Customer Information Change Request Form 2
Uploaded by
tanjenaakter32Customer Information Change Request Form 2
Uploaded by
tanjenaakter32CUSTOMER INFORMATION CHANGE REQUEST FORM
Branch Manager/ OIC, Date / /
……………………………………… Branch/ Uposhakha,
IFIC Bank PLC
ACCOUNT INFORMATION (Please specify your account information)
Account Name
Account Number
CUSTOMER INFORMATION UPDATE (Please fill only required fields; Strike off the section if not required)
Name Change Request Account Holder’s Name Spouse Name Father’s Name Mother’s Name
Updated Name
*Supporting document is required (NID/ Affidavit/ etc.)
Address Change
Present Address Work Address Communication Address
Request
New Address
Permanent Address*
*Mandatory for any address change
Can you reproduce last Yes No Reason for Inability
signature?
** SS card update is required.
Signature Change New signature will be updated
Existing Signature New Signature after approval.
Expiry
NID/Smart ID Passport
Date
Driving Expiry
Mobile Number
License Date
E-mail Address E-TIN
Spouse Name
Transaction Profile Image Nominee Other (please specify)
Others
Update Change Change/Update ……………………………………..
I/We have authorized the above instructions. I/We hereby declare that all details provided in this form are true and correct and are supported by valid documents
enclosed with this form. I/We accept and agree that this declaration shall be in addition to any other declaration provided by me/us with respect to the facility provided
by IFIC Bank and agree to indemnify and keep IFIC Bank indemnified from any loss, damage, claim, action, costs, charges and expenses which IFIC Bank may suffer or
incur as a result of any defect/misrepresentation made by me/us in the above declaration.
Signature of 1st Applicant Signature of 2nd Applicant Signature of 3rd Applicant
Signature Signature Signature
Name: Name: Name:
BANK USE ONLY
All the information stated above and customer signature has been checked and verified. All relevant supporting documents have been obtained as per bank’s
policy.
Note: The form and supporting documents will be attached with the customer’s Account Opening Form.
Remarks:
Initiating Official’s Signature Approving Official’s Signature
Signature Signature
Name: Name:
EID: EID: