deducted b) Date Change c) EMI- under construction d) EMI Amount Change

    In case of payments, if any - Cheque / DD No. I


    Dated: DD/MM/YYYY
    Please note:
    • For any refund, copy of cancelled cheque or bank statement showing IFSC, bank account number & account holder’s name needs to be a�ached.
    • Payment deposited will first be adjusted towards the overdue amounts (EMI/ cheque bounce/ late payment charge), if any.
    • Once loan tenure is reduced due to part payment, at a later date, increase of tenure by reducing EMI will not be permi�ed.
    • For a change in loan repayment bank account, current month’s EMI will be debited from exis�ng bank account only.

    Change of Address: Communica�on Residence Office Permanent


    New Address:
    Landmark: City: State:
    Pin Code: E-mail Address: Contact Number:
    Document for proof of address (Mandatory for change in Correspondence Address)
    PCHF/CRF_FORM/March_20/V.04

    Document Type/No.: Issue Date: Valid Till:


    Remarks:
    I / We hereby take full responsibility for the request men�oned above & PCHF Official’s Name:
    confirm that all the applicants are aware of the said request & have no
    objec�on.
    Sign:
    Customer Sign:
    Time In: Time Out:

    Customer Acknowledgment Copy


    Date: Branch: Loan Account No.
    Customer Name: Customer Service Officer Name:
    Service Request No. Details of Cheque submi�ed, if applicable
    Signature
    • For any refund, copy of cancelled cheque or bank statement showing IFSC, bank account number & account holder’s name needs to be a�ached.
    • Payment deposited will be first adjusted towards the overdue amounts (EMI / cheque bounce / late payment charge), if any.
    • Once loan tenure is reduced due to part payment, at a later date, increase of tenure by reducing EMI will not be permi�ed.
    • For change in loan repayment bank account, the current month’s EMI will be debited from exis�ng bank account only.

    For any queries please call us on 1800 266 6444 or write to us at [email protected]

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