Annexure -5

APPLICATION FOR RE-GENERATION OF PIN MAILER FOR
PASSWORD LOST / LOCKED / FORGOTTEN

(Tick the applicable boxes)
To
Branch Manager Date:
Indian Bank,
……………………………………………..Branch
Dear Sir,
Request for issue of new login password
issue of new transaction password
I am an account holder in your branch with CIF Number:
I have lost/forgotten/misplaced the password / my pass word has been locked for the Internet Banking
for the above CIF.
I request you to issue me new login password;
I request you to issue me new transaction password
(Please tick the applicable box / boxes)
The necessary charges may be recovered from my primary account number ……………………………
Yours faithfully,
1.Signature & 2.Signature & 3.Signature & 4. Signature & 5.Signature &
Name Name Name Name Name
(to be signed by all in case of joint accounts and all partners in case of partnerships)
FOR BRANCH USE
Verified the signature/s. Informed Project Office through IP message on …………………………… and MIS
sheet sent.
Other Comments/Noting:
Date: Officer In Charge Branch Manager/Assistant Branch Manager
Disclaimer: Customer is advised to check/verify the Information furnished above before submitting, Indian Bank cannot be held liable
in case any harm, damages, loss caused due to incorrect information provided by the customer.