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BAAAF0710
To: Citibank, N.A. Customer Service Center3800 Citibank DriveTampa, FL 33360
U.S.A.
Customer’s name: ____________________________________________________________________________________________________________________________________
Account Number: ____________________________________________________________________________________________________________________________________
ID Number: ___________________________________________________________________________________________________________________________________________
Identified with: _______________________________________________________________________________________________________________________________________
(Type of ID)
I acknowledge that the following corrections have been performed in the following fields in my account opening application:
Application Field Change Made Correction/Addition ?
1. __________________________________________________ ____________________________________________________________ Correction Addition
2. __________________________________________________ ____________________________________________________________ Correction Addition
3. __________________________________________________ ____________________________________________________________ Correction Addition
4. __________________________________________________ ____________________________________________________________ Correction Addition
5. __________________________________________________ ____________________________________________________________ Correction Addition
6. __________________________________________________ ____________________________________________________________ Correction Addition
7. __________________________________________________ ____________________________________________________________ Correction Addition
8. __________________________________________________ ____________________________________________________________ Correction Addition
9. __________________________________________________ ____________________________________________________________ Correction Addition
10. __________________________________________________ ____________________________________________________________ Correction Addition
_______________________________________________________________________________________ ____________________________
Signature of account holder Date
Note: One form per account holder is required.
© 2013 Citibank, N.A., Member FDIC.
Citibank with Arc Design is a service mark of Citigroup Inc. or Citibank, N.A., used and registered throughout the world.
Account Application Amendment Form
Amendment Form
Purpose
This form was designed for the use of correction(s) on the account opening application.
Process of the country
The RO/QP must complete the following fields with black ink and print letters.
Reference Number “P number”
Client’s name(s)
Type of ID(s)
ID number
Field were the correction was made
Indicate the correction done
Cross out the fields that are not utilized
The client(s) “affected” by the change(s) must:
Sign the form giving acknowledge of the correction (For example: a change to a
beneficiary must be signed by ALL account holders)
Indicate the date that the correction was authorized (the date indicated on this
form can NOT exceed 30 days from the date the account application was signed
by the customer(s))
The RO/QP must:
Verify the signature and make sure it is the same as the signature on the ID’s
Attach the correction form to the application
Tampa Process:
The account opening processor must verify the following:
The date indicated on the form that it is NOT to exceed 30 days from the date the application was
signed by the customer
Verify the signature and make sure that is same signature on the ID’s and application
Verify all field corrected on the application against the correction form
In case of any discrepancies the application will:
Citidocs, return image back to the country where the application was sent from.
All physical files should be sent to the Issues Unit
Note: If the customer(s) is(are) not at the branch, the RO/QP will call the customer to inform him/her of the corrections and that the form will besend via Fax to him/her for the consent of the changes.
This form must be sent back to the RO/QP via COURRIER for verification of signatures and to be attached to the account opening application