Personal Account e w³k wnmve ACCOUNT OPENING FORM wnmve Lvjvi dig Name of the Customer MÖvn Ki bvg Account Number wnmve b ^i Unique Customer Identification Code BDwbK Kv gvi AvBwW KvW Branch Name kvlvi bvg
The following papers/documents are required (wb œwjwlz KvMRcÎ/`wjjvw` cö qvrb) Documents required to open Account for Resident Customer (wbevmx MÖvnK `i Rb wnmve Lvjvi cö qvrbxq KvMRcÎ) 1.Two copies of recent passport-size photograph of the account holder(s)/person(s) who will operate the A/C duly attested by the introducer. cwipq`vbkvix Øviv mz vwqz MÖvnK/MÖvnKM Yi ev wnmve cwipvjbvkvix/cwipvjbvkvixm Yi `yb Kwc m úªwz Zvjv cvm cvu AvKv ii Qwe 2. Introduction by an Account Holder of Prime Bank Limited. cövbg e vsk wjwg U Wi h Kv bv GKRb wnmveavix KZ K cwipq cö`vb 3. Photocopy of valid National ID/Passport/Birth Registration Certificate. In case of Birth Registration Certificate another photo ID acceptable to the Bank to be provided for Account Holder/Legal Guardian and all Nominees. wnmve cwipvjbvkvix/wjm vj MvwW qvb Ges mkj bwgwbi ˆea RvZxq cwipqcî/cvm cvu /Rb wbeüb mb`cî Ges Rb wbeüb mb`c Îi ÿ Î e vs Ki Kv Q MÖnY hvm AwZwi³ d Uv AvBwW cö`vb Ki Z n e 4. Paper related to source of income of account holder/legal guardian such as employer s certificate/pay slip/job ID/salary certificate/valid trade license (for business man)/spouse income (where applicable) etc. wnmveavix/wjm vj MvwW qv bi Av qi Drm msµvší KvRcÎvw` hgb : wb qvmkvix KZ K mb`/ c-w øc/pvkzixi AvBwW/ ez bi mvwu wd KU/ UªW jvb mý (e emvqxi Rb )/ ^vgx ev xi Avq cö hvr ÿ Î 5. One copy of recent passport-size photograph of nominee (Attested by account holder). MÖvnK KZ K mz vwqz bwgwb/g bvbxz e w³i GK Kwc m úªwz Zvjv cvm cvu AvKv ii Qwe 6. Letter of Introduction in Company Letterhead Pad from Employer (for Payroll Account). cöwzôv bi wbr ^ c v W wb qvmkvix KZ K mb` ( c ivj wnmv ei Rb ) 7. E-TIN certificate (if applicable). B-wUb mb` (cö hvr Î) 8. My First Account/Minor Account (additional requirement) copy of Birth Registration Certificate & School ID/Receipt of tuition fees and two copies of recent passport size-photograph to be attested by the guardian. gvb dv GKvD U/bvevjK-Gi wnmv ei Î (AwZwi³ cö qvrb) Rb mb`c Îi d UvKwc Ges zj AvBwW/wUDkb wd iwk` I m cöwz Zvjv cvm cvu mvb Ri `yb Kwc Qwe hv AwffveK KZ K mz vwqz 9. Foreign citizen in Bangladesh (additional requirement) photocopy of passport with valid visa and work permit. ` k Ae vbiz we `wk bvmwi Ki Î (AwZwi³ cö qvrb) cvm cv U i d UvKwc, ˆea wfmv I IqvK cviwgu-gi d UvKwc 10. Photocopy of Utility Bill of recent month of present business addresses (Electricity/WASA/Gas/Telephone). ez gvb wvkvbvi mv úªwzk gv mi BDwUwjwU we ji d UvKwc (we`ÿ r/iqvmv/m vm/ Uwj dvb) Documents Required to Open Account for Non-Resident Taka Account NRTA Awbevmx MÖvnK `i GbAviwUG wnmve Lvjvi cö qvrbxq KvMRcÎ 1. Account Opening Form: to be filled in and signed by each applicant. wnmve Lvjvi Av e`bcî hv cö Z K Av e`bkvix K c~iy I ^v i Ki Z n e 2. Copy of passport along with valid visa/work permit (In case of foreign passport customer needs to provide the copy of No visa required for Bangladesh page). cvm cv U i d UvKwc, ˆea wfmv Kwc/IqvK cviwgu-gi d UvKwc (we `wk cvm cv U i Î Ò ` ki Rb wfmv cö hvr bqó c ôvwui mshy³ Ki Z n e) 3. Proof of employment/income (employment certificate/pay-slip/employment contract mentioning annual income/bank statement mentioning monthly salary or last tax return paper). PvKzwii cögvycî/dcvr b mb`cî/ c-w øc/pvkzwii wb qvm Pzw³cÎ hv Z evrmwik Avq ewy Z _v K/gvwmK ezb ewy Z e vsk U g U ev me kl U v wiuvb -cî 4. Introduction by an Account Holder of Prime Bank Limited. cövbg e vsk wjwg U Wi h Kv bv GKRb wnmveavix KZ K cwipq cö`vb 5. Recent Passport-size photograph for each account holder attested by the introducer. cö Z K Av e`bkvixi m cöwz Zvjv cvm cvu mvb Ri Qwe cwipq cö`vbkvixi (whwb Av e`bkvix K e vs Ki wbku cwipq Kwi q Qb) Øviv mz vwqz n Z n e 6. Nominee details & one copy of nominee photograph (photo to be attested by the applicant). bwgwb ev bwgwbm Yi we ÍvwiZ weeiy I GK Kwc Qwe (Av e`bkvix KZ K mz vwqz) 7. Form QA22 for Foreign Resident. dig QA22 we `wk bvmwik `i Rb Documents required to open Non-Resident Investors Taka (NITA) Account bb iwm W U Bb f im UvKv (wbuv) GKvD U Lvjvi cö qvrbxq KvMRcÎ 1. Copy of passport along with valid visa/work permit (in case of foreign passport customer needs to provide the copy of No visa required for Bangladesh page). cvm cv U i d UvKwc, ˆea wfmv/iqvk cviwgu-gi d UvKwc (we `wk cvm cv U i Î Ò ` ki Rb wfmv cö hvr bqó c ôvwui mshy³ Ki Z n e) 2. Proof of employment/income (employment certificate/pay-slip/employment contract mentioning annual income/bank statement mentioning monthly salary or last tax return paper). PvKzwii cögvycî/dcvr b mb`cî/( c-w c/pvkzwii wb qvm Pzw³cÎ hv Z evrmwik Avq ewy Z _v K/gvwmK ezb ewy Z e vsk wee wz ev me kl U v wiuvb -cî) 3. Introduction by an Account Holder of Prime Bank Limited. cövbg e vsk wjwg U Wi h Kv bv GKRb wnmveavix KZ K cwipq cö`vb 4. Six copies of recent passport-size photograph of the applicant attested by the introducer. Av e`bkvixi Qq Kwc m úªwz Zvjv cvm cvu mvb Ri Qwe hv cwipq cö`vbkvix KZ K mz vwqz 5. Five copies of recent passport-size photograph of the nominee(s) which must be attested by the applicant. bwgwbi m úªwz Zvjv cvup Kwc Qwe hv Av e`bkvix KZ K mz vwqz 6. Duly completed account opening forms, BO account forms, BO account nominee form, Trade account opening forms, Power of Attorney & Tripartite Agreement. wnmve Pvjy Kivi Av e`b dig, wei wnmve dig, wei wnmve bwgwb dig, UªW wnmve PvjyKiY dig, Avg gv³vibvgv I wîc xq Pzw³bvgv Notes (`ªóe ) Please confirm any overwriting by full signature. Kv_vI NlvgvRv (Ifvi ivbwus) n j `qv K i Avcbvi m c~y ^v i w` q wbwðz Kiæb Above mentioned documents sent from abroad by the customer must be verified and attested by any reputed International Bank/Notary Public/Bangladesh High Commission or Consulate General s Office. Dc iv³ KvMRcÎmg~n Kv bv MÖvnK KZ K we `k n Z cöwiz n j Zv h Kv bv AvšÍR vwzk e vsk/ bvuvix cvewjk/ `k nvb Kwgkb ev Kbmÿ ju Rbv ij Awdm KZ K hvpvbk Z I mz vwqz n Z n e *Bank at its satisfaction can collect additional information & documents in addition to above mentioned list. *e vs Ki mš wó mv c ÿ G ZvwjKvq ewy Z Z _ i AwZwi³ Z_ I `wjjvw` msmön Ki Z cvi e
...Branch/kvLv PLEASE FILL UP THE FORM IN CAPITAL LETTER IN ENGLISH AbyMÖnc~e K digwu Bs iwr eo nv Zi A i c~iy Kiæb Please fill up all fields carefully & strike-out the ones which are not applicable AbyMÖnc~e K mzk Zvi mv _ dig c~iy Kiæb Ges AcÖ hvr Ni jv K U w`b ACCOUNT OPENING APPLICATION FORM wnmve Lvjvi Av e`b dig PERSONAL ACCOUNT e w³k wnmve Date ZvwiL A/C No. wnmve b ^i Existing Customer ez gvb MÖvnK Manager e e vck Prime Bank Limited cövbg e vsk wjwg UW...Branch/kvLv Unique Customer Identification Code BDwbK Kv gvi AvBwW KvW Group Code MÖæc KvW Dear Sir/Madam, wcöq g nv`q/g nv`qv, I/We am/are applying to open an account with your Branch. My/Our account related & detailed information are furnished below : Avwg/Avgiv Avcbvi kvlvq GKwU wnmve Lvjvi Rb Av e`b KiwQ Avgvi/Avgv `i wnmve msµvší I e w³mz we ÍvwiZ Z_ wb œ cö`vb KiwQ : 1. Title of Account In (Block Letter) wnmv ei bvg (q) New Customer bzzb MÖvnK 2. Type of Account Please Tick ( ) wnmv ei cªk wz wuk ( ) w`b Savings mâqx Current PjwZ SND GmGbwW FC Gdwm RFCD AviGdwmwW NFCD GbGdwmwW My First Account gvb dv GKvD U Shukonna mykb v Others Ab vb... 3. Currency - Please Tick ( ) gỳ ªv wuk ( ) w`b 4. Operating Instruction - Please Tick ( ) wnmve cwipvjbv msµvší NvlYv - wuk w`b ( ) Individual GKKfv e Either or Survivor h Kv bv GKRb A_ev whwb RxweZ Joint hš_fv e Others Ab vb... 5. Purpose of Account Opening wnmve Lvjvi D Ïk 6. Does the customer maintain any account with other Bank(s)? Please Tick ( ) Yes (nü v) MÖvn Ki Ab Kv bv e vs K wnmve Av Q wk (wuk w`b)? (if yes, please explain)? (DËi nü v n j wb œiƒ c wee Z Kiæb) Serial No µwgk msl v Name of the Bank e vs Ki bvg Taka UvKv Dollar Wjvi Euro BD iv Pound cvdû Other Permissible Currency Ab vb Aby gvw`z gỳ ªv Branch kvlv Any one h Kv bv GKRb No (bv) Type of Account - Please Tick ( ) wnmv ei cök wz wuk ( ) w`b Deposit A/C Rgv wnmve Deposit A/C Rgv wnmve Deposit A/C Rgv wnmve Deposit A/C Rgv wnmve Deposit A/C Rgv wnmve Loan A/C FY wnmve Loan A/C FY wnmve Loan A/C FY wnmve Loan A/C FY wnmve Loan A/C FY wnmve Others Ab vb Others Ab vb Others Ab vb Others Ab vb Others Ab vb P1 of 28
7. Personal Information : [Attached Annexure-1(KA) form of personal information should be filled in] [e w³ msµvší Z_ vewj : (cwiwkó-1(k) G mshy³ e w³ msµvší Z_ vewj dig c~iy Ki Z n e ] 8. If one or more account holder(s) is/are minor : GK ev GKvwaK wnmveavix bvevjk n j : As a duly appointed guardian of the account holder(s), I hereby declare that the account holder is a minor. His/her necessary information is/are attached herewith. The account will be operated by me until the account holder becomes a major or I furnish further declaration. (As Guardian, Father or Mother or Legal Guardian will be considered) Avwg wb œewy Z wnmveavixi AwffveK wn m e GB g g NvlYv KiwQ h, wnmveavix bvevjk Zvi cö qvrbxq Z_ mshy³ di g cö`vb Kiv n jv wnmveavix mvevjk bv niqv ch ší wksev Avgvi ciez x NvlYv bv `qv ch ší AwffveK wn m e wnmvewu Avgvi ^v i cwipvwjz n e (AwffveK ej Z evev A_ev gv A_ev Ab Kv bv AvBbMZ AwffveK K eysv e) a. Name of Account Holder (Minor) K. wnmveavix (bvevjk)-gi bvg Date of Birth Rb ZvwiL w` b gv m e r m i b. Name of Guardian L. Awffve Ki bvg Relationship with Minor Signature of Guardian bvevj Ki mv _ m ck Awffve Ki ^vÿi For both Minor and Guardian - Personal Information Forms attached in Annexure-1 (KA) are to be filled up and in case of minor applicant both forms must be signed by the Guardian. bvevjk Ges AwffveK - Df qi Rb B cwiwkó-1 (K) G mshy³ Òe w³ msµvší Z_ vewjó dig c~iy Ki Z n e Ges bvevjk Av e`bkvixi Î Dfq di gb Av e`bkvixi ^v ii j AwffveK KZ K ^vÿi Ki Z n e 9. Introducer s Information cwipq`vbkvixi Z_ a. Name K. bvg c. Account Number M. wnmve b ^i d. Branch Name N. kvlvi bvg e. Relationship between Introducer & Applicant O. MÖvnK/wnmve cwipvjbvkvix (MY)-Gi mv _ cwiwpwzi m~î/m úk I certify that I know Mr./Ms. Avwg GZØviv cöz qb KiwQ h Rbve/Rbvev for the past wemz b. Title of Account L. wnmv ei bvg Phone No. dvb b ^i Mobile No. gvevbj b ^i f. Medium of contact P. hvmv hv Mi gva g months/years and confirm his/her occupation and address as stated elsewhere in this application. gvm/ermi hver Avgvi cwiwpz Ges Avwg di g DwjøwLZ Zvi ckv Ges wvkvbv wbwðz KiwQ g. Signature & Date Q. ^vÿi I ZvwiL For Bank s use only ïay e vs Ki e env ii Rb Introducer s Signature Verified By : Bank Officer s Name & Signature (with seal & date) cwipq`vbkvixi Z_ cöz qbkvix mswkøó e vsk kvlvi Kg KZ vi bvg I ^vÿi (wmj I ZvwiLmn) Name bvg Designation c`we Signature (with Seal & Date) ^vÿi (wmj I ZvwiLmn) 10. Initial Deposit Amount cöv_wgk Rgvi cwigvy P2 of 28 In Words K_vq Mode Rgvi aib Cash bm` Instrument Date BÝUªy g U ZvwiL Instrument No. BÝUªy g U b ^i Transfer from A/C No. wnmve n Z vbvšíi Name of the Bank e vs Ki bvg Others (pls. specify) Ab vb (wbw` ó Kiæb)
11. Information of Nominee : Nominee related information should be filled up in Annexure-2. bwgwb msµvší Z_ vewj : cwiwkó-2 G mshy³ bwgwb msµvší Z_ vewj dig c~iy Ki Z n e No. of Nominee(s) bwgwbi msl v 12. Transaction Profile: Information of Transaction Profile Form should be filled up in Annexure-3. m ve jb ` bi AbywgZ gvîv (Transaction Profile) msµvší Z_ vewj cwiwkó-3 G mshy³ TP msµvší Z_ vewj dig c~iy Ki Z n e 13. Source/Sources of fund (to be mentioned specifically and in detail): A _ i Drm/Drmmg~n (mywbw` ó I we ÍvwiZ D jøl Ki Z n e) : 14. Declaration & Signature NvlYv I ^v i I/We hereby acknowledge that I/we have read the terms & conditions and agreed to abide by the mentioned terms & conditions. I/We solemnly declare that the information mentioned above is correct. I/We shall also submit any type of additional information/ documents as and when required by the Bank. Avwg/Avgiv GB g g wbðqzv cö`vb KiwQ h, Avwg/Avgiv wnmve msµvší hvezxq wbqgvewj/kz vewj c owq Ges D³ wbqgvewj/kz vewj g b Pj Z eva _vke Avwg/Avgiv máv b NvlYv KiwQ h, DwjøwLZ Z_ vw` mz Avwg/Avgiv cö`ë Z _ i AwZwi³ mswkøó h Kv bv cö qvrbxq Z_ /`wjjvw` e vs Ki Pvwn`v gvzv ek mieivn Kie Particulars weeiy 1st Applicant 1g Av e`bkvix 2nd Applicant 2q Av e`bkvix 3rd Applicant 3q Av e`bkvix 4th Applicant 4_ Av e`bkvix Signature ^vÿi Name bvg Date ZvwiL For Bank s use only ïay e vs Ki e env ii Rb Comments : gšíe : (Signature) ( ^v i) Account Opening Officer wnmve Lvjvi mv _ mswkøó Kg KZ v (with Name Seal, Signature & Date) (bvghy³ wmjmn ^vÿi I ZvwiL) (Signature) ( ^v i) Signature Admitted by ^v i Aby gv`bkvix (with Name Seal, Designation, Signature & Date) (bvghy³ wmjmn c`we, ^v i I ZvwiL) (Signature) ( ^v i) Approved by (Manager) Aby gv`bkvix Kg KZ v (kvlv e e vck) (with Name Seal, Signature & Date) (bvghy³ wmjmn ^vÿi I ZvwiL) P3 of 28
Other Facilities Ab vb myweavmg~n Cheque Book PK eb : Yes (nü v) No (bv) E-statement B- U g U : Yes (nü v) No (bv) E-mail B- gbj Mobile No. gvevbj b ^i I/We, the undersigned, declare that the information provided above is true, complete and accurate and I/we have not willfully withheld any material fact. I/We shall inform you of any changes thereto. Any overdraft which may from time to time be created in my/our Account shall be my/our joint and several liability. In addition, I/we also declare that I/we have not given any cash or cash/bearer cheque to any Bank representative to open the account without any Bank receipt. I/We hereby agree to enroll in the SMS Service offered by Prime Bank Ltd where I/we shall receive transaction notifications and other bank related information at above mentioned mobile number. Avwg ev Avgiv, wb œ ^v ikvix NvlYv KiwQ h, Dc i ewy Z Z_ vw` mz, m c~y I mwvk Ges Avwg ev Avgiv B QvK Zfv e Kv bv e MZ Z_ Mvcb Kwiwb Avwg ev Avgiv h Kv bv cwiez b m c K Avcbv `i AewnZ Kie hw` Avgvi/Avgv `i wnmv e mg q mg q hz UvKv Rgv Av Q Zvi P q ewk cwigvy UvKv Zy j djv nq (RgvwZwi³) Zvn j Avwg ev Avgiv hš_ Ges Avjv`vfv e `vqx ne Avwg ev Avgiv Av iv NvlYv KiwQ h, Avwg ev Avgiv Kv bv e vs Ki cöwzwbwa K wnmve Lvjvi Rb e vs Ki iwk` Qvov Kv bv bm`/evnk PK `Bwb Avwg/Avgiv cövbg e vsk wjwg UW GmGgGm e vswks mevi Rb ZvwjKvfy³ n Z m wz cö`vb KiwQ, hlv b Avwg/Avgiv jb ` bi Lei I e vsk m úwk Z Ab vb Z_ vw` Dc iv³ gvevbj b ^ i cve 1st Applicant s Signature 1g Av e`bkvixi ^v i 2nd Applicant s Signature 2q Av e`bkvixi ^v i 3rd Applicant s Signature 3q Av e`bkvixi ^v i For Bank s use only ïay e vs Ki e env ii Rb Sector Code m±i KvW Deposit Code Rgv KvW Security Code wmwkdwiwu KvW Rate Code iu KvW A/C Opening Officer (full signature with seal) wnmve Lvjvi Kg KZ v (wmjmn c~y ^vÿi) Checked & Authorized by hvi Øviv cixw Z I Aby gvw`z P4 of 28
