APPLICATION FOR OPENING INDIVIDUAL ACCOUNT (Current Deposit I Fixed Deposit)

Transcription

1 .~ tiii 3ii!f; iikt ~ Bank of Baroda India's International Bank APPLICATION FOR OPENING INDIVIDUAL ACCOUNT (Current Deposit I Fixed Deposit) All prospective customers are required ta complete this application form for the account or accounts they require; The Branch Manager branch For office use Account No.: Dear Sir/Madam, Proof of identity exhibited and copy verified: Proof or residence exhibited and copy verified: Date all formalities completed: We request you to open and account in my/our name(s) styled as: Officer's Date: Title of account: Manager's signature: Date: First applicant - personal details Second applicant - personal details Title: (Mr./Mrs./Miss/Ms.) Title: (Mr.lMrs./Miss/Ms.) Surname: Forenames: Date of birth: Nationality: Passport no. Place of issue: Date of issue: Expiry date: National Insurance No.: Mother(s Maiden Name: Surname: Forenames: Date of birth: Nationality: Passport no. Place of issue: Date of issue: Expiry date: National Insurance No.: Mother(s Maiden Name: (If the applicant is not issuedwith any Passport, full particulars of alternative identification documents be accepted and certified copies be left on record, aspermitted per current guidance notes issuedby JMLSG,in association with BBA) Employment Status (Please tick as appropriate) (If the applicant is not issued with any Passport, full particulars of alternative identification documents be accepted and certified copies be left on record, aspermitted per current guidance notes issuedby JMLSG,in association with BBA) Employment Status (Please tick as appropriate) D Employed D Pensioner D Other D Self-Employed D Employed D Pensioner D Other D Self-Employed

2 * Name and address of Employer (if applicable) Name and address of Employer (if applicable) * If self-employed (Pleasestate your Occupation/profession, Business & expected Turnover/sales) Name & address Of your * If self-employed (Pleasestate your occupation/profession, Business & expected TUrnover/sales) Name & address of your * Gross annual income? * Gross annual income? * Permanent address: * Permanent address Home Tel. NO: Home Tel. NO: Work Tel. no: work Tel. no: address: address: * Full correspondence address (If different from permanent address), If correspondence address is of person other than your own, please state niszner Name and your RelationShip with hlmlher. Please provide evidence of address of recipient of the correspondence similar to one you have provided for YOurself), Address: correspondence recipient's Name & Relationship (if applicable) * Please state the purpose for which the account will be maintained: * Marital status: * Marital status: * Residential status * Residential status Owner-occupier Living with Parents DTenant Owner-occupier Living with Parents D Tenant Other (Give details) other (Give details) Details of present Bank or Building Name of Bank of Building Society Society accounts Details of present Bank or Building Society accounts Name of Bank of Building Society Branch: Branch: sort code: D D-D D-D D sort Code: DO-DO-DO Account number Account number

3 DECLARATION (for non-resident only) ACCOUNTHOLDERS: (first name, last name) Held with: BANK OF BARODA 28 Rue de la tot 1Q40 BRUSSELS certify: 1. Not to have in Belgium its/their domicile, administrative centre of its/their wealth, head office, principal place of business, nor seat of management or administration. 2. Not to have assigned said funds to the exercise of a professional activity in Belgium. 3. I/We declare that I/wE are the Beneficial Owner of the funds that are being/or will be deposited from time to time in my/our account and that these funds in all or any part of it are in no way linked in any manner howsoever or are process of any illegal activities/criminal conduct and do not constitute Money laundering. 4. I/We are aware of my/our obligation and undertake to inform the bank promptly of any change in my/our circumstances and provide missing or updated information as appropriate relating to this account. Date: Place: (SIGNATURES)

4 Joint Applicant's Declaration (FOrthis section ''We/us'' refers to the customer, In case of joint application the following shall apply: and "You" refers to the sank We request you to open an account or accounts in our joint names, or to continue the joint account already opened. We authorise you, until you receive notice in writing from any of us to the contrary, insert "either" "anyone" 2. "and «woras appropriate 1. TO pay and debit to any such account ail cheques, orders to pay, bills of exchange, and promissory notes drawn, signed, accepted or made by*.,--- --: of us, whether the accounttsi be in credit or overdrawn or shall become overdrawn by reason of such debiting. TO grant at the request of * of us, overdraft, loan or other credit facilities or accommodation for our joint account and by way of security therefore, to accept as duly signed or executed on behalf of all of us any document creating or evidencing any charge, mortgage or pledge over or in respect of any securities, deeds or other articles in our joint names. 3. To pay against the signature of * of us any monies held to the credit of any deposit account in our joint names: 4. To deliver against the signature of * of us, any securities, deeds or other articles held in our joint names by way of security or for safe custody otherwise. We agree that, in the event of the death of any of us, you are to payor deliver to the order of the survivor or survivors of us, all monies, securities, deeds and other articles standing to the credit of or held for any account In our joint names. We hereby agree that we shall be jointly and severally responsible for any overdraft, loan or other credit facilities or accommodation which shan be granted in our joint names or for our joint account, together with ail interest, commission and other banking charges and expenses. We understand that in case of term deposit with operating instructions "either or survivor" or "former or survivor", premature termination/payment without any penal charges will be allowed to the survivor in the event of the death of the either of the depositors or former as the case may be on submission of death certificate of the deceased depositor along with application without obtaining consent of the legal heirs of the deceased depositor." The Bank may, on receipt of a written application from "the first named/the second named etc. of us"/"either or survivor of us" OR "any of us or survivors or survivor of US",in its absolute discretion and subject to such terms and conditions as the Bank may stipulate, (al grant a loan/advance against the security of the term deposit receipt to be issued in our joint names or e» make premature payment of the proceeds of the deposit to the "the first named or the second named of us"/"either or survivor of us "/"any one of us or survivors or survivor of us". Please sign below a) I accept the terms and conditions that apply to the account and that I have asked for and you have agreed to provide me with. b) Where this application is for a joint account I/We accept the terms of the joint applicants extra declaration. Name: signature Date: _ Name: signature nate. _ Name: Date:, _ Name: Date:, _

5 Bank of Baroda Rue de ta tot Brussels Belgium Re : a/c no. _ Dear Sirs, This is to request you and authorize you to act upon any instructions/messages/applications or letters etc. sent to you by Facsimile (Fax) or telecopies for transfer of funds/documents/or any other transactions. We hereby agree than upon receipt of the facsimile, Bank of Baroda, as a security procedure, shall telephonically confirm with any of the authorized signatories, the authenticity of communication and on receiving such confirmation, shall be able to conclusively rely on it for the authenticity of the communication. In consideration of your acting upon our faxed letters/messages/ instructions/applications etc. in lieu of original, we hereby further agree and undertake to hold you harmless and to full indemnify you from and against ail losses, claims, costs or damages, which you may sustain or incur by reasons of your acting upon our fax or in case the telefax of authorized signature is fraudulent or forged We further agree and undertake to submit a written confirmation of this fax message immediately after faxing the same to you and in the event the original is not received by you, or not sent by us/misplaced/lost in transit, we hereby agree to your considering the fax message as equivalent to the original letter/message. In the event there is any discrepancy or variance between the faxed message and the original written confirmation, we agree to hold you harmless and indemnify you for relying on the faxed message and the signature appearing on the message. We further agree and undertake to pay you and make good any loss or damage or expenses you may be put to or incur in reliance on the faxed instructions, messages, applications or letters etc. immediately upon your making a demand and hereby waive any defense or counterclaim based on your relying on faxed message/letterlinstruction/application and or the signature appearing on them. Yours faithfully,

6 IFOR TRANSFER OF USD ($) FUNDS 3 To remit USDto JP Morgan Chase Bank N.A., New York (Swift Address: CHASUS33),ABA for credit of account number: of Bank of Baroda, Brussels (SWIFTAddress: BARBBEBB)for ultimate credit to account number: Of beneficiary's name: (Ultimate Beneficiary>. IFOR TRANSFER OF CBP (E) FUNDS 3 TO remit GBPto Bank Of Baroda, London (Swift Address: BARBGB2U,Sort Code: For credit of account number: of Bank of Baroda, Brussels (SWIFTAddress: BARBBEBB)for ultimate credit to account number: Of beneficiary's name: (Ultimate Beneficiary). IFOR TRANSFER OF EUR ( ) FUNDS ~ TO remit EURto KBCBank, Brussels (Swift Address: KREDBEBB),For credit of account number: BE of Bank of Baroda, Brussels (SWIFTAddress: BARBBEBB)for ultimate credit to account number: ----, ::-:---,- Of beneficiary's name: (Ultimate Beneficiary). Dear Customer / Visitor, Above are the details of instructions to be given to your bankers for transferring funds in each currency to Bank of Baroda - Brussels branch. Please transmit these details to your banker for transferring funds easily to our Branch. For any question, please don't hesitate to contact us.

7 BANK OF BARODA, BRUSSELS Documents required for opening Individual/Joint account for residents of Belgium 1. Account opening form along with specimen signature card, duly signed by the account holders. 2. Latest copies of Passport. 3. Copy of Resident Card of Belgium. 4. utility bill for address proof. 5. One latest photograph. Account Holder to visit personally to branch with prior appointment for opening the account along with the originals of above documents for verification. ****** Documents required for opening Individual/Joint account for non-residents, duly attested by anyone of our branches 1. Account opening Form along with specimen signature card, duly signed by the account holders. 2. Latest copies of passport, duly certified by anyone of our branches. 3. One latest passport size Photograph. 4. utility bill for address proof. 5. Faxundertaking as per format.