Mailing Address declaration

Date:

To,

Citibank N.A.

______________________

______________________

Subject: Submission of proof for current/permanent residence due to non-availability of mailing address proof for
account number _________________

I ______________________________ <name of account holder> hereby confirm that following address is my

current residence/office address (please tick one), and is/have requested the same to be updated as my mailing
address in the account.

Mailing Address: [Please provide full address]

_______________________________________

_______________________________________

_______________________________________

Further I confirm that I do not have any proof of the above mentioned mailing address in my name due to
[Please specify reason]
_________________________________________________________________________________________

Hence I am submitting herewith, the address proof for my permanent OR current residence address

Permanent Address: [Please provide full Current Residence Address: [Please provide full
address] address]

_______________________________________ _______________________________________

_______________________________________ _______________________________________

_______________________________________ _______________________________________

*Please note if the address proof for current residence is being submitted, it should match with the current
residence address maintained in your account.

______________________________ ______________________________

[Name of first holder] [Signature of first holder]

______________________________ ______________________________

[Name of joint holder] [Signature of joint holder]

Modified date: 09-Nov-2016