A bank account change form is submitted by an employee who wants salary credited to a different bank account. Because account changes are a common fraud route, the form includes verification steps such as a cancelled cheque, call-back confirmation and an effective payroll month.
Call-back done on registered mobile on [Date] by [Name]
Penny-drop / test credit successful (if used)
Updated in payroll from [Month YYYY]
Privacy notice: [Company Name] collects the details on this page only for crediting your salary and reimbursements. Access is limited to authorised HR staff, and the record will be kept for the duration of employment and the statutory retention period for payroll records, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.
Declaration
I request that my salary be credited to the new account above from the month stated. I confirm I am the holder of this account and that [Company Name] will not be responsible for credits made as per this instruction.
I hereby cancel my earlier nomination(s) for the benefits ticked below and nominate the following person(s).
Gratuity
Group term life insurance
Group personal accident insurance
Unpaid salary, leave encashment and other dues
Other: [Specify]
Nominee Name
Relationship
Date of Birth
Address
Share (%)
Guardian (if minor)
[Name]
[Relationship]
[DD/MM/YYYY]
[Address]
[%]
[Guardian Name / NA]
[Name]
[Relationship]
[DD/MM/YYYY]
[Address]
[%]
[Guardian Name / NA]
[Name]
[Relationship]
[DD/MM/YYYY]
[Address]
[%]
[Guardian Name / NA]
Note: For Provident Fund, I will file or update my e-nomination through the EPFO member portal using my UAN.
Privacy notice: [Company Name] collects the details on this page only for paying benefits and dues to your nominees. Access is limited to authorised HR staff, and the record will be kept for the duration of employment and until all dues are settled, plus the retention period, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.