Account Application Amendment Form - Banking … Application Amendment Form Amendment Form Purpose This form was designed for the use of correction(s) on the account opening application.

BAAAF0710

To: Citibank, N.A. Customer Service Center3800 Citibank DriveTampa, FL 33360

U.S.A.

Customer’s name: ____________________________________________________________________________________________________________________________________

Account Number: ____________________________________________________________________________________________________________________________________

ID Number: ___________________________________________________________________________________________________________________________________________

Identified with: _______________________________________________________________________________________________________________________________________

(Type of ID)

I acknowledge that the following corrections have been performed in the following fields in my account opening application:

Application Field Change Made Correction/Addition ?

1. __________________________________________________ ____________________________________________________________ Correction Addition










_______________________________________________________________________________________ ____________________________

Signature of account holder Date

Note: One form per account holder is required.

© 2013 Citibank, N.A., Member FDIC.

Citibank with Arc Design is a service mark of Citigroup Inc. or Citibank, N.A., used and registered throughout the world.

Account Application Amendment Form

Amendment Form

Purpose

This form was designed for the use of correction(s) on the account opening application.

Process of the country

The RO/QP must complete the following fields with black ink and print letters.

Reference Number “P number”

Client’s name(s)

Type of ID(s)

ID number

Field were the correction was made

Indicate the correction done

Cross out the fields that are not utilized

The client(s) “affected” by the change(s) must:

Sign the form giving acknowledge of the correction (For example: a change to a

beneficiary must be signed by ALL account holders)

Indicate the date that the correction was authorized (the date indicated on this

form can NOT exceed 30 days from the date the account application was signed

by the customer(s))

The RO/QP must:

Verify the signature and make sure it is the same as the signature on the ID’s

Attach the correction form to the application

Tampa Process:

The account opening processor must verify the following:

The date indicated on the form that it is NOT to exceed 30 days from the date the application was

signed by the customer

Verify the signature and make sure that is same signature on the ID’s and application

Verify all field corrected on the application against the correction form

In case of any discrepancies the application will:

Citidocs, return image back to the country where the application was sent from.

All physical files should be sent to the Issues Unit

Note: If the customer(s) is(are) not at the branch, the RO/QP will call the customer to inform him/her of the corrections and that the form will besend via Fax to him/her for the consent of the changes.

This form must be sent back to the RO/QP via COURRIER for verification of signatures and to be attached to the account opening application

Account Application Amendment Form - Banking … Application Amendment Form Amendment Form Purpose This form was designed for the use of correction(s) on the account opening application.

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