Date Siebel Request No.
For Bank Use:
Customer Account Type:
Wealth Privy Resident Individual Non-Individual Non Resident
Individual CRN Corporate CRN
Telephone Number Office Residence
Mode of Operation Singly Either / Survivor Jointly Anyone / Survivor
CASA Account Number Investment account Investment A/c No.
Demat Client ID Credit Card Credit Card No.
Merchant Acquiring Services MID TID
I/We
Request you to update your records as per the details provided below.
To update
Name*
Induvidual Customer
Office / Indian (in case of NRI/PIO) Address. Please select the below Options
Please tick if your Office address is same as your mailing address (where all communications will be sent)
Change to be done at CRN level (i.e. for all the relationships with the bank) Change to be done at above mentioned Account level
Flat Number/Building Street/Block
Area Landmark
City Pin Code State Country
Residence / Overseas (in case of NRI / PIO) Address / Registered Address
Please tick if your Residence address is same as your mailing address (where all communications will be sent)
Change to be done at CRN level (i.e. for all the relationships with the bank) Change to be done at above mentioned Account level
Flat Number/Building Street/Block
Area Landmark
City Pin Code State Country
Non-Individual Customer
Change in address at Corporate CRN (Change will apply to all existing accounts) Change to be done at above mentioned account only
Change in address at all AUS level Change in address to be applied to specific AUS only
List of CRNs of AUS for whom change in address will apply (Applicable in case of ‘Change in address to be applied to specific AUS’ only)
Flat Number/Building Street/Block
Area Landmark
City Pin Code State Country
Telephone Number Office Residence
Mode of Operation Singly Either / Survivor Jointly Anyone / Survivor
Mobile Number
E-Mail address
Please sign in case changes required in Moble No. / E-mail ID
Customer’s Sign
(in case of the Non-individual, please provide sign,
Update PAN Name & Designation with stamp of organization)
Nomination display on Net Banking & all Customer Deliverables Yes No
Request to Correct Date of Birth (provide a valid age proof)
POS / Bharat QR Address Change. Please select the below options
Installation Address Registered Address Mailing Address
Flat Number/Building Street/Block
Area Landmark
City Pin Code State Country
Terminal (Model) Type change: Old Terminal Type: New Terminal Type: TID No:
Deactivation request reason
TID Number 1 : TID Number 2 :
Change in mode of Payment instructions for credit POS/QR settlement:
I would like to change my Kotak (Settlement/Debit) account to IFSC Code :
I would like to change my settlement account (Other Bank A/c Details) to :
Beneficiary Bank A/C Number Beneficiary IFSC Code
Beneficiary Bank A/C Name Branch Name & City
Beneficiary Account Type : Saving Current
Request to update the Activation of the facility : Refund Pre Auth Facility Key Entry Tip Adjustment International Card Acceptance
Request to update the Deactivation of the facility : Refund Pre Auth Facility Key Entry Tip Adjustment International Card Acceptance
Change in transaction Limit : Daily Txn Limit Per Txn Limit Monthly Txn Limit
Change in Parameter DBA Name From _______________ To _______________ Merchant category From _______________ To _______________
Activation / Deactivation of Value added Services Type of Service Charges
Same day settlement: Yes No Settlement Cycle 1 (Cut off time 2 pm) Settlement Cycle 2 (Cut off time 5 pm) Both
Same Day Settlement cycle will be updated in system within 48 hours. Same day settlement fee (as a % of settled value)_________________________________
Contact Person Name
Contact Person Number
Request pertaining to Demat Account only : Dividend A/c Demat Charges
Bank Name :
Branch Name & Address :
Flat Number/Building Street/Block
Area Landmark
City Pin Code State Country
Account Number : MICR Number :
Request to Update PAN Number : Request to update Aadhaar :
Debit Authorization (Authorization for debiting the CASA A/c for bank charges & undertaking for the payment of interest in case of occurrence of Debit
Balances).
I/We authorize the Bank to debit the said account for the applicable service charges payable by the below mentioned person also :
Sr.
Account Holders' Name Demat Account No.
No.
