CUSTOMER INFORMATION UPDATE FORM

PLEASE FILL IN THE REQUIRED INFORMATION AND SEND THE COMPLETED FORM TO HELP@ALAT.NG

Account Details

Account Name

Bank Verification
Account No Number

Personal Details

Date of Birth D D / M M / Y Y Y Y Gender M F Marital Status Married Single Widowed

Mother’s Maiden Name Religion Occupation

Nationality State of Origin Local Govt. of Origin

Residential Address Area/Town

Landmark Bus-Stop Local Govt.

State E-mail

Mobile 1 Mobile 2 Tel

For Phone Number and Email Update

What information do you wish to update? Phone Number E-mail

Old Phone Number New Phone Number

Old E-maild Address New E-mail Address

Mean of Identification

Int’l Passport Driver National ID Voter’s Card (PVC) Nigerian Identification Number

ID No. ID. Issue Date D D / M M / Y Y Y Y

ID. Expiry Date D D / M M / Y Y Y Y

Foreigners Only

Resident Permit No. Issue Date D D / M M / Y Y Y Y

Expiry Date D D / M M / Y Y Y Y

Next of Kin

Full Name Relationship

(Surname/First name/Middle Name)

Tel/Mobile Contact Address

AUTHORIZATION

Account Signatory Name

(Surname/First name/Middle Name)

Please fill the required information and send the

completed form to help@alat.ng Signature & Date