UTILITY BILL AUTHORIZATION FORM / PROOF OF ADDRESS

Date:

To:

Dear Sir / Madam,

I, , confirm that resides at:

I hereby give authorization to him/her to use this Utility Bill in my name for the purpose of , which is for Opening an Account at your Establishment / Proof of Address document.

Please accept this letter as confirmation.

A copy of my identification has been provided for your records.

Thank you.