Annexure-1(Ka) cwiwkó-1(k)...branch/kvlv Account Opening Form : Applicant s Personal Information wnmve Lvjvi dig : Av e`bkvixi e w³ msµvší Z_ vewj This form to be filled up and attached with original copy of Personal & Non-Personal Account Opening Application 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) Photograph e w³i Av jvkwpî Date ZvwiL A/C No. wnmve b ^i Unique Customer Identification Code BDwbK Kv gvi AvBwW KvW For Bank s Use (e vs Ki e env ii Rb ) 1. Title of Account In (Block Letter) wnmv ei bvg (q) 2. Name of Account Holder/Beneficial Owner/ Account Operator (in ) MÖvnK/ ewbwdwmqvj Ibvi/wnmve cwipvjbvkvixi bvg () 3. Involvement with A/C as - Please Tick ( ) wnmv ei mv _ m úk - wuk w`b ( ) Trustee Uªvw 4. Father s Name wczvi bvg 5. Mother s Name gvzvi bvg 6. Spouse s Name ^vgx/ xi bvg 7. Nationality RvZxqZv 8. Resident Status iwm W U vuvm Guardian AwffveK a. K. 9. Date of Birth Rb ZvwiL 11. Gender - Please Tick ( ) wj½ - wuk ( ) w`b Attorney Holder GUwb nvìvi Resident iwm W U (wbevmx) 12. Occupation (details with designation) ckv (c`wemn we ÍvwiZ) Male cyiæl 1st Applicant 1g Av e`bkvix b. L. Service PvKzwi Minor wnmveavix bvevjk Non-Resident bb- iwm W U (Awbevmx) Female gwnjv Employment/Business Details (supporting documents, if available) ckvmz weeiy (mg_ bkvix KvMRcÎ, hw` _v K) Name of the Organization cöwzôv bi bvg Address wvkvbv 13. Monthly Income (for Personal Account) gvwmk Avq (e w³k wnmv ei ÿ Î) 14. Identification cwiwpwz A. National ID Card No. K. RvZxq cwipqcî b ^i B. Passport No. L. cvm cvu b ^i C. Birth Registration Certificate No. M. Rb wbeüb mb`cî b ^i D. Electronic Tax ID (E-TIN) No. N. B jkuªwbk-u v AvBwW (E-TIN) b ^i 2nd Applicant 2q Av e`bkvix 3rd Applicant 3q Av e`bkvix Beneficial Owner ewbwdwmqvj Ibvi (For Foreigners copy of Passport with Visa must be obtained) (we `wk bvmwik n j wfmvmn cvm cv U i Kwc Avewk Kfv e MÖnY Ki Z n e) 3rd Gender Z Zxq wj½ Business e emv Designation c`we Director cwipvjk Account Holder wnmve cwipvjbvkvix (Where necessary Bank should follow the directions of Guidelines for Foreign Exchange Transactions) (cö qvrbxq ÿ Î e vsk KZ K MvBWjvBÝ di d ib G PÄ UªvbR vkkbm&-gi wb ` kbv AbymiY Ki Z n e) w` b gv m e r m i For SL No.13 if required by the Bank additional documents with details to be submitted 13 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 Partner Askx`vi Proprietor GKK më vwakvix Others... Ab vb Others (please specify)... Ab vb (wbw` ó K i ejyb) Expiry gqv` 10. Birth Place (with Country) Rb vb ( `kmn) P5 of 28
E. Driving License No. O. WªvBwfs jvb mý b ^i F. Others (should be specified) P. Ab vb (wbw` ófv e D jøl Ki Z n e) Any one of the document mentioned in serial KA to GA must be submitted. In case of account opening with Birth Registration Certificate, additional photo ID of Account Holder/Account Operator to be provided. In case of Non Residents and Foreigners copy of passport with visa must be submitted. If photo ID is not available, Letter of Introduction from an Honorable Person 1 of the society acceptable to the Bank needs to be submitted. Such Letter of Introduction or Identification Certificate must contain customer/account holder s photograph (with attestation on top of the photo). Besides that to verify customers identity Bank may seek to its satisfaction, documents and information in addition to Serial GHA to CHA listed documents mentioned in this form. K n Z M 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`vbc~e K wnmve Lvjvi ÿ Î Rb wbeüb mb`c Îi AwZwi³ MÖvnK/wnmve cwipvjbvkvixi Av jvkwpîmn Ab h Kvb cwiwpwzcî cö`vb Ki Z n e bb- iwm W U Ges we `wk bvmwik `i Î mswkøó wfmvmn cvm cv U i Kwc Avewk Kfv e cö`vb Ki Z n e Av jvkwpîmn cwiwpwzcî 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 1 KZ K cö`ë cwip qi cöz qbcî cö`vb Ki Z n e D³ cwiwpwzcî 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 N n Z P 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 15. Present Address (residence) ez gvb wvkvbv (Avevm j) Own Rented wbr ^ fvov 16. Permanent Address vqx wvkvbv MÖvnK/wnmve cwipvjbvkvixi Proof of address-gi ^c ÿ WKz g Um cö`vb Ki Z n e (Kgc ÿ 1wU wvkvbvi ^c ÿ) 17. Professional Address ckvmz wvkvbv 18. Contact Details hvmv hv Mi e ËvšÍ Telephone No. : Uwj dvb b ^i : Mobile No. : gvevbj b ^i : Address : wvkvbv Res : evmv : 19. Nominated Person for Emergency Contact Riæwi cö qvr b hvmv hv Mi Rb g bvbxz e w³ Name bvg Address wvkvbv Present ez gvb Relationship with Account Holder/Account Operator wnmveavix/wnmve cwipvjbvkvixi mv _ m ck Mobile No.: gvevbj b ^i : Fax : d v : Permanent vqx Office : Awdm : E-mail B- gbj 20. Credit Card Information (if any) µwwu KvW msµvší Z_ (hw` _v K) Name of the Issuing Organization/Bank (name of all Bank s if more than one) Bmÿ Kvix cöwzôvb/e vsk (GKvwaK n j mkj e vs Ki bvg) Local Card jvkvj KvW International Card AvšÍR vwzk KvW 21. Information for Non-Resident Bangladeshi Awbevmx `wki Rb Z_ Passport No. cvm cvu b ^i Issued By cö`vbkvix KZ c Others Ab vb Valid upto ˆeaZvi ZvwiL Foreign Address ˆe `wkk wvkvbv Date of issue cö`v bi ZvwiL Issued at cö`v bi vb E-mail : B- gbj : Foreign Phone Number ˆe `wkk dvb b ^i Professional ckvmz Ext : ewa Z : Date of expiry gqv `vëx Y i ZvwiL Date of VISA (if available) wfmvi ZvwiL (hw` _v K) Issuing Authority of VISA wfmv cö`vbkvix KZ c Expiry gqv` Occupation ckv Applicant s Signature with Name & Date Av e`bkvixi ^vÿi, bvg I ZvwiLmn Account Opening Officer s Signature with Name Seal wnmve Lvjvi mswkøó Kg KZ vi bvghy³ wmjmn ^vÿi Approved by (Manager) Signature with Name Seal Aby gv`bkvix Kg KZ vi (kvlv e e vck) bvghy³ wmjmn ^vÿi 1. Member of Parliament, Mayor of City Corporation, Deputy Mayor and Councilors, 9th grade or higher grade Gazetted Officers of National Pay Scale, Teacher of Public University, Chairman and Vice Chairman of Upazila Council, Chairman of Union Council, Mayor and Councilors of Pourashova, Professors of Private Universities, Principal of Private College, Head Master of Private High School, Editor of National Daily Newspaper, Notary Public and 7th grade or higher grade National Pay Scale Officers of Semi Government/Autonomous/Government Organization s and 9th grade or above grade National Pay Scale officers of Bangladesh Bank will be treated as Honorable Persons. 1. 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, emikvwi wek we` vj qi Aa vck, emikvwi K j Ri Aa ÿ, emikvwi D P we` vj qi cöavb wkÿk, RvZxq ˆ`wbK cwîkvi m úv`k, bvuvwi cvewjk, AvavmiKvwi/ ^vqëkvwmz/ivóªvqz ms vi RvZxq ezb ji 7g ev Z`~aŸ MÖ Wi Kg KZ vmy Ges `k e vs Ki RvZxq ezb ji 9g I Z`~aŸ MÖ Wi Kg KZ vmy K evsv e P6 of 28
Annexure-1(Ka) cwiwkó-1(k)...branch/kvlv Account Opening Form : Applicant s Personal Information wnmve Lvjvi dig : Av e`bkvixi e w³ msµvší Z_ vewj This form to be filled up and attached with original copy of Personal & Non-Personal Account Opening Application 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) Photograph e w³i Av jvkwpî Date ZvwiL A/C No. wnmve b ^i Unique Customer Identification Code BDwbK Kv gvi AvBwW KvW For Bank s Use (e vs Ki e env ii Rb ) 1. Title of Account In (Block Letter) wnmv ei bvg (q) 2. Name of Account Holder/Beneficial Owner/ Account Operator (in ) MÖvnK/ ewbwdwmqvj Ibvi/wnmve cwipvjbvkvixi bvg () 3. Involvement with A/C as - Please Tick ( ) wnmv ei mv _ m úk - wuk w`b ( ) Trustee Uªvw 4. Father s Name wczvi bvg 5. Mother s Name gvzvi bvg 6. Spouse s Name ^vgx/ xi bvg 7. Nationality RvZxqZv 8. Resident Status iwm W U vuvm Guardian AwffveK a. K. 9. Date of Birth Rb ZvwiL 11. Gender - Please Tick ( ) wj½ - wuk ( ) w`b Attorney Holder GUwb nvìvi Resident iwm W U (wbevmx) 12. Occupation (details with designation) ckv (c`wemn we ÍvwiZ) Male cyiæl 1st Applicant 1g Av e`bkvix b. L. Service PvKzwi Minor wnmveavix bvevjk Non-Resident bb- iwm W U (Awbevmx) Female gwnjv Employment/Business Details (supporting documents, if available) ckvmz weeiy (mg_ bkvix KvMRcÎ, hw` _v K) Name of the Organization cöwzôv bi bvg Address wvkvbv 13. Monthly Income (for Personal Account) gvwmk Avq (e w³k wnmv ei ÿ Î) 14. Identification cwiwpwz A. National ID Card No. K. RvZxq cwipqcî b ^i B. Passport No. L. cvm cvu b ^i C. Birth Registration Certificate No. M. Rb wbeüb mb`cî b ^i D. Electronic Tax ID (E-TIN) No. N. B jkuªwbk-u v AvBwW (E-TIN) b ^i 2nd Applicant 2q Av e`bkvix 3rd Applicant 3q Av e`bkvix Beneficial Owner ewbwdwmqvj Ibvi (For Foreigners copy of Passport with Visa must be obtained) (we `wk bvmwik n j wfmvmn cvm cv U i Kwc Avewk Kfv e MÖnY Ki Z n e) 3rd Gender Z Zxq wj½ Business e emv Designation c`we Director cwipvjk Account Holder wnmve cwipvjbvkvix (Where necessary Bank should follow the directions of Guidelines for Foreign Exchange Transactions) (cö qvrbxq ÿ Î e vsk KZ K MvBWjvBÝ di d ib G PÄ UªvbR vkkbm&-gi wb ` kbv AbymiY Ki Z n e) w` b gv m e r m i For SL No.13 if required by the Bank additional documents with details to be submitted 13 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 Partner Askx`vi Proprietor GKK më vwakvix Others... Ab vb Others (please specify)... Ab vb (wbw` ó K i ejyb) Expiry gqv` 10. Birth Place (with Country) Rb vb ( `kmn) P7 of 28
E. Driving License No. O. WªvBwfs jvb mý b ^i F. Others (should be specified) P. Ab vb (wbw` ófv e D jøl Ki Z n e) Any one of the document mentioned in serial KA to GA must be submitted. In case of account opening with Birth Registration Certificate, additional photo ID of Account Holder/Account Operator to be provided. In case of Non Residents and Foreigners copy of passport with visa must be submitted. If photo ID is not available, Letter of Introduction from an Honorable Person 1 of the society acceptable to the Bank needs to be submitted. Such Letter of Introduction or Identification Certificate must contain customer/account holder s photograph (with attestation on top of the photo). Besides that to verify customers identity Bank may seek to its satisfaction, documents and information in addition to Serial GHA to CHA listed documents mentioned in this form. K n Z M 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`vbc~e K wnmve Lvjvi ÿ Î Rb wbeüb mb`c Îi AwZwi³ MÖvnK/wnmve cwipvjbvkvixi Av jvkwpîmn Ab h Kvb cwiwpwzcî cö`vb Ki Z n e bb- iwm W U Ges we `wk bvmwik `i Î mswkøó wfmvmn cvm cv U i Kwc Avewk Kfv e cö`vb Ki Z n e Av jvkwpîmn cwiwpwzcî 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 1 KZ K cö`ë cwip qi cöz qbcî cö`vb Ki Z n e D³ cwiwpwzcî 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 N n Z P 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 15. Present Address (residence) ez gvb wvkvbv (Avevm j) Own Rented Others wbr ^ fvov Ab vb 16. Permanent Address vqx wvkvbv MÖvnK/wnmve cwipvjbvkvixi Proof of address-gi ^c ÿ WKz g Um cö`vb Ki Z n e (Kgc ÿ 1wU wvkvbvi ^c ÿ) 17. Professional Address ckvmz wvkvbv 18. Contact Details hvmv hv Mi e ËvšÍ Telephone No. : Uwj dvb b ^i : Mobile No. : gvevbj