Authorised Mandate Form (BVN)
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Ticket Number

I have matched imputed details with supplied record to ascertain following :

Surname
First name
Middle name
Others

Caution:

Before completing the disclaimer section below, we advise you thoroughly check again to see that entered details correspond with supplied information. With BVN you’re only enrolled once and any amendment or alterations required due to data wrongly entered would have to be resolved by the applicant dealing directly with the Central Bank of Nigeria which could run into weeks.

Enrolment Date
NAME OF APPLICANT *
Clear Signature