Format of Application for Issue of Loose Cheque in Current Account

The _________ Manager,
_________ Bank,
__________________

Subject: Issue of Loose Cheque in my/our Current Account no. _________

Sir,

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

1.    That I _______.

Thanking You,
Yours Faithfully

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