Date :
Branch:
GRIEVANCE FORM (Nodal Officer)
DECLARATION
NEED HELP? CONTACT US:
Date:
Please send this form, completely filled and signed, to Mr.Ashok Sunar, Nodal Officer - Grievance Redressal,
Axis Bank ltd. NPCl, 5th Floor, “Gigaplex”, Plot No I.T.S, MIDC, Airoli Knowledge Park, Airoli, Navi Mumbai-
400 708. In case you are not sasfied with our resoluon or if you do not receive a response within 30 days
of approaching the bank, you may contact the Banking Ombudsman.The details of the Banking Ombudsman
Scheme 2006 and the addresses of the Banking Ombudsman offices are available in the Grievance Redressal
Mechanism secon of our website or at any of our branches.
Signature of the customer:
Customer name:
Account number/Loan A/c no.:
Was the complaint lodged previously? :
Date of previous complaint:
Yes
No
Registered mobile no.:
Landline no.:
Account type: Savings
Current Term deposit Demat Loan A/c Others
Details of grievance/complaint
I/We, the complainant/s here declare that:
(a) The informaon furnished herein above is true and correct; and
(b) I/We have not concealed or misrepresented any fact stated in aforesaid columns
and the documents submied herewith
Service request no.:
Please enter a vaild Service Request No. Please obtain a Service Request No. If you
do not have one by following Step 1
Call us on 18604195555 & 18605005555 Visit axisbank.com/support
