<p>REQUEST FOR INDIVIDUALIZED PCARD SECURITY ACCESS CODES</p><p>IF YOU HAVE EXPERIENCED DIFFICULTY COMMUNICATING WITH JPMORGAN CHASE BY TELEPHONE, CONSIDER REQUESTING NEW SECURITY ACCESS CODES. USE THIS FORM</p><p>LAST 4 DIGITS OF CARD NUMBER: ______</p><p>CARDHOLDER LAST NAME: ______</p><p>SPECIFY YOUR PREFERENCE FOR EACH FIELD:</p><p>Mother's Maiden</p><p>Social Security Number*</p><p>Birth Date (mm/yyyy) / </p><p>IT IS RECOMMENDED THAT YOU DO NOT PROVIDE REAL PERSONAL DATA FOR THESE SECURITY CODES.</p><p>FOR EXAMPLE: </p><p>Mother's Maiden MOM</p><p>Social Security Number* 99164</p><p>Birth Date (mm/yyyy) 08 1988 / YOU MUST BE AT LEAST 18, SO THE YEAR OF BIRTH CANNOT BE LESS THAN 18 YEARS + TODAY’S DATE.</p><p>CARDHOLDER SIGNATURE ______DATE ______</p><p>BEFORE SUBMITTING THIS REQUEST MAKE A COPY FOR YOUR RECORDS</p><p>SUBMIT THIS REQUEST IN A SEALED ENVELOPE MARKED “CONFIDENTIAL” TO THE PCARD PROGRAM ADMINISTARTOR AT MAILCODE 1020.</p><p>DO NOT EMAIL THIS REQUEST</p>