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ATM Card Request and Maintenance Form As of Oct 2024

This document is an ATM Card Request and Maintenance Form used for various requests related to ATM cards, including new applications, maintenance requests, and lost card declarations. It requires the applicant's personal information, account details, and specific requests such as blocking a card or replacing it. The form also includes an acknowledgment section for processing and approval by bank personnel.

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rcambray53
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66 views1 page

ATM Card Request and Maintenance Form As of Oct 2024

This document is an ATM Card Request and Maintenance Form used for various requests related to ATM cards, including new applications, maintenance requests, and lost card declarations. It requires the applicant's personal information, account details, and specific requests such as blocking a card or replacing it. The form also includes an acknowledgment section for processing and approval by bank personnel.

Uploaded by

rcambray53
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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ATM CARD REQUEST / MAINTENANCE FORM

Date:

Name of Applicant: CIF No:


Last First M.I.

Name of Co-Depositor And/Or

Account Name: CIF No:


Last First M.I.

Card Number

Type of Card CA/SA Debit Card-International


Primary Account (For RCBC ATMs) SA
CA

Default Account (Other ATMs) CA/SA

My Wallet Cash Card -Local My Wallet Cash Card – International


Others (Please specify):

MAINTENANCE REQUEST
Please process the following pertaining to my ATM Card:
Block card Unlink Accounts (via Business Center)
New PIN/Re-PIN Others
SMS Enrollment Link Additional Accounts
Replace Card

LOST ATM
Lost ATM Card Declaration:
I declare on _________date and time_________that:
1. I lost my ATM for the above account.
2. All my efforts to find the lost ATM was unsuccessful.
3. I am authorizing for the said lost ATM to be immediately blocked/deactivated.
4. I am requesting for the issuance of a replacement ATM.
I confirm that all facts and information stated by me in this form are true and correct. I shall indemnify and/or hold RCBC and its stockholders, directors,
officers, or employees free and harmless against any loss or damage that they may incur in connection with my declaration and requests in this form,
except if such claim directly arose from the Bank's sole fault or gross inexcusable negligence.

Accountholder’s Signature/Date Signed

ACKNOWLEDGMENT:

Telephone PIN ATM Card

Processed by/Date Approved by/Date Card/PIN released by

F
ATM CARD CLAIM STUB
To Business Center New Card Application
From Replace Card

ACCESS CARD NUMBER NAME RECEIVED BY/DATE APPROVED BY/DATE

ATM-CMF (November 2022)

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