PERMOHONAN PERTUKARAN AKAUN BANK

Saya .. No. fail pencen

No. K/P (baru) ............................................ (lama) beralamat di
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nombor telefon ..........................(R) ............(H/P)
memohon untuk menukarkan nombor akaun bank ....... (no. akaun
bank semasa) bagi bank ............................................. (nama bank semasa) kepada akaun bank
............................................ (no. akaun bank baru) bagi bank .............................................
(nama bank baru) atas sebab-sebab terperinci seperti berikut:
1.

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2.

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LULUS/TIDAK LULUS

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Tarikh:

Tarikh:
Jawatan:

(Tandatangan pemohon)

(Tandatangan pegawai yang memberi kelulusan)

NOTA: * Sila serahkan salinan dokumen yang menyokong penjelasan di atas. Cth: sekiranya permohonan
penukaran disebabkan penutupan cawangan bank yang berhampiran dengan tempat kediaman,
mohon salinan dokumen berkenaan penutupan cawangan tersebut.
* Permohonan penukaran akaun bank ini tertakluk kepada pertimbangan Jabatan ini berdasarkan
penjelasan yang kukuh / hasil siasatan yang dijalankan.
* Sila kemukakan satu salinan muka surat hadapan buku bank/penyata akaun semasa yang
menunjukkan butir-butir pemilik dan nombor akaun