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Change of Status Form

This document is a change of status form that allows an individual to update their contact information, address, name, PAN number, and spouse details stored in a company's system. The form allows the individual to select the type of information they want to change, provide both their previous and updated details, and requires signatures to authorize and process the requested changes.

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Parag Shrivastava
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2K views1 page

Change of Status Form

This document is a change of status form that allows an individual to update their contact information, address, name, PAN number, and spouse details stored in a company's system. The form allows the individual to select the type of information they want to change, provide both their previous and updated details, and requires signatures to authorize and process the requested changes.

Uploaded by

Parag Shrivastava
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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Change of Status Form

Date:

Mailing Address: Forever Plaza, 74, Hill Road, Opp. St. Stanislaus High School, Bandra (W), Mumbai 400 050.

I, bearing FBO ID#* would like to add/change/delete the following details in the system:
Please tick the applicable boxes of the information that you would like to change:

1. NAME CORRECTION:

Previous FBO Name:* Last First Middle


(as per system)
New FBO Name: Last First Middle

2. ADDRESS CORRECTION: (Please submit copy of Aadhar/Passport/Election Card/Bank Statement/ Driving License/Voter ID/Light Bill or Electricity Bill showing address page.)
Previous Address: (as per system)

New Address:

` 3. CONTACT INFORMATION CORRECTION: (Please note that either the Mobile or Alternative Contact can be deleted and not both.)
Previous Information: (as per system) Delete Delete
Mobile:* Alternative Contact No:*

Email Address:* Delete

New Information:

Mobile:* Alternative Contact No:*

Email Address*:

4. PERMANENT ACCOUNT NUMBER (PAN) CORRECTION: (Please submit copy of PAN Card. PAN has to be of the applicant in who’s name the FBO ID is in.)

PAN Number:*

5. SPOUSE INFORMATION CORRECTION: (Applicable only for the applications which contains Primary and Secondary name)

Spouse Name: Last First Middle

Make Primary Applicant Delete Spouse Correct Name SPOUSE SIGNATURE:

6. ANY SPECIAL REQUESTS:

I understand that requesting the above mentioned changes me/or my spouse will adhere to the rules, regulations and current policies set forth by the Company.

DETAILS OF PERSON SUBMITTING THIS FORM: FBO SIGNATURE:

Name:

FBO ID#: SIGNATURE:

* Marked fields are mandatory


Quick Tip: To have your information updated faster, submit a scanned copy of this form with signatures via email to [email protected]
Ver 10/29/20

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