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Dependent Declaration Form

In terms of directives issued by State Bank of Pakistan / UBL Bank, I,

holding CNIC # hereby declare as under:

1. The source of funds/proceeds to be deposited in my account along with details of the financial supporter
are as follows:

Details of Financial Supporter/Funds Provider

Relationship Supporter’s In case of Remittances,


Name CNIC #
Source of Income Country of Remittance

2. If the funds / amounts are received / deposited in my account from a source other than the source mentioned
above, I undertake to inform / declare in writing to update the Bank’s record.

Customer’s Signature

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