Loan Application cum Account Opening Form

Transcription

1 Loan Application cum Account Opening Form For SE Customers 2040-Ver 2.0-Aug 2017 CB Bank Limited 001 / Aug 17 / 1.6

2 Indicative List of ocuments that can be provided for Know our Customer (KC) requirements For Sole Proprietorship / Partnership Firm Sales Tax Registration Service Tax Registration Registration Certificate under Shop and Establishment Act Registration Certificate for SSI with Govt. Agency Registration Certificate Issued by Registrar of firms Licenses issued by any Government Authorities (Like licenses issued by Shops and Establishments) Importer Exporter Code Certificate Proprietorship eclaration PAN Card Partnership eed (Notarised / Registered) Partnership Letter NOC from other bank/s in case the Firm enjoys credit facility from any other bank/s For Club / Societies / Association / Trust Account Certificate of Registration from Registrar of Co-operative societies / Trust / Charity Commissioner (Applicable to all Public Trusts) Certificate of tax Exemption, if any (applicable to Trusts) Trust eed including supplemental deed for change in the trustee Resolution to open and operate an account Pan Card List of anaging Committee embers / embers on Board of Trustees For Pvt. / Public Ltd. Company emorandum of Association and Articles of Association Board Resolution to open and operate an account NOC from other bank in case the Company enjoys credit facility from any other bank Certificate of Incorporation List of latest irectors of the Company with address & telephone numbers duly certified by the Company Secretary / CFO / of the Company eclaration on letter head of Company if local address provide is different from emorandum of Association and Articles of Association Form IR 12 & ROC required if change in directors from those appearing in emorandum of Association and Articles of Association Pan card Local Body Tax (LBT) Certificate CX Certificate for Commodity Trades Certificate issued by Statutory / Regulatory Authorities containing name of the firm Complete latest Income Tax Return Form (not just the acknowledgement) in the name of Proprietor, where the firm's income with the its name is reflected, duly authenticated / acknowledged by the I. T. Authorities. Please Note: a) istinct / Separate Board anaging Committee Resolution and Partnership Letter is to be provided for each eposit Account, as applicable. b) In case of Partnerships, Limited Companies, Trusts, Societies, Associations and Clubs, person(s) with conditional mode of operation / authority will get only non-financial transactions on Net Banking and Phone Banking will not get Payment Gateway access. c) In case of Proprietorship, Partnerships, Limited Companies, Trusts, Societies, Associations and Clubs all signatures should be accompanied by stamp of the organisation, as applicable. d) The Channel Access for Investment Account(s) is restricted to enquiry rights on Phone Banking along with view and transaction rights for Net Banking. e) In case of Partnerships, Limited Companies, Trusts, Societies, Associations and Clubs, Investments Account(s), transaction rights on Net Banking / ebit Cards will be granted only to person(s) with unconditional mode of operation/authority. f) In case of Partnerships, Limited Companies, Trusts, Societies, Associations and Clubs ebit Cards will be issued only to person(s) with unconditional mode of operation/authority. g) Proprietor of a Proprietorship concern and will get both financial and non financial transactions on Net Banking, Phone Banking. They are also eligible for ebit Cards and Payment Gateway access. h) Net Banking and Phone Banking access is applicable for all investment Account(s) existing or to be opened in future for the Organisation. i) The Net Banking, Phone Banking, Payment Gateway access is applicable for all eposit Accounts existing or to be opened in future for the Organisation. j) Payment Gateway is provided as per the terms and conditions of the Bank and regulatory guidelines as applicable from time to time. k) This application shall be continued to be governed by the terms and conditions of the Bank and the Applicant herein further undertake to observe the terms and conditions of the Bank from time to time accordingly. l) All alerts, e-news letter and promotional mails will be sent to the Preferred obile Number and Preferred I. m) obile number will be used for SS Banking registration for eligible accounts. Instruction for filling Account Opening Form Please fill the form preferably in BLACK ink only Hint boxes give tips and highlight important points across the form A B C Please fill the form in CAPITAL LETTERS only Please tick the appropriate boxes Please write your NAE as it appears in all your support documents Specify the addresses along with City, State and PIN Code Please countersign in full against any overwriting / alteration ALL PHOTOCOPIES of documents to be SELF-ATTESTE by the applicant

