for Approval

Mem orandum
ment Committee
Piocess lmProve

A
Bank Alfalah
BANKALF ALAH
LTD.

Request for Modification in Particulars of Customer Account

(lndividual & Sole Proprietorship Accounts)
Please Complete Applicable Section Only and Cancel Out / Strike throuth other inapplicable sections
Oate: Branch Name Branch Code:

Account litle Account Numbe,i

Customer / Client lD-

rypes of Amendments

l/ we hereby request you to ChanSe / Update the Information or status in the above mentloned account as perthe following deteils

chanse of Address and contact Details E Change ln Title of Account

f]
lD renewal/ DOB/ Fathe/s name/Mothe/s Maiden Name f---'l other chan'es:

1. Change of Address and Contact Details

Current Residential Address Office Address

E Permanent Resldential Addrass Residence Phone E Office/Buslness Phone

Mobile Phon€ No. Fax l{umber €mail

other contact Details

House /
Olfice / Sulte/ Street, Residence Phone
City / Town office / Businesr Phone

State / Province Mobile Phone Number

Country & PostalCode Far Number
Email

Corespondence Addrets/ MalllnS Address (please select anyorle optlonl

I same as my current Residenllal Address ! Same as my ffice lddress fl Same as my ee.manent Residentia I Address

2. tD Renewal/ / Date of Birth / Father's Name/ Amendment in Mother's Maiden Name (Please select options which requir€ up-datron)

E tDlPasspon Erpiry Date E oate of Birth Mothe/s Maiden l{am€ Fathe/s/Hurband l{ame

lolPassport Number(s) Expiry Date Date of Binh

Mothe/s Maiden I{ame Fathe/s/Husband Name

3. Change in Title of Account

Please specifythe reason for chanSe in Title ofAccount

EristlnS Itle of a.count New Title of A(count

Si8nature of Appli.ant (s)

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 um tor
$lem orand
ement
lmProv ufD.
Process

A
Bank Alfalah
BAN K
ALF

4
.Ch.r rl,, ,r Sor rr. .l Fufa! / f.cm., atririse in ffrrloyer / aLr. f"!! !11,1 r i\ .,.t. )

Nature of Change

Existint :

Revlsed:

FATCA and CRS Confi.ma\ion (Applicoble fot oll Anendnents)

FATCA: ls any ofyour previous or new information / address / contact number (Mobile / office)/ source offunds based in the U5? Yes No

ln .ose ol FAICA conlitmotion is Yes , then pleose lollow the below documentollons occotdingly:

- conplele lrcsh "FA|U Checklis( lot the cunomet ond follow documentolion requircmenE.

CRS: ls any of your previous or new informatron

US and Pakistan?
/ address/ contact nurnber (Mobile / office)/ source of funds based otherthan - ] I{o

ln .ose oJ CRS conlhmotion It Yes , then pleose lollow the below docunenlotlont occo.dingly:

Complete'lndividuol fox Residency Set<eftilicrrtion" Fon

Applicants Conlirmation: I / we hereby confirm that the inlormation above is true, accurate and complete. I / we also agree and unde(ake to notify the Bank
within 30 cal€ndar day5 il th€re is a .hange in any information, which I / we have provid€d to th€ bank.

siSnature of Appllcant(sl:

Applicanl 1 Applicant 2

Date

For Bank Us€ Only Branch Authori2ation

We confirm that the new information provided by the customer has been assessed for impact on FATCA and CRS classification of the account and a kesh FATCA
Checklist and CRS relevant forms (where required) has been completed, and new documentation, if required (as established throuSh the check|st ) has been
obtained.

Request Received (Date &Time)l

Received gy (Name & SiSnature) Approved By (Name & Si8nature)

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