Annexure V

Date: ……/……./……………

Kumari Bank Limited APPLICATION FOR CHANGE IN CUSTOMER INFORMATION

Branch:……………………….

Dear Sir/Madam,
This is to inform that certain KYC information I/We had provided during the time of account opening
now stands changed. The Details of such Information are:
SN Details Previous Details New Details
1 Communication Address*
2 Permanent Address

3 Phone Number

4 Mobile Number
5 Email
6 Other…………………..

Account Number:………………………………………………………………………………………………………………………………………
Account Name: …………………………………………………………………………………………………………………………………………

……………………………………………..
Signature (s) b:tvt -x?_ Stamp -5fk_
(Note*Address verification document is submitted and self declared site map is drawn on the overleaf of
this application for communication address)

For Bank Use only

Entered By: Verified By:

Staff Name: ………………………………………… Staff Name: ………………………………………
Signature: …………………………………………… Signature: ……………………………………………
Date: …………………………………………………… Date: ……………………………………………………