3 Bank Use only (* Fields are andatory) Application No.: IN Customer I: Account No.: *Segment Code SOL Code: R (Name & Code) Sourcer (Name & Code) Please open my account at your ate: Branch Please affix a recent photograph Sign across the photo Channel: Self Connector CBE Branch Other (please specify) Relationship Form Type of Current Account Classic Premium SmartGain Excel Privilege Customer I only Others (please specify) Applicant's Personal etails *Name: r. rs. s. r. *ate of Birth: (* Fields are andatory) Existing Customer I (If applicable): (First Name) (iddle Name) (Last Name) *Gender: ale Female Third Gender aximum 32 characters other s aiden Name: arital Status: Single arried other s Full Name: Father's / Spouse Full Name: *Country of Birth: *Citizenship: U.S. Person: es No *Place of Birth: *Residence for Tax Purposes: Please fill FATCA / CRS declaration form if you are not an Indian citizen and resident *Nationality: Indian Other (pl. specify) Religion: Category: General OBC SC ST Others (Pl. specify) *Permanent Account Number (PAN): Form 60 *Aadhaar Number: If PAN is not available please fill in Form 60 Residential Address: City: PIN: *Landmark: State: Telephone: (with ST Code) Preferred Id: Country: *Preferred obile No.: If address provided, Physical Statement will not be send Office Address (Name of the Firm): City: PIN: Office address would be considered as your communication address *Landmark: State: Telephone: (with ST Code) Preferred Id: Country: *Preferred obile No.: If address provided, Physical Statement will not be send 3

4 Applicant's Loan Requirement Type of Loan: Cash Credit Overdraft Term Loan Non Fund based Limits LC / BG Others Fund Based Amount Required ( ` in Lakhs): Total Amount Required (`): Non- Fund Based Amount Required ( ` in Lakhs): Tenor of Loan: onths Security Offered: Stocks / Book ebts / Plant & achinery / Immovable Property / Land / Others ortgage of the immovable property Estimated Collateral Value (`): Use / Purpose of the Loan: Property Address: State: Country: obile No.: City: PIN: Signature and Stamp of the Organisation / Any Authorised Signatory Authorised Signatories are by default eligible for free SS facility, if mobile no. is mentioned Applicant's Profile Name of the Firm: Same as overleaf ate of Incorporation / Registration: No. of ears in Existence: *Permanent Account Number (PAN): Form 60 CIN: PAN for the FIR to be shared GST Number: Constitution: Proprietorship Partnership Pvt. Ltd. Public Ltd. Trust / Soc. / Clubs Others (Please specify) Nature of Business: anufacturing Trading Services Importer / Exporter Others (Please specify) *escription of Business: Credit Facilities I / We enjoy credit facilities with other bank(s) I / We do not enjoy credit facilities with other bank(s) No Objection Certificate (NOC) Bank Name of the Facility Limit ROI Takeover NOC to be attached incase customer(s) are enjoying credit facility with other bank(s) es es No No Authorised Signatory / Guarantor / Co-applicant 1 Existing Customer I: es No (Please fill the below details) *Name: r. rs. s. r. Prof. (First Name) (iddle Name) (Last Name) *ate of Birth: *Gender: ale Female Third Gender Please affix a recent photograph Sign across the photo *Permanent Account Number (PAN): Form 60 *Aadhaar Number: esignation: Communication Address: State: Country: obile No.: City: Signature / Thumb impression of Authorised Signatory / Guarantor / Co applicant 1 PIN: Authorised Signatories are by default eligible for free SS facility, if mobile no. is mentioned 4

5 Authorised Signatory / Guarantor / Co-applicant 2 Existing Customer I: es No (Please fill the below details) *Name: r. rs. s. r. Prof. Please affix a recent photograph Sign across the photo (First Name) (iddle Name) (Last Name) *ate of Birth: *Gender: ale Female Third Gender *Permanent Account Number (PAN): Form 60 *Aadhaar Number: esignation: IN: Communication Address: State: Country: obile No.: City: Signature / Thumb impression of Authorised Signatory / Guarantor / Co applicant 2 PIN: Authorised Signatories are by default eligible for free SS facility, if mobile no. is mentioned Authorised Signatory / Guarantor / Co-applicant 3 Existing Customer I: es No (Please fill the below details) *Name: r. rs. s. r. Prof. Please affix a recent photograph Sign across the photo (First Name) (iddle Name) (Last Name) *ate of Birth: *Gender: ale Female Third Gender *Permanent Account Number (PAN): Form 60 *Aadhaar Number: esignation: IN: Communication Address: State: Country: obile No.: City: Signature / Thumb impression of Authorised Signatory / Guarantor / Co applicant 3 PIN: Authorised Signatories are by default eligible for free SS facility, if mobile no. is mentioned ode of Operation Self / Proprietor/ andate Jointly Anyone of the Authorised Signatory Others (Please specify) Services Cheque Book: es No Physical Statement: onthly Quarterly early Statement: onthly Quarterly early Since I / we have registered for statement of account, I / we hereby give my / our consent to the Bank to send physical statement of account only once a year on completion of financial year. SS Banking & Alert Facility: Alerts facility enables you to receive alerts on your Preferred I and / or Preferred obile Number regarding large debit, large credit, SI failure, balance below AQB and balance update. New alerts may be added from time to time. Please Note: Authorised signatory/ies of the Firm / Company / Trust / Association / Society are eligible for free obile alert facility subject to compliance of terms and conditions as stipulated by the Bank from time to time. I / We don t wish to receive any Bank related promotional calls, SS alerts or s. CB On The Go (obile Banking) Account Statement Internet Banking Utility Bills Phone Banking Preferred Language Options: English Hindi arathi Gujarati Tamil Telugu Authorised Signatories are by default eligible for free phone Banking facility. Telephone Personal Identification Number (T Pin) will be sent to the mailing address Please fill a separate obile Banking Registration Form for Joint Account Holder 5

6 Processing Fee etails Processing fee payable upfront & Non-refundable: ` Cheque / Number ated: rawn on in favour of CB Bank Limited I / We agree to open a Savings / Current Account with CB Bank es No CB Current and Savings Accounts come with a host of benefits such as Free RTGS / NEFT, Payable at Par Cheque Book, Free Phone / Internet / obile Banking, Free access to VISA ATs, Any Branch Banking and much more. Nomination etails (Form A1) for Individual / Sole Proprietor es, I/we want to nominate the following person No, I /we do not want to nominate anyone on my /our behalf I / We nominate the following person to whom in the event of my / our / minor s death the amount of the deposit / in the account may be returned by CB Bank Limited Nominee Name: Address: Relationship with Applicant, if any * As the nominee is a minor on this date, I / we appoint (Name & Address) Age: ears ate of Birth: Nomination under Section 45ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules 1985 in respect of bank deposits. to receive the amount of the deposit / in the account on behalf of the nominee in the event of my / our / minor s death during the minority of the nominee. In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook, statement and eposit Confirmation Adviseissued in respect of your account and / or the passbook issued to you es No I / We do hereby declare that what is stated above is true to the best of my / our knowledge and belief. Witness(es): Name : Name : Signature(s) / Thumb Impression(s) of Applicant(s) Thumb impression is required to be attested by 2 witnesses. In case of signature, no witness is required. Signature : Address : Signature : Address : Place : ate : Place : ate : * Strike out if nominee is not a minor. ** Where deposit is made / account is held in the name of the minor the nomination should be signed by a person lawfully entitled to act on behalf of the minor. 6

