The Hongkong and Shanghai Banking Corporation Limited w` nsks GÛ mvsnvb e vswks K cv ikb wjwg UW. Branch kvlv
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- Delilah King
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1 The Hongkong and Shanghai Banking Corporation Limited w` nsks GÛ mvsnvb e vswks K cv ikb wjwg UW APPENDIX-1(KA) cwiwkó-1(k) Date ZvwiL D D M M Y Y Y Y Branch kvlv PERSONAL INFORMATION e w³ msµvší Z_ vewj (Attach this form with the Personal and Non-Personal Account Opening Request Form) (GB digwu c~iyc~e K e w³k I A-e w³k wnmve Lvjvi Av e` bi g~j As ki mv _ mshy³ Ki Z n e) (For Bank s use only) (e vs Ki e env ii Rb ) Account Number wnmve b ^i Unique Customer I.D. Code BDwbK Kv gvi AvBwW KvW Photograph (Attested by the client) (Please staple it) Qwe (K v q U KZ K mz vwqz) (`qv K i vcj&& Kiæb) Existing Customer ez gvb MÖvnK 1. Name of Account wnmv ei bvg 2. Name of the Accountholder (as in NID/Passport/Driving License) wnmve cwipvjbvkvixi bvg (RvZxq cwipqcî/cvm cvu /WªvBwfs jvb mý Abyhvqx) Title Mr. Mrs. Ms. First Name bv gi cö_gvsk Middle Name bv gi ga gvsk Last Name bv gi klvsk 3. Other Name/Former Name/Alias c~e ezx ev Ab vb bvg Supporting Document Attached mnvqk `wjjvw` 4. Type of Accountholder (put mark) wnmve cwipvjbvkvixi aiy (wb P cö hvr ÿ Î wuk w`b) 1 st Applicant 1g Av e`bkvix 2 nd Applicant 2q Av e`bkvix 3 rd Applicant 3q Av e`bkvix Director cwipvjk Shareholder Askx`vi Sole Proprietor ^Z vwakvix Delegatee cöwzwbwa Minor Accountholder bvevjk wnmveavix Guardian AwffveK Attorney Holder GUwb nvìvi Account Signatory wnmve cwipvjbvkvix Trustee Uªvw Beneficial Owner ewbwdwmqvj Ibvi Owner mz vwakvix Contributor Ae`vbKvix Others Ab vb 5. Father s Name wczvi bvg 6. Mother s Name gvzvi bvg 7. Husband s/wife s Name ^vgx/ xi bvg 8. Nationality RvZxqZv (foreign nationalities must submit a photocopy of their passport and visa) (we `kx bvmwik n j wfmvmn cvm cv U i Kwc Avewk Kfv e MÖnY Ki Z n e) Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [May 2017] Page 1 of 5
2 9. Residence Status (put mark) iwm WÝ vuvm (wuk w`b) Resident iwm W U Non-resident bb- iwm W U (If necessary, bank staff must follow the guidelines for foreign exchange transactions) (cö qvrbxq ÿ Î e vsk KZ K MvBWjvBÝ di d ib G PÄ Uªvb RKkbm& Gi wb ` kbv AbymiY Ki Z n e) Country of Residence emevmkvix `k 10. Date of Birth Rb ZvwiL 11. Place of Birth Rb vb Province/District of Birth h Rjvq Rb Country of Birth h ` k Rb 12. Gender (put mark) wj½ (wuk w`b) Male cyiæl Female gwnjv Transgender Z Zxq wj½ 13. Occupation Type (put mark) ckvi aiy 1 Student QvÎ/QvÎx 2 Employed Full-Time c~y Kvjxb PvKzwiiZ 3 Employed Part-Time LÛKvjxb PvKzwiiZ 4 Not in Employment ekvi 5 Self-Employed ^D ` vmx ckvrxex 6 Retired AemicÖvß 14. Occupation Details (put mark) ckvi we ÍvwiZ (wuk w`b) Salaried Job PvKzix Business e emv Self-Employed ^D ` vmx ckvrxex Others Ab vb Public mikvwi Proprietorship e w³gvwjkvbvaxb Private emikvwi Partnership Askx`vi Limited Company wjwg UW Kv úvwb Organization s Name cöwzôv bi bvg Job Title/Designation c`ex Employee ID No. (If any) ckvmz cwipqcî b ^i (hw` _v K) 15. Monthly Income (in BDT equivalent) gvwmk Avq (mgcwigvb UvKvq) 1 Less than 15,000 15,000 UvKvi Kg 2 15,001-25,000 15,001-25, ,001-40,000 25,001-40, ,001-70,000 40,001-70, ,001-1,20,000 70,001-1,20, ,20,000+ 1,20,000 UvKvi ewk Annual income (including other allowances/bonuses/income/benefits not covered in monthly income) (in BDT equivalent) me gvu evwl K Avq Ges Ab vb fvzv/ evbvmmg~n/avq/myweavw` hv gvwmk Av qi ewn f Z (mgcwigvy UvKvq) 16. Proof of Identity cwiwpwzcî (for number 15, documents must be submitted according to the bank s requirements) (15 bs µwg Ki Î we ÍvwiZ D jølc~e K cö hvr ÿ Î e vs Ki Pvwn`v gvzv ek `wjjvw` cö`vb Ki Z n e) (a) National ID No. RvZxq cwipqcî b ^i Date of Issue cö`v bi ZvwiL (b) Passport No. cvm cvu b ^i Valid Till gqv` Date of Issue cö`v bi ZvwiL (i) Passport issuing country/authority cvm cvu cö`vbkvix `k/kz cÿ (ii) Place of issue cö`v bi vb (iii) Place of renewal (if applicable) gqv` ewa ZKi Yi vb (hw` _v K) (iv) Date of renewal (if applicable) gqv` ewa ZKi Yi ZvwiL (hw` _v K) (c) Birth Certificate No. Rb wbeüb mb`cî b ^i (d) Electronic-Tax ID (E-TIN) No. B jkuªwbk-u v AvBwW (E-TIN) b ^i (i) Country/ies of Tax filing obligation due to residency emev mi Kvi Y Ki Av ivckvix `k/ `kmg~n Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [May 2017] Page 2 of 5
3 (ii) Do you have Tax obligations in any other country? Ab Kv bv ` ki Ki AvIZvaxb wk bv (iii) If yes, which country/ies? nü v n j, Kvb `k/ `kmg~n? (e) Driving License No. WªvBwfs jvb mý b ^i Valid Till gqv` (f) Other (please mention in specific details) Ab vb (wbw` ófv e D jøl Ki Z n e) [From the list of documents described in points (a) to (c), you must provide at least one document. However, if a birth certificate is provided, it must accompany a photo identification document of the accountholder. Non-residents and foreign nationals must submit copies of their passports along with the relevant visas. If a photo identification document is not available, then the applicant will be required to provide a bank acceptable identification document issued by society s well-renowned persons* as per bank s satisfaction. The said identification document/certificate will need to be attested together with a photograph of the applicant (attestation covering the front page of photograph). Additionally, in order to fully verify the identity of the customer/applicant, the bank reserves the right to ask for additional documents/information upon its satisfaction, including but not limited to the documents/information mentioned in the points (d) to (f) or any points of this form.] [a n Z c b ^i µwg K ewy Z `wjjvw` n Z Avewk Kfv e h Kvb GKwU `wjj cö`vb Ki Z n e Z e Rb wbeüb mb` cö`v bi ÿ Î Rb wbeüb mb`c Îi AwZwi³ bwgwbi Av jvkwpîmn Ab h Kvb cwiwpwz cî cö`vb Ki Z n e bb- iwm W U Ges we `kx bvmwik `i Î cvm cv U i Kwc Avewk Kfv e cö`vb Ki Z n e Av jvkwpîmn cwiwpwz cî bv _vk j m wel q e vs Ki mš wó mv c ÿ Zv `i wbku MÖnY hvm mgv Ri MY gvb e w³* KZ K cö`ë cwip qi cöz qbcî cö`vb Ki Z n e D³ cwiwpwz