Fill - Free fillable Mailing Address Declaration Form PDF form

Mailing Address Declaration Form

VER 1.2/BAN/MADF DOM/WPC/07-19

Date:

To,

Citibank N.A.

______________________

______________________________

[Name of first holder]

______________________________

[Name of joint holder]

______________________________

[Signature of first holder]

______________________________

[Signature of joint holder]

Subject : Confirmation of mailing address (Residence/ Office) for account number ____________________________________________

I ____________________________________________________________ hereby confirm that following address is my residence/office

address, and

I request you to update the same as my mailing address.

Mailing address (Please provide full address)

___________________________________________________________________________________________________________________

Further I confirm that I do not have any proof of the above mentioned current residence/mailing address address in my name due to

__________________________________________________________________________________________________________________

As I do not have any proof of mailing address in my name, I am submitting herewith, the address proof for my permanent address

Permanent address (Please provide full address)

___________________________________________________________________________________________________________________

(name of the account holder)

Citibank India does not market any product or service to individuals resident in the European Union, European Economic Area, Switzerland, Guernsey

and Jersey.

This is not, and should not be construed as, an offer, invitation or solicitation to

buy or sell any of the products and services mentioned herein to

individuals resident in the European Union, European Economic Area, Switzerland, Guernsey and Jersey

1. Valid Passport with address page 2. Valid Driving License with address page 3. Documents issued by Government departments of foreign

jurisdictions 4. Letter issued by Foreign Embassy/Mission in India (For foreign Passport holder only) 5. Overseas Citizen of India (OCI) card

Alternatively where one of the above documents is available for permanent address, below documents can be submitted as proof for

mailing/residential address or vice versa.

1. Utility bill not more than 2 month old of any service provider (Electricity , telephone, post- paid mobile phone, piped gas,

water bill).

2. Property or municipal tax receipt.

Commonly accepted documents for proof of address (self-attested):

( )Please specify reason

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