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Reference Number

	Excellent	Very Good	Good	Fair	Poor
Timing or service availability	Excellent	Very Good	Good	Fair	Poor

Recognition/Greeting/Proper Attention	Excellent	Very Good	Good	Fair	Poor

Incorporation of feedback	Excellent	Very Good	Good	Fair	Poor

Customer complaint resolution	Excellent	Very Good	Good	Fair	Poor

Quickness and accuracy of service	Excellent	Very Good	Good	Fair	Poor

Ease of availability of information	Excellent	Very Good	Good	Fair	Poor

Flexibility of loan repayment schedules	Excellent	Very Good	Good	Fair	Poor

Satisfaction with field officers functioning	Excellent	Very Good	Good	Fair	Poor

Rural Cutomers trust in the manager	Excellent	Very Good	Good	Fair	Poor

Rural customers trust in bank staff	Excellent	Very Good	Good	Fair	Poor

	Excellent	Very Good	Good	Fair	Poor
Expectation that manager will fill form	Excellent	Very Good	Good	Fair	Poor

Speed of loan disbursement process	Excellent	Very Good	Good	Fair	Poor

Safety of money deposited in bank	Excellent	Very Good	Good	Fair	Poor

Safety of gold deposited in bank	Excellent	Very Good	Good	Fair	Poor

Number of visits to open an account with bank

Number of visits for loan with the bank

Number of visits for loan repayment

Does Penal interest act as a detriment to repayment?

Yes

Dont know

Are you a borrower rewarded for prompt interest repayments

Yes

Dont Know

Is there timely reminder to customer to repay the loan

Yes

Dont Know

Do you feel the need to have ATM m/cs

Yes

Dont Know

Do you feel the need for online banking

Yes

Dont Know

Do you feel the need for telephone banking

Yes

Dont Know

Attitude of bank staff towards the customers

Helping

Not helping

Sometimes bad

Briefly Narrate any good /bad experience with the bank staff

Any specific areawhere you feel our bank will improve in providing better services

Customer Name

Acct Number