For Bank Use only
Date of Acceptance Sol ID
KMBL/Feb 2022/V 1.05
Receiver’s stamp
Sign & Emp Code
Signature verified by
Authorized by
Documents sent to CPC / RPC on
Declaration:
I / We hereby authorize the bank to debit all types of applicable bank charges / service charges payable by me / us to Said Account /s. I / We undertake that
sufficient balances shall be maintained in the Said Accounts to facilitate the debiting of applicable Service Charges. The failure on part of me / us to maintain
sufficient balances in the Said Account shall not any way impair the right of the Bank to Debit the Service Charges. I / We hereby further authorize the Bank to
charge any interest on Debit balance in the Said Accounts due to the debiting of applicable Service Charges. The Bank shall not be obliged to provide overdraft
facility on the Said Account but for towards the debiting of applicable Service Charges payable by us / me. I / We specifically agree and confirm that any matter
or issue arising hereunder shall be governed by and constructed exclusively in accordance with the Indian Laws and shall be subject to the jurisdiction of the
courts of Mumbai in India.
I / We also undertake to intimate the Bank in case of non receipt of alerts on the Mobile number / E-mail ID provided to the Bank for receipt of Alerts. I / We
agree that the Bank shall not be held responsible for non-receipt of transaction related alert in case of a fraudulent transaction in the my / our account / s.
I / We agree that in case of non updation of Mobile Phone Number in my account, Bank will restrict electronic transactions (e.g. NB, MB, ECommerce, POS) in
the account and will allow only ATM cash Withdrawals.
I have voluntarily supplied the above information which I acknowledge that the Bank is required to obtain to provide its products and services to me. I have
gone through the Privacy Notice published by the Bank on its website www.kotak.com and having agreed to the same I hereby give my consent in favour of
the Bank to process my personal information for the purposes and in the manner provided in the Privacy Notice while I avail various products and services
from the Bank.
Date :
Signature(s)
1st Account Holder 2nd Account Holder 3rd Account Holder 4th Account Holder
(In case of Non-Individual, please provide Sign, (In case of Non-Individual, please provide Sign, (In case of Non-Individual, please provide Sign, (In case of Non-Individual, please provide Sign,
Name & Designation with stamp of Name & Designation with stamp of Name & Designation with stamp of Name & Designation with stamp of
Organization) Organization) Organization) Organization)
Customer Acknowledgement
Imp Notes:
(For Individual - at Account level changes, all the account holders need to sign whereas at CRN level changes, respective CRN holder has to sign For Non-
Individual, signatures as per MOP required.)
Please Note :
* To be accompanied by a copy of the gazette notification along with updated PAN Card. If the change of name is on account of marriage, an attested copy of the
marriage certificate along with updated PAN Card must be submitted (Applicable for CASA accounts only).
1. For change in address, please provide proof (self attested) of the new address by submitting a copy of Passport / Driving Licence / Election Card / Electricity Bill
or Landline Telephone Bill, not more than 3 months old (For Demat only) and for CASA as per KYC Grid. Also for change in address request for a Demat A/c
please provide valid identity proof & a copy of latest DP transaction statement along with new address proof.
2. For updating PAN Number, kindly provide an original copy of PAN Card.
3. For change of bank details in case of a Demat account; proof of the new bank details are required to be submitted (attested copy of bank statement or copy of
Cheque)
4. Please submit separate requests for different client IDs (For Demat only)
5. For Demat related requests, the form must be signed by all the account holders (For Individuals) and by Authorized Signatories as registered (For Non-
Individuals).
6. In case of Mutual Fund Investment, submit the "KYC Details Change Form for Individuals / Non Individuals" to KRA (KYC Registration Agency) for affecting
address change and contact details change across all AMC's. Forms are available on respective AMC / KRA sites.
7. In case of Mutual Fund, for any change in mode of operation, change in name, signature & Bank details, customer to give a separate request for each AMC
(folio wise) to the Bank or to the AMC directly. In case of name change on account of marriage Notarized copy of Marriage certificate, Pan Card with new name
and old and new signature of the investor, if so changed, attested by Bank is required.
8. For change in Mobile / E-mail Id, please provide an ID proof.
9. Please note that address change at account level will be done only when you have mentioned the respective account number at the top.
10 For change of bank details in case of a NEFT account; details of new bank details are required to be submitted with (cancelled copy of Cheque).
11. Please note that address change at terminal level will be done only when you have mentioned the respective MID / TID number at the top and address proof
given.
Acknowledgement Slip
We acknowledge the receipt of Customer Modification instruction from Mr./ Mrs. /Ms
relating to Customer relationship number under service request number
Date: Bank Official (Sign and stamp)
For Kotak Mahindra Bank Ltd.,
Kotak Mahindra Bank Ltd. CIN: L65110MH1985PLC038137
Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai - 400 051. www.kotak.com
