ACCOUNT SIGNATORY RECORD CHANGE REQUEST
INSTRUCTIONS Please use the attached form for modifying the account signatory record maintained by Capital Security Bank. When completing this form, please bear in mind the following: 1
Upon acceptance of this form by Capital Security Bank, any prior account signatory record is replaced in its entirety with this new record.
2
Each new signatory is required to submit the following documentation: a) A notarized copy of the signatory’s passport (or other form of government-issued photo identification, if a passport is not available); and b) A notarized copy of a recent utility bill evidencing the current residence of the signatory. c) A CSB Client Biography d) ID Scan - Google Store: https://play.google.com/store/apps/details?id=com.capitalsecuritybank - Apple Store: https://apps.apple.com/us/app/capital-security-bank-idscan/id6444767152?platform=iphone - Web version too: https://idscan.capitalsecuritybank.com
ACCOUNT SIGNATORY RECORD CHANGE REQUEST Name of Account Holder: Signatory to be revoked & reason for change request:
The persons whose names and signatures appear below are, subject to the conditions set out below, and authorized to conduct transactions on the account. List the type of activities the persons will be conducting on account. 1 Full name:
Specimen signature:
2 Full name:
Specimen signature:
3 Full name:
Specimen signature:
4 Full name:
Specimen signature:
Restrictions: If no restrictions (such as joint signature being required) are inserted, each of the above signatories are authorized to sign individually. By the signature below, the above-named Account Holder hereby requests that any and all prior Account Signatory Records be replaced in their entirety with this Account Signatory Record Change Request with immediate effect. Signature of Account Holder by its Authorized Representative:
Date: