Uttara Bank Limited
_____________ Branch
Update Form for Internet Banking Service
Date: 20____
The Head of Branch/Operation Manager
………………………………… Branch
Uttara Bank Limited.
Sub: Request for Updating Personal Details.
Dear Sir/Madam,
With reference to my
User ID
Account Title
Please choose your request:
Service Permission
Balance Transfer
(User will endorse
the applicable box)
Own Account Other Account Other Banks’ Account Other Banks’ Account
(for BEFTN) (for RTGS)
Address Update
Mobile No.
Email
Declaration of the Customer
I confirm that the above information is true and complete. I accept and agree to be bound by the terms and condition of
using Internet Banking Service and the rules governing customer account with Uttara Bank Limited.
Signature of the Applicant : Date:
For Branch use Only
The above customer’s information and signature are verified and found correct. The customer is registered. We
recommend for issuance of Login ID and password for Internet Banking.
Made By Verified By
Signature: __________________________________ Signature: __________________________________
Name:_____________________________________ Name:_____________________________________
Designation: ________________________________ Designation: ________________________________
PA Number: ________________________________ PA Number: ________________________________
For Bank use Only(ICT Division )
Registration Date & Time:____________________________________________
First Authorization Second Authorization Third Authorization
______________ ______________ ______________