TH YU CU DANH CHO CHU THE ACB

Knh gi: - NGN HANG TMCP CHU-CN/PGD: ........................................

A. Thng tin khach hang
H tn khach hang:.....................................................................................S CMND/PP:................................
ia chi lin h : ...................................................................................................................................................
in thoi lin h: .....................................................Email:...........................................................................

B. nghi thc hi n (cac) yu cu cho (cac) s the: (Quy khach vui long in va anh du () vao thich hp)
Th chnh:................................................................S th:......................................................Hiu lc:..........
Th phu:....................................................................S th.......................................................Hiu lc:..........
Stt

N i dung yu cu

The chnh

Xac nh n nh n the/
PIN

Kch hot the/ khng

C
kch hot the

Th

PIN

Ban iu khoan iu ki n
Khng

ng k mi

The phu
Th

PIN

Ban iu khoan iu ki n
C

Khng

Thay i phng thc ng k mi

Thay i phng thc

Dich vu xac thc

giao dich the trc
tuyn (3D Secure)

Kch hot dich vu Thay i thng tin Kch hot dich vu Thay i thng tin
- Token: S: ...............................................

- Token: S: ...............................................

(chon 1 trong 2 phng

thc xac thc: OTP
Token ho c OTP
SMS/Email)

- SMS/Email:

- SMS/Email:

Kha the tm thi/

M kha the

Kha th tm thi

Khi phuc PIN/Cp

li PIN

Bao mt the
Thay the va:

7
Tra li phi th
Gia hn the va:
8
Tra li phi th

Nhn the/PIN ti ia
chi KH yu cu (ap
dung cho the tin dung)

10

Huy the (*)

TD:

TD:

Email:

Email:

M kha th

Kha th tm thi

M kha th

L do:......................................................
Khi phuc PIN
Cp li PIN

L do:......................................................
Khi phuc PIN
Cp li PIN

L do:.........................................................

L do:.........................................................

Nh n PIN mi ti:......................................

Nh n PIN mi ti:......................................

ia im mt th:..................................

ia im mt th:..................................

Ngay:............................... luc: ..............

i s
Khng i s

Ngay:............................ luc: .................

i s
Khng i s

Chuyn Chip (EMV)

Chuyn Chip (EMV)

Khng

Khng

Nh n th mi ti:........................................
i s
Khng i s

Nh n th mi ti:........................................
i s
Khng i s

Chuyn Chip (EMV)

Chuyn Chip (EMV)

Khng

Nh n th mi ti:........................................

Khng

Nh n th mi ti:........................................

ia chi nh n th, PIN:......................................................................................................

S lng th:...................S lng PIN:.................Loi th:.........................................
Huy th Chuyn i (T) th tn dung

Huy th Chuyn i (T) th tn dung

1. Th thng xuyn khng s dung c

3. u i khng hp dn/t u i

2. Thai phuc vu cua nhn vin

4. S dung th tn dung cua nhiu ngn hang

QF C3/TTT 12.15

1/2

8. Thng xuyn khng nhn c BTBGD

5. Thu tuc gia hn th phc tp

Ly do (chon 1 trong cac ly

6. Ph, li cao
do)

Tra li phi th
Trch tin
TKKQ/TTK thanh
toan d n the tn
dung

11

12

9. Th d bi h, gy

7. ATM ACB thng xuyn h hng

10. Khac:.......................................

Khng

Khng

H tn chu TK: ...............................................................CMND/PP:.............................

S TKKQ/TTK:...................................S tin yu cu trch:.....................................................

(Bng ch:....................................................................................................................)
S th nh n tin :.........................................................................Hi u lc:........................

Cac yu cu khac

Bng vic ky tn vo mu n ny, ti/chung ti ng y vi ni dung yu cu tai muc:................................cho The

chinh, muc.........................................cho The phu v cam kt:

Thc hi n (cac) yu cu trn theo ung Ban iu khoan iu ki n s dung the cua ACB
Thanh toan phi cho cac yu cu nu trn theo biu phi ACB va phi/li phat sinh t cac phi nay (nu c).
(*):

Thanh toan (cac) giao dich cung li, phi phat sinh (nu c) ma ti/chung ti thc hi n nhng cha c li k
trong Ban thng bao giao dich trc va (cac) giao dich khiu nai cung cac khoan li, phi phat sinh lin quan nu
ti/chung ti c khiu nai nhng kt qua khiu nai khng thanh cng.

ng y rng Th yu cu v/v huy the nay s ng thi la Bin ban thanh ly vic s dung the cua ti/chung ti trong
trng hp ngha vu thanh toan n cho ACB cua Ti/chung ti chm dt.

Nhng thng tin trn la ung s th t va hoan toan chiu trach nhi m v cac thng tin nay.

Khach hng vui long mang theo ban photo chng t ny cung CMND/H chiu v Giy gii thiu cua Cng ty (i
vi the Visa Business) c ky v ong du theo h s m ti khoan/the m cng ty a ng ky vi ACB khi:

Nh n Th mi

Nh n PIN mi

Thanh l th

Ti CN/PGD ACB:...............................................................vao ngay.........................................

Chu Tai khoan (danh cho muc 11)

........................., ngay.........thang..........nm.......
Chu the/ Ngi c uy quyn

(Ky va ghi r ho tn)

(Ky va ghi r ho tn)

Trung Tm DVKH 24/7: 1900 54 54 86 - (08) 38 247 247 - 1800 577 775 (min ph danh cho khach hang u tin)

PHN THC HIN CUA N VI TIP NHN

PHN DANH CHO TRUNG TM

THE/ PHNG THE HA NI

1. Thc hin yu cu ti muc: ..............................

2. Lin h Contact Center 24/7 kha Returned th luc: ...../.....(gi/phut)
ngay.....thang.....nm....
3. nghi...................................thc hin yu cu cua KH ti muc.............

Nhn vin thc hin:.....................................

Ngay thc hi n: ............................................

i vi muc 4: M kha the: code ang kha hi n ti:..........................

i vi muc 4: Kha the tam thi: nghi ............................................

kha code:................................................................................................

Kim soat vin: .............................................

Ghi chu:..............................................................................................................

Ngay kim soat:.............................................

Nhn vin:.................................................................Ngay:................................
Kim soat vin:.........................................................Ngay:................................
Ghi chu: Nhn vin, Kim soat vin ky v ghi r ho tn

QF C3/TTT 12.15

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