Accounts Claim Form

This form is for customers claiming funds from a Dormant Account

Please be advised you will be required to upload a copy of your photo identification and any other supporting documentation with this application.

If any information on your ID is different from information held by Bank of St Helena, please provide relevant documentation (i.e. marriage certificate).

Before you apply, here are a few things we would like to make you aware of:

Terms and Conditions

Customer Data Security

Website Legal Information

Privacy Policy

All compulsory fields are marked with ‘*’.

Customer and Account Details

Account Number *

Customer Title *

Dr / Mr / Mrs / Miss / Ms

Customer Name *

First

Middle

Last

Account Name (if different from Customer Name)

Date of Birth *

Account Address *

Address Line 1

City

State / Province / Region

Postal Code

Current Address *

Address Line 1

City

State / Province / Region

Postal Code

Please provide proof of Address

Please upload proof of your current address

Click or drag files to this area to upload. You can upload up to 2 files.

Account Last Used *

St Helena
Ascension

Home Telephone Number *

Work Telephone Number

Mobile Number

Email *

Please upload a copy of your photo ID (e.g. Passport)

Click or drag files to this area to upload. You can upload up to 3 files.

Signed

Name *

First

Middle

Last

Signature (if you feel your signature is not legible, you may upload it in the section below)

This application will not be accepted without a signature - please write it here or upload below.

Signature Upload (if required)

Click or drag a file to this area to upload.

Date *

Captcha *

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