BLOM BANK s.a.l

Premature Profile Reactivation Request

	This page displays the eBlom Internet Banking Premature Profile Reactivation Request form. You have to print this form, complete it, sign it and submit it to your branch and wait for your reactivation which normally takes two working days starting from the date you submitted this form to your branch.
	Client Information
		Client ID _____________________
		Telephone Number _____________________
	I hereby confirm my request to reactivate my eBlom Internet Banking profile prematurely, i.e. before the suspension period that I requested for the eBlom Internet Banking service is over.
		Name _____________________
		Date _____________________
		Place _____________________
		Signature _____________________