Please ensure all information is accurately filled out and submit this form to the respective department for processing. This form is an essential part of [Your Company Name]'s procedure for verifying and maintaining accurate account records.
Name: | |
Account Number: | |
Email: | |
Phone Number: | |
Address: | |
ID: | |
Proof of Address: |
Type of Account: |
|
Bank Name: | |
Branch Address: | |
Branch: |
Purpose of Verification: |
|
Date: |
Name: [Bank Representative’s Name]
Signature:
Date: [MM-DD-YYYY]
I hereby acknowledge that the information provided above is accurate and authorize [Your Company Name] to use this information for the stated verification purpose.
Account Holder’s Signature:
Date: [MM-DD-YYYY]
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