Citibank Singapore Ltd

International Personal Bank

Robinson Road P.O. Box 0361
Singapore 900711
Co. Reg. No. 200309485K

24-Hour CitiPhone Banking

T: +65 6224 5757
F: +65 6632 4759
www.ipb.citibank.com.sg

Change of Address and Contact Details Form

Name (as it appears on account):
Effective Date of Change:

(mm/dd/yy)

Account/Relationship Number:

Please update:

r All my Citibank Accounts

r My Banking and Investment Accounts Only

r All my Credit Card Accounts Only

r Others:

New Mailing Address Update#

Postal Code (

Postal Code (

Country of Residence Update (Mandatory Field)

New Residential Address Update# (If different from Mailing Address)

New Email Update#

New Contact Number Update

Contact No.

Country Code

Area Code

Telephone No.

Preferred Email Address

Home#
Office#
Mobile#
Alternate Email Address
Additional No.
Home Fax#
Office Fax#
#

The new information provided herewith will replace the existing information in the Banks record.

Customer Signature

_______________________________
Name:

_______________________________
Name:

For Bank Use Only

Face-to-Face

_______________________________
Name:

Date Received:

r Mail-in/Fax-in

Customer met & ID Sighted by: _____________________________________________

(Name & Initial)

Signature verified by: _____________________________________________________

(Name & Initial)

Independent Verification: _________________________________________________

(CM met/ID sighted, signature witnessed/verified)
(Name & initial)

Call back by: _____________________________________________________________

(Name & Initial)
Date/Time/Extn: _________________________________________________________

2014 Citibank. Citibank is a registered service mark of Citigroup Inc. Citibank Singapore Limited Co. Reg. No. 200309485K Printed on 06/2014