Merchant’s Bank Account Details Form

[This form must be filled and duly signed before Merchant’s Bank account details are add or modified in
Airtel Money platform for Auto sweep facility].

CUSTOMER’S BANK DETAILS

CUSTOMER NICK CUSTOMER‘S BANK ACCOUN BRANCH BANK

ACCOUNT NAME NAME MSISDN NAME T CODE BRANCH
NUMBER

CUSTOMER AUTHORISE SIGNATORY

1.Name: …………………………………………….. 2. Name…………………………………………………………..

Signature …………………………………………… Signature…………………………………………….……….

Date ………………………………………………… Date……………………………………….…………………….

NB: For Registered company have the company seal where applicable.

CUSTOMER ACCOUNT VERIFICATION [ Bank only]

Officer Name………………………………………………..……..

Officer Tittle………………………………………………..………

Signature and stamp…………………………………..……….

Date…………………………………………………………..………..

NB: The Bank to confirm Account signing mandate.

AIRTEL AUTHORISE SIGNATORY

Name Sign Off Date

Reviewed By AM Operation/Corporate Head
Recommended By AM Director/ Head
Recommended by AM Finance Manager