ACCOUNT MANAGEMENT FORM

Account Owner's Name: Date of Birth (DD/MM/YYYY):

Ana Rebecca Ensomo 01/08/1990

Please choose a request below and fill out the details

Change Maya-Registered Mobile Number Reason for Changing:

Maya-Registered Mobile Number:

09182518028 Lost Phone/SIM
Stolen Phone/SIM

New Mobile Number: 09914735746 Disconnected/Defective SIM

Changing Mobile Number
Others, pls specify ____________________

Reactivate Account Reason for Reactivation:

Dormant Account*
Maya-Registered Mobile Number: Lost Phone/SIM
Stolen Phone/SIM

*For dormant accounts, please make sure you have cashed in at least P200.00 to your Maya account
*For lost or stolen phone/SIM, please make sure you have regained access to your Maya account

Fix a Duplicate Account

Account(s) to be Cancelled: Account to be Retained:

Reason for Having More Than 1 Account

Transfer of Balance Reason for Transfer

Voluntarily Closed Account
Source Maya Wallet Number: Duplicate Account
Deceased Account Holder
Target Account Holder's Name:

Target Maya Wallet Number:

Amount to be Transferred:

Ana Rebecca Ensomo

Account Owner's Signature Over Printed Name Date Signed