CUSTOMER BANK MAINTENANCE REQUEST FORM FOR REFUNDS
(Form to be filled only if new bank details to be updated or existing bank details to be modified
for Customer Refunds)
Bank details for New Customer
Amendment of Bank details for existing Customer
To select an item, double click on the check box and select “Checked”.
CUSTOMER INFORMATION:
Customer Name CÔNG TY TNHH THƯƠNG MẠI DỊCH VỤ XUẤT NHẬP
KHẨU VINAWEST
Registered Address Đ/C: 60-62-64 Lý Hồng Thanh, P. Cái Khế, Q. Ninh Kiều, Tp.
Cần Thơ.
Postal Code
Country VIỆT NAM
Contact Person (s) BÙI PHƯƠNG KHẮC NHỰT
Customer official email ID nhutbpk@vinawest.com
(Mandatory)
Telephone Number 0907559334
Fax Number
CUSTOMER BANK ACCOUNT DETAILS:
Beneficiary Name CÔNG TY TNHH THƯƠNG MẠI DỊCH VỤ XUẤT NHẬP
KHẨU VINAWEST
Account Number 0111000326439
Bank Code & Branch Code
SWIFT/BIC ID
IBAN
Bank Name Ngân hàng Vietcombank Chi nhánh Cần Thơ
Bank Address 03-05-07 Hòa Bình, Phường Tân An, Quận Ninh Kiều, Thành
Phố Cần Thơ
Currency VND
Reason for Bank Modification
(If refund has to be processed to a
different Bank Account)
Note: Only one bank account can be
maintained per currency.
ANY ONE OF THE BELOW MANDATORY DOCUMENTS - SCANNED COPIES TO BE
PROVIDED ALONG WITH THIS MASTER DATA REQUEST FORM:
(Please check the box appropriately, double click on the check box and select “Checked)
1. Customer Bank details in a company letter head duly signed by an Authorized person of
the Company with Name, Designation and Seal
2. Customer Bank Statement having details of Bank account Name, Bank Account Number,
Customer address details, duly signed by an Authorized person of the Company with
Name, Designation and Seal
3. Contract with Bank details
4. Invoice copy with Bank details
5. Bank Certificate issued by Bank
6. Cancelled cheque/Bank passbook
SIGN OFF BY THE CUSTOMER:
I/We hereby confirm that the information provided herein is correct and that the documents submitted along
with this customer refund bank maintenance form are genuine. I further understand that the refund will be
delayed if the form is not correctly filled in or mandatory supporting documents are not submitted along with
this form.
Name of the Requestor: BÙI PHƯƠNG KHẮC NHỰT
Title/Designation: Director
Signature:
Date: 10/10/2024
Place: CanTho City
Stamp:
