Who is Recipient?

• Select the date on which the sender signs and sends this letter:

• The recipient of this letter is:

  • An individual
  • A business, company or state authority

• The recipient is:

  • Bank or financial institution
  • Insurance company
  • Other

• Indicate the recipient's full legal name:

• Indicate full name of the recipient's contact person:

• Indicate the mailing address of the recipient:

General Information

• Provide the sender's insurance account number:

  !

  This information is being used by the recipient of this letter to quickly identify the sender and update their profile.

• Provide the sender's bank account number:

  !

  This information is being used by the recipient of this letter to quickly identify the sender and update their profile.

• Provide the sender’s full name and the contact details currently held by the recipient:

• Provide the sender’s new legal name to be updated in the records:

• Does the sender want to attach any document as proof of the legal name change?

  • No
  • Yes

  !

  If an individual changes their name, acceptable proof of the legal change may include a marriage or divorce certificate, or a court order for a change of name.

  If a company or business changes its name, acceptable proof may include an updated certificate of registration or other official company documents reflecting the new name, such as an updated constitution.

• Indicate the name and date of a document that is being attached as a proof:

• Do you want to add a signature?

  • Yes
  • No

• Sender's signature:

  Save signature Clean

  Edit signature