ELECTRONIC BANKING MAINTENANCE & CANCELLATION FORM

_____________________
(Branch)
* REQUIRED FIELD
NAME OF DEPOSITOR(S)* : DATE* : ( MM / DD / YY )

MOTHER’S MAIDEN NAME* : MOBILE NUMBER* : E-MAIL ADDRESS* :

PRESENT ADDRESS* :

ELECTRONIC BANKING FACILITY : TYPE OF ACCOUNT : ACCOUNT NUMBER :

Phone Banking Savings Account (SA)

___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Mobile Banking System Current Account (CA)
Internet Banking Others, pls. specify ________________________ (Branch should verify the Account Number)
SMS Banking

MAINTENANCE
For Phone Banking : For SMS Banking :
Reset TPIN Reset MPIN
Reactivate Facility Access Reactivate Facility Access
Deactivate Facility Access Deactivate Facility Access

For Internet/Mobile Banking System :

Reactivate Facility Access Change Email Address, pls specify
Deactivate Facility Access
Transfer of Maintaining Branch (For Internet Banking) Change Mobile Number, pls specify
Reset / Unlock OARM (For Internet Banking Security Questions) [e.g. 63 9171234567 Mobile number in the Philippines]

Reset Device (For Mobile Banking System)

Country Code Mobile Number Country

A. ENROLLMENT (For Phone & SMS Banking only)

rd
Enroll 3 Party Account for Fund Transfer, pls. specify below
ACCOUNT NUMBER ACCOUNT NAME
SA CA ____________________________________ __________________________________________
SA CA ____________________________________ __________________________________________
SA CA ____________________________________ __________________________________________
SA CA ____________________________________ __________________________________________

Enroll Payee/s for Bills Payment, pls. specify below (For SMS Banking Only)
NAME OF INSTITUTION / MERCHANT
____________________________________
____________________________________
____________________________________
SUBSCRIBER NUMBER
_________________________________________
_________________________________________
_________________________________________

B. CANCELLATION (For Phone & SMS Banking Only)

Cancellation of Facility Services Disenroll Payee/s for Bills Payment, pls. specify below (For SMS Banking Only)
Disenroll Account/s for Fund Transfer, pls. specify below
ACCOUNT NUMBER ACCOUNT NAME NAME OF INSTITUTION / MERCHANT SUBSCRIBER NUMBER
SA CA _____________________ _____________________ ___________________________________ ___________________________________
SA CA _____________________ _____________________ ___________________________________ ___________________________________
SA CA _____________________ _____________________ ___________________________________ ___________________________________

In case of Joint-OR Accounts, all transactions/requests/instructions by any one of the depositors/accountholders are deemed done with the consent of all co-depositors/co-accountholders. In case of conflicting requests or
instruction by any one of the depositors/accountholders, the Bank shall act on the request/instruction received earlier in time, without incurring any liability for any delay or inaction with respect to the request or
instruction from the co-depositors/co-accountholders received by the Bank at a later time.
______________________________________
Signature of Depositor*

PROCESSD BY / DATE : APPROVED BY / DATE : ENCODED BY / DATE :

Note: Please present 1 Valid ID with picture for verification.

Form 2058 (Rev. Jan2017)