7 Confirmation I confirm having met the Applicant/s in person. I confirm having met r. / s., Applicant in person at the Bank, Branch, c Communication Address, c Office Address (anyone address as mentioned in the application form) and hereby confirm the identity and address as provided in this account opening form and also confirm having verified the copy of the documents (as applicable) against originals as produced by the applicant/s. For Office Use Only I also confirm that this Form has been signed by the applicant(s) / Authorised Signatory(ies) / Guarantor(s) in my presence. I have also verified the obile number by calling the no. mentioned in this account opening form. Name of Bank Official: r. rs. s. HRS No.: ate: Signature of Bank Official eclaration I / We have read, understood and hereby agree to the terms and conditions as applicable to my / our account set forth on CB Bank Limited (the Bank ) website at I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank s website only. I / We do hereby declare that data/information furnished in this Form is true and correct to the best of my / our knowledge and belief. I/We are not related to any irector / officials of the Bank. I/ We, understand that as a pre-condition, relating to grant of the loans/advances / other non-fund based credit facilities to me/us, the Bank, requires my/our consent for the disclosure by the Bank of, information and data relating to me/us, of the credit facility availed of / to be availed, by me/us, obligations assumed / to be assumed, by me/us, in relation thereto and default, if any, committed by me/us, in discharge thereof. I / We, hereby agree and give consent for the disclosure by the Bank of all or any such; (a) Information and data relating to me / us, (b) The information or data relating to any credit facility availed of / to be availed by me / us, and (c) efault, if any, committed by me/us, in discharge of my / our such obligation. as the Bank may deem appropriate and necessary, to disclose and furnish to Credit Information Bureau (India) Ltd., and other agency duly authorized in this behalf by the Reserve Bank of India. (d) I/ We hereby authorise the Bank to ascertain from Credit Information Bureau(India)Ltd/any other Credit bureau authorise by RBI, my/our credit score for the purpose of processing my/our loan application. (e) I /We hereby understand that among all other things, minimum balance requirement for variants of Current account under various scheme codes would be applicable and is in line with such updated information as available on the bank's website. I / We hereby authorize issuance of AT / ebit Card and provision of Statement, Statement, Phone Banking, obile Banking Services, Internet Banking and Bill Payment Services, as requested in the form. I / We are aware of Charges Applicable for various services offered and I / we affirm, confirm and undertake that I /we have read and understood the Terms and Conditions for usage of the Phone Banking, obile Banking Services, Internet Banking and Bill Payment Services of the Bank as set forth in the Bank's website and I / we will adhere to all the terms / conditions as applicable from time to time. I / We further authorise the Bank to debit my / our Account(s) towards any applicable charges for any / various service / services provided as applicable from time to time. I / We declare, confirm and agree: a) That all the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all respects and I / we have not withheld any information. I / We understand certain particulars given by me / us are required by the operational guidelines governing banking companies. I / We agree and undertake to provide any further information as and when the Bank may require. (b) That I / we have had no insolvency proceedings initiated against me / us nor I / we have ever been adjudicated insolvent. (c) That I / we have read the application form and brochures and am / are aware of all the terms / conditions of availing finance or service or products from the Bank. (d) I / We agree and understand that the Bank reserves the right to reject my application without providing any reason and reference to me / us. I / We agree and understand that the Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and shall not return the same to me / us. (e) To inform the Bank regarding change in my / our residence /employment and to provide any further information as and when the Bank may require from time to time. (f) I/We, undertake that: (i) the Credit Information Bureau (India) Ltd. and any other agency so authorized may use, process the said information and data disclosed by the Bank in the manner as deemed fit by them (ii) the Credit Information Bureau (India) Ltd. and any the agency so authorized may furnish for consideration, the processed information and data or products to other credit grantors or registered users, as may be specified by the Reserve Bank of India in this behalf. (g) That I/We shall not hold the Bank liable for sharing of information furnished by me with other Banks / Financial Institutions / Credit Providers / any other entities. (h) I/We agree and understand that I / we have to complete further application for specific liability products /services from the Bank as prescribed from time to time, and that such further applications shall be regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in such further forms as prescribed, the particulars and information set forth herein as well as the documents referred or provided herewith are true, correct, complete and up-to-date in all respects. (i) I / We agree and understand that such further applications will require incorporation of the application form number, and / or such details as the Bank may prescribe, to facilitate data management. (j) I / We authorise the Bank to issue a ebit cum AT Card to me / us (Authorised Signatory(ies)). (k) I / We acknowledge that the issue and usage of the ebit cum AT Card is governed by the terms and conditions as in force from time to time and I / We agree to be bound by the same. (l) I / We accept that the terms and conditions of ebit cum AT Card are liable to be amended by the Bank from time to time. (m) I / We further unconditionally and irrevocably authorise the Bank, to debit my / our Account annually with an amount equivalent to the fee and charges for use of the ebit Card. (n) I / We, hereby authorise the eligible parties (mentioned in the form) to access the Internet Banking, Phone Banking and obile Banking channels as provided for viewing of and transaction from the Account. (o) I / We, hereby state that if I / we wish to revoke the above (n) authorisation, I / We, shall duly issue a letter of revocation ( the revocation letter ) to the Bank in this regard. I / We hereby agree that such revocation of authorisation as aforestated shall come into effect within ten clear working days after receipt of such revocation letter by the Bank. (p) I / We, agree that in case of death of any or more of the joint applicant(s), the due would be paid at the Bank's discretion, on request before due date (subject to penal clause for premature payment as may be stipulated from time to time) as per mode of operations indicated above. (q) I / We also understand that continuation of the account with the Bank is at the sole discretion of the Bank and in case the Bank is dissatisfied with the conduct of the Account / accountholder, the Bank has the right to close the account after giving me / us one month's notice or withdraw the concessions in to or any service granted to me / us or charge the Bank's applicable rates for such services. (r) I / We understand that the Bank may at its absolute discretion, discontinue any of the services completely or partially without any notice to me / us. (s) I / We agree that on receipt of written application from any of the Authorised Signatory(ies) and / or survivor or survivors of us, the Bank at its sole discretion and subject to such terms and conditions, grant a loan / advance/renew/enhance against the security / collateral issued in joint names. (t) I / We understand that CB On The Go facility will be offered to customers whose account is an individually operated resident account, In the case of joint Account(s) this facility will not be available. (u) I / We understand that CB obile Banking will also not be available to Non Resident Accounts. (v) I / We agree to receive only statement incase of address is provided. (w) I / We understand that Processing Fee and Administrative Fee are nonrefundable and in the event of my / our this application being rejected by the Bank for any reason or same being withdrawn by me / us, I / we shall not be entitled for refund of the same. *Rubber Stamp of the Company / firm / concern required Authorised Signatory(ies) Guarantor(s) Place: ate: 7

