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  • Debit Card Pin Reissuance Form 1

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    blaisetembong
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    This document is an application form for reissuing a debit card PIN number from United Bank for Africa (UBA) in Nigeria. It requests the customer's full name, corporate name if applicable, account number, debit card number, contact details, and signature authorizing UBA to debit their account N150 for the PIN reissuance fee. The form also has sections for official use only including recording the fee transaction ID and verification of the customer's signature by officers.

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    debit card

    Original Title

    debit-card-pin-reissuance-form-1

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    This document is an application form for reissuing a debit card PIN number from United Bank for Africa (UBA) in Nigeria. It requests the customer's full name, corporate name if applicable, account number, debit card number, contact details, and signature authorizing UBA to debit their account N150 for the PIN reissuance fee. The form also has sections for official use only including recording the fee transaction ID and verification of the customer's signature by officers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views1 page

    Debit Card Pin Reissuance Form 1

    Uploaded by

    blaisetembong
    This document is an application form for reissuing a debit card PIN number from United Bank for Africa (UBA) in Nigeria. It requests the customer's full name, corporate name if applicable, account number, debit card number, contact details, and signature authorizing UBA to debit their account N150 for the PIN reissuance fee. The form also has sections for official use only including recording the fee transaction ID and verification of the customer's signature by officers.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Debit Card PIN Reissuance

    Application Form
    *This form is valid only for Nigeria Date
    *Items in bold are compulsory

    Full Name

    Corporate Name

    Account Number

    Card Number (PAN)

    First 6 numbers Last 4 number

    Telephone / Mobile

    Email

    I/we hereby authorize UBA to debit my/our account with N150


    towards PIN reissuance charges.

    Customer Signature

    Official Use Only


    Fee Transaction ID

    We/I further confirm that customer’s signature has been verified and signature verification
    applied

    Officer Name/Staff ID/SOL Signature/Date

    Customer Service Officer

    Branch Operations Manager

    Version 1.2
    August 17, 2012

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