INTERNET BANKING PIN/PASSWORD RESET FORM

Date Ref No.

The Manager,
Amãna Bank PLC,

__________________________Branch
I/We hereby request you to re-set my/our access information, the relevant details given below,

INFORMATION OF ACCOUNT HOLDER/S

Customer
Identification File CIF Branch :
(CIF) No:
Full Name of
1) Mr / Mrs / Miss / Dr / ____
Applicant :
Full Name of
Joint Account 2) Mr / Mrs / Miss / Dr / ____
Holder/s :
(Applicable only for 3) Mr / Mrs / Miss / Dr / ____
Joint Accounts)

Residence Tel. No.

Contact Details of
Mobile Office Tel. No.
Applicant:

E-mail (Block
Letters) :
Mandatory*

(Please mark for your request in appropriate box)

Please issue only my Password

Please issue only my PIN

Please issue both my Password & PIN

Further, I/We hereby take full responsibility on the request and confirm that the information given above is true and accurate.
Note: All parties to sign in the case of Joint Accounts, giving consent to the applicant to use the Internet Banking Facility.

Signature of Account 1) 2) 3)
Holder/s :

FOR BRANCH USE ONLY FOR OFFICE USE ONLY

EMP No. Initials Date EMP No. Initials Date

Application checked by : ___________ ______ _________ Customer Password/PIN

Re-set by : _________ ______ _______
Signature Verified
______________________________ Customer Password/PIN
Identity Verified Branch Rubber Stamp & Authorised Authorised by : _________ ______ _______
Officer’s Signature