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Customer-request-form 1

The document is a Customer Request Form that collects personal and account information for various banking requests. It includes sections for individual and enterprise details, request types such as account statements, migrations, closures, and updates, as well as certification and authorization signatures. Additional instructions note the need for valid identification and a utility bill to accompany the form.

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binaryfxtminvestmentcompany
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21 views

Customer-request-form 1

The document is a Customer Request Form that collects personal and account information for various banking requests. It includes sections for individual and enterprise details, request types such as account statements, migrations, closures, and updates, as well as certification and authorization signatures. Additional instructions note the need for valid identification and a utility bill to accompany the form.

Uploaded by

binaryfxtminvestmentcompany
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Customer Request Form

PERSONAL INFORMATION (PLEASE USE CAPITAL LETTERS)


BVN No: Account No: Date:
D D M M Y Y Y Y
Mobile No: Whatsapp No:
FOR INDIVIDUAL ONLY:
Title: MR/MRS/MISS/DR/CHIEF/PROF: Surname:

First Name: Middle Name:


FOR ENTERPRISE/SOLE PROPRIETOR ONLY:
Business Name:

BN: TIN:
PLEASE TICK YOUR REQUEST TYPE:
D D M M Y Y Y Y D D M M Y Y Y Y
Account Statement Request: From Date: To Date:
Old Account Class New Account Class
Account Migration Request:
Documentation Submitted?
Reference/Confirmation/ Address Letter to:
Non-Indebtedness Letter:
Failed Transaction:

PND Lift SMS deactivation SMS activation Collapse ID


D D M M Y Y Y Y
Transaction Date Transaction Amount

POS ATM MOBILE WEB USSD


Reason for Account Closure: Move Balance to Existing Account:
Account Closure Request

:Card Issuance/ Visa Card MasterCard Verve Card Mobile Pin Activation/Modification
Mobile App:
PIN Activation PIN Reset: Enable Profile: Phone Unlock: Token Activation

ACCOUNT INFORMATION UPDATE (for update on existing data with the bank, tick as appropriate)
BVN Update/correction Customer Information Update Reactivation

Reason for Change: Marriage Others: SEX: Male Female


For Address Change
New Address:

For Change of Phone no:


D D M M Y Y Y Y
New Phone Number: Update of Date of Birth:
For Change of E-mail:
New E-mail:
For Change of Name:
Title: MR/MRS/MISS/DR/CHIEF/PROF: Surname:

First Name: Middle Name:


Certification:

I, ................................................................................................................................ certify that the information provided by me above are true and correct and here
by authorize the update.
Other remark(s):

Authorized Signatory/Date Authorized Signatory/Date

FOR OFFICIAL USE ONLY


Customer Care Officer: Signature Date
D D M M Y Y Y Y

Head of Operations: Signature Date


D D M M Y Y Y Y

Account officer/Branch Manager: Signature Date


D D M M Y Y Y Y

*Kindly provide valid means of identification and utility bill in addition to this form

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