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Kencom House,

Moi Avenue,
P.O. Box 48400 - 00100,
Nairobi, Kenya.
Tel: +254 20 3270000,
2852000, 2851000
ATM ORDER FORM Mobile: +254 711012000/
734 108200

BRANCH…………………………………………………………………….

NAME ……………………………………………………………………….

ACCOUNT NUMBER………………………………………………………

ADDRESS……………………………………………………………………

DATE…………………………………………………………………………

Dear Sir/Madam,

ATM CARD (Tick as appropriate)


NEW/FAULTY/LOST
MISPLACEDPIN/FORGOTTEN

Please refer to the above and:

1. Issue a new card


2. Block the card
3. Block the card and issue replacement

Please choose mode of Dispatch: (Charges will be deducted from


your KCB account).

o DHL (approx. KES 3500)


o Regular mail (approx. KES 500)
o Collection from KCB Branch

Signature ………………………………………..

Date………………………………………………
www.kcbgroup.com

KCB Bank Kenya Limited


Directors: L. M. Njiru (Chairman); J. N. Oigara; T. D. Ipomai; C.S. – National Treasury; S. K. Rono;
Ms. N. Onyango; Mrs. C. Okongo; J. W. Muigai; Mrs. A. O. Eriksson; Ms. E. Nyala; S. Makome

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