8 Annexure R etails of the beneficial owners: Name OB (//) Nationality Occupation / Profession Residential Address (with Ids & Landline / obile Numbers) For Companies (Private & Public) Shareholders with more than 25 % of Shares/Capital ( whether acting alone or together or through one or more judicial person would be treated as BOs) Partnership accounts/ Trusts(Public/Private)/ Association of Persons(AOP)more than 15% interest (Capital/Profit)in the Partnership/Trust /AOP For Partnership firms, Signatures of all the Partners in the account to be obtained For others, either all Authorized Signatories may sign OR those as per mandate in the account OR by the irectors/trustees who have signed on the Resolution For Partners/ irectors/trustees / Authorised Signatories/ AOPs (Signature to be done under Rubber stamp of the entity) 8

9 Customer Information & ue iligence (CI) Form Information Countries where business associates located (for Businessmen, only) etails Source of Funds for Credits in the Account Savings Salary Business Proceeds Sale of Property Investments Inheritance Professional fee Other (please specify) Expected Annual Turnover (`) Less than ` 1 Lakh Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs Upto ` 1 Crore Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores ore than ` 25 Crores Expected number of transactions in a month Up to to 50 ore than 50 Wire Transfers Expected Into the Account es No Value ` From the Account es No Value ` Foreign Inward Remittances Expected es No Approximate Value ` For Bank Use Only Is any of the Signatories / Beneficial Owners of the entity a Political / Public Figure or related to a Political / Public Figure? es No if yes, please give position oes it seem that the initial eposit and/or the declared transaction profile is in line with the status/occupation declared? es No For individuals fill separate FATCA / CRS Form Signed in my presence Name & Signatures of the Officer along with HRS Number Risk categorisation * Kindly fill the following details: Basis of Categorisation: Politically Exposed Person omiciled in Risk Country Trust Sleeping Partner High Risk Profession Others (Please specify): Information: Politically Exposed Person due to position / status as: If omiciled in Risk Country - Country Name: If into High Risk Profession then please mention nature of Business / Occupation: *etails of Customer s Source of Funds & Estimated Net Worth: Income from Employment Income from Business Income from Investments Inherited Funds Others (Please specify): *Estimated Net Worth `: Please fill in for Sole Proprietorship Account Re: Opening of a new account in the name of (the concern ) I refer to the captioned account and declare as under: I, the undersigned, am the sole proprietor of the concern and am solely responsible for the liabilities thereof. I shall advice you in writing of any change that takes place in the constitution of the concern and I will be liable to you for any obligation which may be standing in the concern's name in your books on the date of the receipt of such notice and until all such obligations shall have been liquidated. ours faithfully, Name: Signature (Please sign without Stamp 9

10 Please fill in for a Partnership Firm Re: Opening of a new account in the name of (the firm ) We refer to the captioned account and declare as under: We, the undersigned, are the only partners in the firm and are jointly / severally responsible for the liabilities thereof. We shall advice you in writing of any change that takes place in the partnership and all the present partners shall be liable to you on any obligation which may be standing in the firm's name in your books on the date of the receipt of such notice and until all such obligations are liquidated. ours faithfully, Name of Partners Signature (without stamp) [To be signed by all partners] Self-Certification for Entities FATCA / CRS eclaration Form Part I A. Is the account holder a Government body/international Organization/listed company on recognized stock exchange If No, then proceed to point B es No If yes please specify name of stock exchange, if you are listed company, and proceed to sign the declaration B. Is the account holder a (Entity/Financial Institution) tax resident of any country other than India If yes, then please fill of FATCA/ CRS Self certification Form es No If No, proceed to point C C. Is the account holder an Indian Financial Institution If yes, please provide your GIIN, if any, es No If No, proceed to point. Are the Substantial owners or controlling persons in the entity or chain of ownership resident for tax purpose in any country outside India or not an Indian citizen If yes, (then please fill FATCA/ CRS self-certification form)). If No, proceed to sign the declaration Customer eclaration ( ) Under penalty of perjury, I/we certify that: 1. The applicant is: (i) An applicant taxable as a US person under the laws of the United States of America ( U.S. ) or any state or political subdivision thereof or therein, including the istrict to Columbia or any other states of the U.S., (ii) An estate the income of which is subject to U.S. federal income tax regardless of the source thereof. (This clause is applicable only if the account holder is identified as a US person) 2. The applicant is an applicant taxable as a tax resident under the laws of country outside India. (ii) I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA/CRS. The Bank is not able to offer any tax advice on FATCA/CRS or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions. (iii) I/We agree to submit a new form within 30 days if any information or certification on this form becomes incorrect. (iv) I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBT or close or suspend my account. (v) I/We certify that I/we provide the information on this form and to the best of my/our knowledge and belief the certification is true, correct, and complete including the taxpayer identification number of the applicant. Name of the Entity es No Signature 1 Signature 2 Signature 3 (As per OP) ate: 10

