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Request Document PDF

This document is a request form for a customer to obtain copies of documents from their bank account. It collects information such as the customer's account name and number, contact details, and the type of document requested, such as bank statements or cheque images. The customer can choose whether they want the documents certified or delivered to them by courier or for collection at the branch. It also includes a declaration acknowledging fees and charges and provides spaces for signatures and details of the document delivery for the bank's records.

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miriam chew
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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103 views1 page

Request Document PDF

This document is a request form for a customer to obtain copies of documents from their bank account. It collects information such as the customer's account name and number, contact details, and the type of document requested, such as bank statements or cheque images. The customer can choose whether they want the documents certified or delivered to them by courier or for collection at the branch. It also includes a declaration acknowledging fees and charges and provides spaces for signatures and details of the document delivery for the bank's records.

Uploaded by

miriam chew
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Request For Document

Part 1 My / Our Particular


Account Name
NRIC / Passport No./
Business Registration No.
Account No.

Contact No.

Person authorised to collect NRIC / Passport No.


Part 2 My / Our Request
1. I/we request a copy of the following document(s) :
Cheque Image Image Return Document (Duplicate)
Clearing Cheque (original) Deposit Slip / Credit Advice
Withdrawal Slip / Debit Advice Security Document
Statement of Account
Others, please specify
Additional Information on the document(s) requested [ e.g. statement for xx month, cheque number etc.]

2. I / we request for certification of the document(s) requested


No Yes

3. Please deliver the document(s) to me/us as follows :-


To collect at branch By Courier
Part 3 Payment
Debit from Savings Account / Current Account - - -
Part 4 Declaration # Only applicable for Person authorised to collect
I / We understand that the copy document is subject to the fees and charges. For I hereby acknowledge receipt of the copy of document requested.
details of the charges, please refer to UOB Fees & Charges at our Name
website: [Link]
ID no. as per NRIC/PP

Customer Signature Recipient's Signature


Date: - - Date: - -
D D M M Y Y Y Y D D M M Y Y Y Y
Part 5 For Bank Use Only
1
OTC Attended By Approved By EWF Maker EWF Checker
Offsite(with Biometric) 2
Offsite(without Biometric) 3
Offsite Collected By:
Name Name Name Name

Rec Date & Time Scan Date & Time QR Date & Time
Mail In 4 Customer Signature Verified 1,2,3 Supporting Document, if any 1,2,3,4,5 Job Batch ID No. No. of Pages
5
Fax MyKad Biometric Verified 1,2
Reason for copy document:
For statement request For attention of
Branch Code: Waived Service Fee Courier Fee Branch COC / CMOC GSU
1006200071 (SVC-DEPCA) 1007622081
Cost Centre: GL No. T&O Others
1006200521 (SVC-DEP-SA) (RECY-COURIER)

Charges (RM): Postage (RM): Total Charges (RM): Copy made on (ddmmyy)

[DOC-01 : Rev 09/18]


United Overseas Bank (Malaysia) Bhd. (271809K)

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