cî ev cöz qbcî MÖvnK/wnmve cwipvjbvkvixi Av jvkwpîmn (Av jvkwp Îi Dc ii c ô mz vwqzmn) n Z n e GQvov, cö Z K e vsk h_vh_fv e MÖvn Ki cwiwpwzi wel q wbwðz niqvi j ÿ e vs Ki mš wó mv c ÿ Dc ii e b ^i µwg K ewy Z `wjjvw`mn AwZwi³ Av iv Kvb `wjjvw` Ges GB di g DwjøwLZ Z_ vw`i AwZwi³ Z_ msmön Ki Z cvi e ] Note: If a Birth Certificate is provided, a Government issued photo identification document needs to be provided along with it as per Bank s internal policy. wet `ªt Rb wbeübcî Rgv`v bi ÿ Î e vs Ki wbqg Abyhvqx mikvi cö`ë mwpî cwipqcîi Rgv w` Z n e *Society s well-renowned persons include Member of Parliament, City Corporation Mayor, Deputy Mayor and Councillors, Gazetted Officers who fall under the 9th grade or above on the National Pay Scale, Public University Teacher, Sub-District Chairman and Vice Chairman, Union Parishad Chairman, Municipality Mayor and Councillors, Private University Professor, Private College Principal, Private High School Headmaster, Editor of National Daily Newspaper, Notary Public, Officers of Semi-Government/Autonomous/State-owned Institution, who fall under 7th grade or above on the National Pay Scale, and Bangladesh Bank Officers who fall under 9th grade or above on the National Pay Scale. *MY gvb e w³ ej Z msm` m`m, wmwu K c v ik bi gqi, WcywU gqi I KvDwÝjiMY, RvZxq ezb ji 9g I Z`~aŸ MÖ Wi M R UW Kg KZ v, cvewjk wek we` vj qi wkÿk, Dc Rjv cwil `i Pqvig vb I fvbm Pqvig vb, BDwbqb cwil `i Pqvig vb, cšimfvi gqi I cši KvDwÝjiMY, emikvix wek we` vj qi Aa vck, emikvix K j Ri Aa ÿ, emikvix D P we` vj qi cöavb wkÿk, RvZxq ˆ`wbK cwîkvi m úv`k, bvuvwi cvewjk, AvavmiKvix/ ^vqëkvwmz/ivóªvqz ms vi RvZxq ezb ji 7g ev Z`~aŸ MÖ Wi Kg KZ vmy Ges evsjv `k e vs Ki RvZxq ezb ji 9g I Z`~aŸ MÖ Wi Kg KZ vmy K eysv e 17. Multiple citizenship held? (put mark) GKvwaK bvmwikz Av Q wk bv? (wuk w`b) Country NID and/or Passport Number Country of Issue Date of Issue Date of Expiry `k GbAvBwW Ges/A_ev cvm cvu b ^i cö`vbkvix `k cö`v bi ZvwiL gqv `vëx Y i ZvwiL 18. Present Residential Address ez gvb wvkvbv (Avevm j) a) Time at present residential address ez gvb wvkvbvq Avcwb KZw`b a i Av Qb? Years eqi Months gvm b) What were the residential addresses held by you during the last 3 years? MZ wzb eq i Avcbvi AvevwmK wvkvbvmg~n Kv_vq wq jv? 19. Permanent Address vqx wvkvbv Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [May 2017] Page 3 of 5
4 20. Occupational Address ckvmz wvkvbv Proof of present residential address must be submitted by accountholder MÖvnK/wnmve cwipvjbvkvixi ez gvb Avev ji cögvy mv c ÿ WKz g Um Aek B cö`vb Ki Z n e 21. Correspondence Address hvmv hvm wvkvbv (a) Address (put mark) wvkvbv (wuk w`b) Present ez gvb Permanent vqx Occupational ckvmz (b) Telephone No. Uwj dvb b ^i (I) Home evmv (II) Office Awdm (c) Mobile No. gvevbj b ^i (d) B- gbj (e) Fax No. d v b ^i 22. In case of an emergency, please contact Riæix cö qvr b hvmv hv Mi Rb g bvbxz e w³ Name bvg Address wvkvbv Relationship with Accountholder wnmveavix/wnmve cwipvjbvkvixi mv _ m ck Mobile No. gvevbj b ^i Address B- gbj 23. Credit Card Information (if available) µwwu KvW msµvší Z_ (hw` _v K) Issuing Bank/Institution cö`vbkvix e vsk/cöwzôvb Card Number and Type KvW b ^i Ges aiy Card Category (put mark) KvW K vuvmwi (wuk w`b) a. b. c. 24. Existing account(s) with HSBC (Including accounts/cards held with any foreign entity/branch of HSBC) GBPGmwewm-Gi `kx/we `kx h Kv bv kvlvq _vkv Ab Kv bv wnmve _vk j Country and Branch Name Account/Card Number Type of Account (put mark) `k Ges kvlvi bvg wnmve/kvw b ^i wnmv ei aiy (wuk w`b) Special proposition held with any HSBC entity (put mark) GBPGmwewm-Gi mv _ h Kv bv we kl m úk (wuk w`b) Private Banking e w³mz e vswks Premier wcöwgqvi Advance A vwfvý Name of Country/HSBC entity where special proposition is held GBPGmwewm-Gi h `k ev A½cÖwZôv bi mv _ m úk Av Q Zvi bvg Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [May 2017] Page 4 of 5
5 25. Car Ownership Mvwoi gvwjk 26. Marital Status ˆeevwnK Ae v 1 Single AweevwnZ 2 Married weevwnz 3 Widowed wecwzœk/weaev 4 Divorced/Separated ZvjvKcÖvß 27. Occupation of Spouse ^vgx/ xi ckv 28. Number of Children mšív bi msl v None GKwUI bv 1 or 2 1 A_ev 2 3 to 5 3 _ K 5 More than 5 5 Gi ewk 29. Education wkÿv 1 Limited/None ^í/ bb 2 Primary cöv_wgk 3 Secondary gva wgk 4 Graduate œvzk 5 Post Graduate œvz KvËi 30. Residence emevm 1 Rented House/Flat fvov evwo/evmv 2 Rented Public Housing mikvwi fvov evmv 3 Mortgaged Property gu MR m úwë 4 Own Private House/Flat wbr ^ evwo/evmv 5 Living in Parent s Dwelling gvzvwczvi evwo Z 6 Company Residence Kv úvwb cö`ë evmv 31. Household Income (Gross Monthly in BDT equivalent) cvwievwik Avq (me gvu gvwmk Avq, mgcwigvb UvKvq) 1 Less than 15,000 15,000 UvKvi Kg 2 15,001-25,000 15,001-25, ,001-40,000 25,001-40, ,001-70,000 40,001-70, ,001-1,20,000 70,001-1,20, ,20,000+ 1,20,000 UvKvi ewk 32. Please tell us why you have decided to open an account with The Hongkong and Shanghai Banking Corporation Limited w` nsks Ges mvsnvb e vswks K c v ikb wjwg U W wnmve Lvjvi wel q Kb wm vší wb q Qb? 1 Recommended by family/friends 2 Family has always banked with HSBC 3 Response to particular advertising cwiev ii m`m /eüzi civg k cwiev ii jvkrb memgqb GBPGmwewmÕi mv _ e vswks K i Q wbw` ó GKwU weávc bi Kvi Y 4 Dissatisfaction with previous bank 5 Convenient location of bank 6 Employer s bank for salary payment c~e ezx e vs Ki mevq Amš ó n q vb myweavrbk ezb cö`v bi Rb Kv úvwbi wbav wiz e vsk 7 Price related reasons 8 Service reasons 9 Other reasons LiP m úwk Z Kvi Y mev msµvší Kvi Y Ab vb Kvi Y I/We confirm that the information given above is true and correct Avwg/Avgiv GB g g wbwðz KiwQ h, Dc i cö`ë mkj Z_ mwvk Ges wbfz j Applicant s Signature Name: Av e`bkvixi ^vÿi, bvg I ZvwiL Signature Verified by Branch Official wnmve Lvjvi mswkøó Kg KZ vi bvghy³ wmjmn ^vÿi Name with seal: bvghy³ wmjmn ^vÿi ZvwiL Signature of Approval Official (Branch Manager) Aby gv`bkvix Kg KZ vi (kvlv e e vck) Name with seal: bvghy³ wmjmn ^vÿi ZvwiL Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [May 2017] Page 5 of 5
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