The _________ Manager,
_________ Bank,
__________________

Subject: Issue of New Cheque Book in my/our Savings Account no. _________

Sir,

Please issue me/us a Cheque Book in my/ our Savings Account no. _________ in this connection I undertaking & declare as under:

1.    That till date I have not been issued any Cheque Books/ Loose Cheque.

Thanking You,
Yours Faithfully,

Signature: _________
Name & Address: _________
Contact No. : _________