Address & Contact Number Update Form

DD-MM-YYYY
Service Outlet: __________________________________________ Date: _____________________

Account Holder Information

Account Title:____________________________________________________________________________________________________________________________

Account Number:

DD-MM-YYYY
Date of Birth: _________________________________________________Mother’s Name: ________________________________________________________
Please update my/ our Address, Contact Number or E-mail ID with you as per bellow information:

Address Update (Please mention the Flat/ Floor No, Building Name if available)

□ Office □ Communication Address: Residence/ Office/ Permanent Address

Fill up new Office Address and Tick mark which one will be treated as Communication Address
a) New Address: ________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________Post Code ______________

□ Residence □ Permanent
Fill up new Residence/ Permanent Address (if applicable)
b) New Address: ________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________Post Code _____________

Contact Number & E-mail ID
+ 88 AREA CODE NUMBER + 88 NUMBER

□ Residence Number: ______________________□ Mobile Number: __________________ □ E-mail ID: ______________________________________

+ 88 NUMBER + 88 NUMBER

□ Office Phone Number: ____________________________ EXT: _________________ □ Fax Number: __________________________________________

Declaration (I/We declare that, the above mention information(s) are provided by me/us is correct)

1st Accountholder’s Signature 2nd Accountholder’s Signature

For Service Outlet use only: All Account Holders are required to sign regardless of mode of operation
Customer physically presented Proof of Address received IB facility checked (Yes/No) Debit Card checked (Yes/No)

Received by (with seal/PIN) Approved by (with seal/PIN)

For A/C Services use only: If IB or Debit Card is available, to update changed information in Internet Banking or IRIS software,
this Form must be forwarded to CS&LS after execution by Account Services.

Data inputted by (with seal/PIN) Approved by (with seal/PIN)

For Custodial Service & Liability Support (CS&LS) use only: (if Internet Banking/Debit Card or both available)

____________________________ __________________________
Data inputted by (with seal/PIN) Approved by (with seal/PIN)

** Seal is mandatory for Business Account *All blank fields must be marked as “N/A”

Process Management, Operational Risk Management, Risk Management Division’2013