Fillable ACB BANK PARTICULARS B) BANKING DETAILS OF ACCOUNT (Kwazulu-Natal Department of Health)

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ACB BANK PARTICULARS B) BANKING DETAILS OF ACCOUNT (Kwazulu-Natal Department of Health)

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Bar Code
Z894
ACB BANK PARTICULARS
Please have this form completed by your bank as confirmation of your bank particulars.
National Treasury
Pensions Administration
SEE INSTRUCTIONS OVERLEAF
A) BENEFICIARY PARTICULARS
Date
C) PREVIOUS BANKING DETAILS OF ACCOUNT HOLDER (Complete only if banking details have changed)
B) BANKING DETAILS OF ACCOUNT HOLDER (This section must be completed by the bank)
D) DECLARATION
I CONFIRM THAT THE ABOVE DETAILS ARE CORRECT:
To be completed by the beneficiary (i.e. Pensioner/Member/Executor/Other)
Thumb print of beneficiary (Compulsory)
Tel No.
C O D E
Cell No.
C O D E
Fax No.
Residential
address
6.
Account No.
5.
Branch code
4.
Branch name
3.
Name of bank
2.
Type of account
Cheque
Transmission Savings
1.
Account
holder name
8.
Passport No.
7.
ID No.
6.
Middle names
5.
First name
4.
Surname
1.
Pension No.
2. Date of birth C C Y Y M M D D
3.
Title
10.
Branch email
address
C O D E
9.
Branch postal
address
7. Branch tel No.
C O D E
8.
Branch fax No.
C O D E
3.
Branch code
4. Branch name
2.
Name of bank
1.
Account
holder name
Surname of Bank Official
Initials
Signature of
Bank Official
C O D E
5.
Account No.
6.
Type of account
Cheque
Transmission Savings
G.P.-S 81/329645
Official Date
Stamp of Bank
C C Y Y M M D D
39512
(Compulsory)
(Compulsory)
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ACB BANK PARTICULARS B) BANKING DETAILS OF ACCOUNT (Kwazulu-Natal Department of Health)

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Completed 14 April 2021

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