ACCOUNT MANAGEMENT FORM

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

Benedict Manluco Serrano January 5, 2009

Please choose a request below and fill out the details

Change Maya-Registered Mobile Number Reason for Changing:

Lost Phone/SIM
Maya-Registered Mobile Number: 0992-689-3190 Stolen Phone/SIM
Disconnected/Defective SIM
New Mobile Number: 0994-739-5590 Changing Mobile Number
Duplicate
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: 0992-689-3190 Account to be Retained: 0994-739-5590

Reason for Having More Than 1 Account Duplicate

Transfer of Balance Reason for Transfer

Voluntarily Closed Account
Source Maya Wallet Number: 0992-689-3190 Duplicate Account
Deceased Account Holder
Target Account Holder's Name: Benedict M. Serrano

Target Maya Wallet Number: 0994-739-5590

Amount to be Transferred: ₱ 2,600.00

BENEDICT MANLUCO SERRANO March 12, 2024

Account Owner's Signature Over Printed Name Date Signed