11 Part II Self-Certification Form (Entity) for Foreign Account Tax Compliance Act ( FATCA ) and Common Reporting Standards (CRS) Section 1: Entity information Name of the Entity Customer I (if existing) Entity Constitution Type Entity Identification type Tax Identification Number (TIN) U.S. GIIN Company Identification Number Global Entity Identification Number (EIN) Other Entity Identification No Entity Identification issuing Country Country of Residence for tax Purpose Section 2: Classification of Non-Financial entities I/We (on behalf of the entity) certify that the entity is: a) An entity incorporated and taxable in US (Specified US person) es No If es, please provide your U.S. Taxpayer Identification Number (TIN) TIN TIN b) An entity incorporated and taxable outside of India (other than US) es No If es, please provide your TIN or its functional equivalent Provide your TIN issuing country TIN c) Please provide the following additional details if you are not a Specified US Person: FATCA / CRS classification for Non-financial entities (NFFE) Active NFFE Passive NFFE without any controlling Person Passive NFFE with Controlling Person(s): US Others irect Reporting NFFE (Choose this if any entity has registered itself for direct reporting for FATCA and thus bank is not required to do the reporting) Please provide GIIN number: Section 3: Classification of financial institutions (including Banks) I/We (on behalf of the entity) certify that the entity is : a. An entity is a U.S. financial institution es No If es, (i) Please provide your Taxpayer Identification Number (TIN) TIN (ii) Please provide GIIN, if any If No, please tick one of the following boxes below: FATCA Classification Please provide the Global Intermediary Identification number GIIN) or other information where Reporting Foreign Financial Institution in a odel 1 Inter-Governmental Agreement ( IGA ) Jurisdiction Reporting Foreign Financial Institution in a odel 2 IGA Jurisdiction Participating FFI in a Non-IGA Jurisdiction Non-reporting FI Non-Participating FI Owner-ocumented FI with specified US owners

12 Section 4: Controlling person declaration If you are classified as Passive NFFE with Controlling Person(s) or Owner documented FFI or Specified US person, please provide the following details: Name of controlling Correspondence Country of residence TIN TIN issuing Country Controlling person person Address for tax purpose Type etails Controlling Person 1 Controlling person 2 Controlling person 3 Controlling person 4 Controlling person 5 Indentification Type Identification Number Occupation Type Occupation Birth ate Nationality Country of Birth Section 5: eclaration (i) Under penalty of perjury, I/we certify that: 1. The number shown on this form is the correct taxpayer identification number of the applicant, and 2. The applicant is (i) an applicant taxable as a US person under the laws of the United States of America ( U.S. ) or any state or political subdivision thereof or therein, including the istrict of Columbia or any other states of the U.S., (ii) an estate the income of which is subject to U.S. federal income tax regardless of the source thereof, or 3. The applicant Is an applicant taxable as a tax resident under the laws of country outside India. (ii) I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with CRS/FATCA. The Bank is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions. (iii) I/We agree to submit a new form within 30 days if any information or certification on this form gets changed.. (iv) I/ We agree as may be required by /Regulatory authorities, bank shall be required to comply to report, reportable details to CBT or close or suspend my account. (v) I/We certify that I/we provide the information on this form and to the best of my/our knowledge and belief the certification is true, correct and complete including the tax payer identification number of the applicant I/We hereby confirm that details provided are accurate, correct and complete S.V Authorized Signatories and Company Seal (if applicable) Name ate (//)

13 Please call CB 24-Hour Customer Care to enquire about your account application status CB Bank Limited

14 CB Bank Limited Nomination Form Received: es No Acknowledgement Please provide this number for future reference Applicant's Name: Name of the Firm: Total Amount Required by Applicant (`): Lakhs Nature of Facility: Name of the Bank Official: Branch: ate: Signature of Bank Official

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