ATM CARD AND PIN REQUEST FORM

TO BE FILLED BY THE REQUESTING CUSTOMER

የደንበው ስም (Customer Name):

የሂሳብ ቁር (Account Number):

ፊርማ (Signature):

ቀን (Date):

ሰአት (Time):
[time* time id:time]

አዲስ ካርድ (New Card)

ጊዜው ያለፈ ካርድ (Expired Card)

የተጠፋ ካርድ (Lost/Damaged Card)

የሚስጥር ቁጥር ለውጥ (PIN Reissuance)

TO BE COMPLETED BY THE PERSONAL BANKER

Customer Verified By Name:

Signature:

Date:

TO BE COMPLETED BY BACK OFFICE; IF FEES APPLY

Fee Charged By Name:

Signature:

Date:

TO BE COMPLETED BY THE IT SUPERVISOR

Red

Silver

Black

Customer Name:

Card/Batch No.:

Name:

Signature:

Date:

TO BE COMPLETED BY THE OPERATOR OF CARD WORLD PRODUCER (CWP)

Import Successful

Emboss Successful

Process Successful

Export Successful

Name:

Signature:

Date:

ህግ እና ደንብ/Terms and Conditions

1. A card is not transferable...

2. The Cardholder shall be fully liable...

3. A card remains the property...

Card Holder’s Name:

Signature: