WIB St Maarten

Application (Open/Change Form)

Please fill in with capital letters.

Branch*

Date*

(a) New Application - Fill in Section 1 and 2.
(b) Changed Details - Fill in Section 1 (Client Number always) and indicate changes or enter “DELETE” where required in Section 1, 2.
(c) Service Request - Fill in Section 1 (Client Number only) and 3 where required.

Section 1 - Identification

New

Change

Mr.

Mrs.

Miss

First name*

Middle Initial*

Surname*

E-mail address*

Customer Number*

(New Applicants do not complete)

Section 2 - Address and account details

Address*

Telephone Number*

At least one account must be entered

Current account*

First*

Current account*

Second*

If Applicable

Saving account*

Third*

If Applicable

Section 3 - Language

Choose 1 *

Papiamentu

English

The undersigned hereby applies to The Windward Islands Bank Ltd. for the BANKOMATIKO Smartcard facility and certifies that the information contained above is true and correct.

PLEASE TAKE NOTE THAT IF YOUR ATM CARD OR PIN IS NOT PICKED UP WITHIN TWO MONTHS (60 DAYS) YOUR ACCOUNT WILL BE CHARGE A FEE OF US $10.00 PER ITEM.

When ready, I will pick up the Bankomatiko Smartcard and PIN envelope at: *

Pondfill

Bush Road

Simpson Bay

St. Eustatius

Date*

Data Protection Agreement

I consent to having this website store my submitted information so they can respond to my inquiry.*