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Electronic Banking Form Guide

This document is an electronic banking maintenance and cancellation form for a bank. It collects information such as the depositor's name, account number, contact details, and requests to either maintain an existing electronic banking service by changing account details or canceling the service. The form requests identification verification and contains terms for using the bank's electronic banking facilities.

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ErickStaMaria
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52 views1 page

Electronic Banking Form Guide

This document is an electronic banking maintenance and cancellation form for a bank. It collects information such as the depositor's name, account number, contact details, and requests to either maintain an existing electronic banking service by changing account details or canceling the service. The form requests identification verification and contains terms for using the bank's electronic banking facilities.

Uploaded by

ErickStaMaria
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
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ELECTRONIC BANKING MAINTENANCE & CANCELLATION FORM

_____________________
(Branch)

* REQUIRED FIELD

NAME OF DEPOSITOR(S)* :

DATE* :

MOTHERS MAIDEN NAME* :

( MM / DD / YY )

MOBILE NUMBER* : (Country Code + Mobile Number)

E-MAIL ADDRESS* :

TYPE OF ACCOUNT* :

ACCOUNT NUMBER* :

PRESENT ADDRESS* :

ELECTRONIC BANKING FACILITY* :

Phone Banking

Savings Account (SA)

Mobile Banking

Current Account (CA)

Internet Banking

Others, pls. specify ________________________

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
(Branch should verify the Account Number)

SERVICE(S) REQUESTED:

A.

MAINTENANCE
Change PIN

Change of Email Address, pls. specify below

Reset PIN
Reactivation of Facility Access

Change of Mobile Number, pls. specify below

[e.g. 63 9171234567 Mobile number in the Philippines]

Reset / Unlock OARM (Security Questions)

Country Code

B.

Mobile Number

Country

ENROLLMENT
rd

Enroll 3 Party Account for Fund Transfer, pls. specify below


ACCOUNT NUMBER
SA

ACCOUNT NAME

CA _______________________________________

____________________________________________

SA

CA _______________________________________

____________________________________________

SA

CA _______________________________________

____________________________________________

SA

CA _______________________________________

____________________________________________

Enroll Payee/s for Bills Payment, pls. specify below (For Mobile Banking Only)
NAME OF INSTITUTION / MERCHANT

SUBSCRIBER NUMBER

_______________________________________

C.

____________________________________________

_______________________________________

____________________________________________

_______________________________________

____________________________________________

CANCELLATION (For Phone & Mobile Banking Only)


Cancellation of Facility Services
Disenroll Account/s for Fund Transfer, pls. specify below
ACCOUNT NUMBER
SA

CA _____________________

ACCOUNT NAME
_____________________

Disenroll Payee/s for Bills Payment, pls. specify below


NAME OF INSTITUTION / MERCHANT
___________________________________

SUBSCRIBER NUMBER
___________________________________

SA

CA _____________________

_____________________

___________________________________

___________________________________

SA

CA _____________________

_____________________

___________________________________

___________________________________

I / We hereby certify that the information given by me / us is true and correct, and that, I / we agree to the terms and conditions
governing the use of the Electronic Banking Facility of the Philippine National Bank.

______________________________________
Signature of Depositor*
PROCESSD BY / DATE :

APPROVED BY / DATE :

_______________________________________
Signature of Co-Depositor
ENCODED BY / DATE :

Note: Please present 1 Valid ID with picture for verication.


Form 2058, Apr 2015

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