Duplicate Pin Request Form

* Note: For duplicate PIN generation the Bank may levy charges as applicable.

Duplicate PIN Request Form

Date :

Sub: Duplicate PIN (Personal Identification Number) request.

(Please USE BLOCK LETTERS only-All fields marked ” * “ are MANDATORY)

* Name as on the Card :

* ATM/DEBIT Card Number :

* Customer Identification No.:

Account No. :

Please arrange to issue a duplicate PIN. ( Please tick the

appropriate box)

I have forgotten my PIN.

I have not received the PIN till date.

The ATM does not accept the PIN as advised by the bank through the PIN mailer.

The PIN received is illegible.

Kindly mail the regenerated PIN to the address as mentioned below.

I authorised the Bank to change my mailing address and send all my future bank correspondence to my address as

mentioned.

* Company Name / Flat No. &

Bldg. Name :

* Road No./Name :

* Address Landmark :

* City : * Pin Code :

* State : Country :

* Tel. (o) : EXT. No. : STD Code : * Tel .(R):

Mobile No. : Email ID :

____________________

(Customers Signature) Branch Stamp

For Bank Use only :

PB’s Signature for having Verified

1 ) Signature of Customer

2 ) A/c details are correct

Branch Code :

Acknowledgment For Duplicate Pin Request

CUSTOMER COPY

ATM / DEBIT Card No. :

Acknowledgment date :

Signature of Bank official : __________________

BRANCH CODE :

( To be completed by customer only )

The Branch Manager,

HDFC Bank Ltd.

BANK

HDFC

We understand your world

BM/approval ( in case of exception) Signature Code

PB Authoriser’s Signature and Code

D D M M Y Y

* Note: For duplicate

PIN generation the

Bank may levy

charges as

applicable.

D D M M Y Y Y Y

C 70