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Registration of bank account for web enabled online payment facility for Housing loan Customers

To, HDFC LTD, Manager Sub : Request for Registration of bank account for web enabled online payment facility with HDFC LTD I/We, the undersigned, hereby request you to kindly register my bank account with you for web enabled online payment facility. The details are as follows : Housing Loan Account no. Customer Name (Applicants Name / Co-applicant's Name) Customer name as per Bank account. Bank Account No Bank Name Bank Account type (SB / CA / CC / NRE / NRO / if others specify) Account Type Bank Branch Account operated since MICR Code Mobile no email ID ____________ years / months

Salary Account

Main Business Account

Others (Specify ________________ )

I, hereby declare that the particulars given above are correct and complete. I have also attached following self attested documents along with originals for verification purpose to HDFC LTD. I/We am/are aware that the existing facility is avaialble for selected banks only. I/We undertake not to close this bank account without HDFC LTD's written consent. I/We understand, as per the condition of the offer letter, I've to make the repayment of the loan by Electronic Clearing Scheme / Standing Instructions from HDFC Bank / Salary Deductions / Post Dated Cheques (either one). The Online payment facility extended would be for one-off payment transaction only. Required documents : (All Originals for Verification purpose only) For Identification proof : Driving License / Passport copy / PAN card/Voter ID / Identity card issued by employer/Letter issued by the Unique Identification Authority of India containing details of name,address and Aadhaar number/Letter from recognized public authority or public servant verifying the identity and residence,subject to the satisfaction of HDFC (please tick any one) Driving License / Voter ID/Passport copy / Ration Card / Electricity Bill / Telephone Bill/Ration Card/ Letter from employer subject to the satisfaction of HDFC/ Letter from recognized public authority or public servant verifying the identity and residence or rent receipt or Lease agreement ,subject to the satisfaction of HDFC/Bank account statement (please tick any one) Original & Photocopy of last 3 month Bank account Statement (all Originals for Verification purpose only)

For Address proof :

Bank Statement :

Date: __________________ Signature of the Account Holder (s) For official purpose only :
Date of Receiving form : Officer Name : Service Center : Officers ID :

Signature :