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Citi Bank Pakistan Account Statement Bank

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Citi Bank Pakistan Account Statement  Bank Powered By Docstoc
					Branch: __________________

           REQUEST FOR ACCOUNT STATEMENT / BANK CERTIFICATE

Account Number: _____________________________________________________________________

Account Title: ________________________________________________________________________

I /We hereby request you to issue me /us the following against my/our above stated account:

  Statement of Account for the period from _________________ to ____________________
   Reference Certificate                   Balance Certificate                Withholding Tax Certificate

    Proprietorship Certificate             Zakat Deduction Certificate

In case of Bank Certificate, please address it to:
Name of Recipient: ____________________________________________________________________
Name of Organization: _________________________________________________________________
Address: ____________________________________________________________________________

The above document will be collected by:
  Myself          OR             Kindly mail it to my correspondence address available in your records
  A Representative bearing my authority letter




                                                                                                                       BB - ASI - VC2 - 10 - 09
Representative’s Name __________________________ CNIC # ________________________________



______________________________                             ________________________                 ____________
Account Holder’s Name                                       Signature                               Date

______________________________                             ________________________                 ____________
Account Holder’s Name                                       Signature                               Date

Contact No.: ___________________

Notes:
(1)- Please collect the above requested documents within 7 days from the date of submission of this form and
thereafter the said document/s will be destroyed.
(2)- Issuance of the requested documents shall be subject to payment of fees/charges as prescribed by Citibank from
time to time in Schedule of Bank Charges and same charges /fees shall be deducted / debited from your account/s.

                                             FOR BANK USE ONLY

SV: Name ____________________Initials____________________              Request:     In Person       Mail / Messenger

   Blue    Gold   Charges Deducted Rs. _______ by: __________          Name: ________        Initials: __________

Customer No. ____________________                                      Date: _________      Time:     __________

				
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