Helb phone Number, Bank Account Changing Application Form.
Do you need to change your Phone Number and Bank Account number? Well. Fill out this form and send it to Helb for immediate action.
STUDENT’S PERSONAL PAYMENT DETAILS UPDATE REQUEST FORM
| FULL NAME | ||||||
| NATIONAL ID CARD NO. | ||||||
| INSTITUTION/SCHOOL | ||||||
| ADM/REG NO. | ||||||
| MOBILE PHONE NO. | ||||||
| EMAIL ADDRESS | ||||||
| MODE OF PAYMENT
Tick the preferred mode of Payment |
BANK | MOBILE PHONE | ||||
| OLD MOBILE PAYMENT PHONE NO. | ||||||
| NEW MOBILE PAYMENT PHONE NO. | ||||||
| BANK NAME | ACCOUNT NO. | BRANCH | ||||
| OLD BANK ACCOUNT NO. | ||||||
| NEW BANK ACCOUNT NO. | ||||||
| Declaration: I declare that the NEW Payment details -Mobile Payment Phone or Bank Account Number provided above is mine and that I will be solely responsible for any risk associated with it.
Signature: Date: |
||||||
| Attachments:
Tick if attached |
Copy of National ID Card | |||||
| Copy of ATM/Bank Card (Front side only) | ||||||
| Other document(s)- Specify | ||||||
| FOR OFFICIAL [HELB] USE ONLY
(BANK ACCOUNT/ MOBILE PAYMENT PHONE NO. RECEIVED/CONFIRMED BY) |
||||||
| Name | ||||||
| Signature | ||||||
| Date | ||||||
Lending Department: Student’s Personal Payment Details Update Request Form.