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Change of Status Form
Change of Status Form
Change of Status Form
Form Date:
Mailing Address: Forever Plaza, 74, Hill Road, Opp. St. Stanislaus High School, Bandra (W), Mumbai 400 050.
I, bearing FBO ID#* would like to add/change/delete the following details in the system:
Please tick the applicable boxes of the information that you would like to change:
1. NAME CORRECTION:
Last First Middle
Previous Address:
(as per system
)
New Address:
`
3. CONTACT INFORMATION CORRECTION:
(Please note that either the Mobile or Alternative Contact can be deleted
) and not both.
Previous Information:
(as per system
) Delet Delet
Mobile:
* e Alternative Contact* No: e
Email Address:
* Delet
e
New Information:
Mobile:
* Alternative Contact* No:
Email Address
*:
4. PERMANENT ACCOUNT NUMBER (PAN) CORRECTION: (Please submit copy of PAN Card. PAN has to be of the applicant in who’s name the FBO ID is in.)
PAN Number:*
5. SPOUSE INFORMATION CORRECTION: (Applicable only for the applications which contains Primary and Secondary name)
Last First Middle
Spouse Name:
Name: