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‫ﺇﺩﺍﺭﺓ ﺧﺪﻣﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﻴﻦ‬ ‫ﻃﻠﺐ ﺍﻟﻤﺪﻓﻮﻋﺎﺕ ﺍﻟﺸﻬﺮﻳﺔ ﺍﻟﻤﺒﺎﺷﺮﺓ‬

Customer Services Directorate Application for Monthly Direct Debit

Customer Details ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺸﺘﺮﻙ‬


DDI Reference No. 50393988001002 ‫ﺭﻗﻢ ﺗﻌﻠﻴﻤﺎﺕ ﺍﻟﺪﻓﻊ ﺍﻟﻤﺒﺎﺷﺮ‬
Electricity Account 7667420 ‫ﺭﻗﻢ ﺣﺴﺎﺏ ﺍﻟﻜﻬﺮﺑﺎﺀ‬
Customer Name FATEMA SAYED MOHAMED ALAWI MOHAMED ‫ﺍﺳﻢ ﺍﻟﻤﺸﺘﺮﻙ‬
CPR/CR (Nationality) 600301532 (Bahrain) ‫ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬/‫ﺍﻟﺮﻗﻢ ﺍﻟﺸﺨﺼﻲ‬
Customer Address House 232 ROAD 0507 ISA TOWN 0805
‫ﺍﻟﻌﻨﻮﺍﻥ‬
Mobile phone 39224885 ‫ﺍﻟﻬﺎﺗﻒ ﺍﻟﻨﻘﺎﻝ‬
e-mail NABOOLS@HOTMAIL.COM ‫ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
Bank Account Details ‫ﻣﻌﻠﻮﻣﺎﺕ ﺍﻟﺤﺴﺎﺏ ﺍﻟﺒﻨﻜﻲ‬

Bank Name AHLI UNITED BANK


‫ﺇﺳﻢ ﺍﻟﺒﻨﻚ‬
Bank Account (IBAN) BH46 AUBB 0001 3524 6703 00 ‫ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ ﺍﻟﺒﻨﻜﻲ ﺍﻟﺪﻭﻟﻲ‬

Bank Account Name FATEMA SAYED MOHAMED ALAWI MOHAMED ‫ﺍﺳﻢ ﺻﺎﺣﺐ ﺍﻟﺤﺴﺎﺏ‬
Payment Frequency Monthly ‫ﺷﻬﺮﻱ‬ ‫ﺗﻜﺮﺍﺭ ﺍﻟﺪﻓﻌﺎﺕ‬
Maximum Payment BD. 70.000 ‫ﺃﻋﻠﻰ ﻗﻴﻤﺔ ﺩﻓﻊ‬
First Payment Date 28/07/2022 ‫ﺗﺎﺭﻳﺦ ﺃﻭﻝ ﺩﻓﻌﺔ‬
‫ﺃﻧﺎ ﺍﻟﻤﻮﻗﻊ ﺃﺩﻧﺎﻩ ﻭﺑﻌﺪ ﺍﻃﻼﻋﻲ ﻋﻠﻰ ﺍﻟﺸﺮﻭﻁ ﺍﻟﻤﺒﻴﻨﺔ ﻓﻲ ﻫﺬﻩ ﺍﻻﺳﺘﻤﺎﺭﺓ ﺍﺗﻌﻬﺪ ﺑﺎﻻﻟﺘﺰﺍﻡ ﺑﻬﺎ‬
I undersign have read and accepted the conditions of this application and agreed upon.

Applicants Name FATEMA SAYED MOHAMED ALAWI MOHAMED ‫ﺍﺳﻢ ﻣﻘﺪﻡ ﺍﻟﻄﻠﺐ‬
CPR/CR 600301532 ‫ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬/‫ﺍﻟﺮﻗﻢ ﺍﻟﺸﺨﺼﻲ‬
Bank Signature ‫ﺍﻟﺘﻮﻗﻴﻊ ﺍﻟﺒﻨﻜﻲ‬
Date ‫ﺍﻟﺘﺎﺭﻳﺦ‬

DD-RNH Average Bill 46.621 O/S as registered = BD 370.630

EMPOWERED BY:
EWA

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