DORMANT ACCOUNT REACTIVATION FORM

Date :__________________________________________________________

Account No : _____________________________________________________

Customer Name : _________________________________________________

Reason for Dormancy : _____________________________________________

________________________________________________________________

Amount Deposited: D _______________________________________________

CUSTOMER INFORMATION UPDATE

Residential Address : _________________________________________________

Tel: ________________________ Mobile : ______________________________

E-mail Address : _____________________________________________________

Occupation : ________________________________________________________

Employer Name : ____________________________________________________

Office Address : _____________________________________________________

My account has been inactive for over six months, I wish to resume transaction of business through my
account with you . Kindly reactivate my account and I understand that I am required to effect deposit as
part of the account reactivation process, I also confirm that the above information is correct.

_______________ _______________ ______________

Authorised Signatory Authorised Signatory AuthorisedSignatory

FOR OFFICE USE ONLY

Customer Information Updated by

CSI: ________________________ Signature: ____________________

HOP: _______________________ Signature: ____________________