b ^i : Address : wvkvbv Res : evmv : 19. Nominated Person for Emergency Contact Riæwi cö qvr b hvmv hv Mi Rb g bvbxz e w³ Name bvg Address wvkvbv Present ez gvb Relationship with Account Holder/Account Operator wnmveavix/wnmve cwipvjbvkvixi mv _ m ck Mobile No.: gvevbj b ^i : Fax : d v : Permanent vqx Office : Awdm : E-mail B- gbj 20. Credit Card Information (if any) µwwu KvW msµvší Z_ (hw` _v K) Name of the Issuing Organization/Bank (name of all Bank s if more than one) Bmÿ Kvix cöwzôvb/e vsk (GKvwaK n j mkj e vs Ki bvg) Local Card jvkvj KvW International Card AvšÍR vwzk KvW 21. Information for Non-Resident Bangladeshi Awbevmx `wki Rb Z_ Passport No. cvm cvu b ^i Issued By cö`vbkvix KZ c Valid upto ˆeaZvi ZvwiL Foreign Address ˆe `wkk wvkvbv Date of issue cö`v bi ZvwiL Issued at cö`v bi vb E-mail : B- gbj : Foreign Phone Number ˆe `wkk dvb b ^i Professional ckvmz Ext : ewa Z : Date of expiry gqv `vëx Y i ZvwiL Date of VISA (if available) wfmvi ZvwiL (hw` _v K) Issuing Authority of VISA wfmv cö`vbkvix KZ c Expiry gqv` Occupation ckv Applicant s Signature with Name & Date Av e`bkvixi ^vÿi, bvg I ZvwiLmn Account Opening Officer s Signature with Name Seal wnmve Lvjvi mswkøó Kg KZ vi bvghy³ wmjmn ^vÿi 1. Member of Parliament, Mayor of City Corporation, Deputy Mayor and Councilors, 9th grade or higher grade Gazetted Officers of National Pay Scale, Teacher of Public University, Chairman and Vice Chairman of Upazila Council, Chairman of Union Council, Mayor and Councilors of Pourashova, Professors of Private Universities, Principal of Private College, Head Master of Private High School, Editor of National Daily Newspaper, Notary Public and 7th grade or higher grade National Pay Scale Officers of Semi Government/Autonomous/Government Organization s and 9th grade or above grade National Pay Scale officers of Bangladesh Bank will be treated as Honorable Persons. 1. 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, emikvwi wek we` vj qi Aa vck, emikvwi K j Ri Aa ÿ, emikvwi D P we` vj qi cöavb wkÿk, RvZxq ˆ`wbK cwîkvi m úv`k, bvuvwi cvewjk, AvavmiKvwi/ ^vqëkvwmz/ivóªvqz ms vi RvZxq ezb ji 7g ev Z`~aŸ MÖ Wi Kg KZ vmy Ges `k e vs Ki RvZxq ezb ji 9g I Z`~aŸ MÖ Wi Kg KZ vmy K evsv e P8 of 28 Approved by (Manager) Signature with Name Seal Aby gv`bkvix Kg KZ vi (kvlv e e vck) bvghy³ wmjmn ^vÿi
...Branch/kvLv Account Opening Form : Nominee s Information wnmve Lvjvi dig : bwgwb msµvší Z_ vewj Applicable only for Personal Account: Multiple Forms to be Filled up for Multiple Nominees (ïay e w³k wnmv ei ÿ Î cö hvr n e Ges G Ki AwaK bwgwb n j GKvwaK bwgwb dig c~iy Ki Z n e) Annexure-2 cwiwkó-2 A/C No. wnmve b ^i Unique Customer Identification Code BDwbK Kv gvi AvBwW KvW For Bank s Use (e vs Ki e env ii Rb ) Nominee Photograph Attested by Account Holder (staple) bwgwbi Av jvkwpî (MÖvnK KZ K mz vwqz) ( vcj Kiæb) I/We are nominating the following individual(s) as my/our nominee(s) to pay the amount of my/our account after my/our death. I/We preserve the right to change or cancel the nomination at any time and hereby further agree that the bank will pay money as per my/our instruction and Bank will not be liable in any way for such payments. Avwg/Avgiv GB wnmv ei A_ Avgvi/Avgv `i g Zz i ci wb œv³fv e wb œ ewy Z e w³/e w³my K cö`v bi Rb g bvbxz Kijvg Avwg/Avgiv DwjøwLZ g bvbqb h Kv bv mgq evwzj ev cwiez bi AwaKvi msiÿy Kwi, Avwg/Avgiv GB g g Av iv m wz Ávcb KiwQ h, Avgvi/Avgv `i wb ` kbv gvzv ek e vsk A_ cö`vb Ki e Ges GRb e vsk Kv bvfv e `vqe n e bv 1. Title of Account In (Block Letter) wnmv ei bvg (q) 2. Account Number wnmve b ^i 3. Nominee s Name bwgwbi bvg 4. Father s Name wczvi bvg 5. Mother s Name gvzvi bvg 6. Spouse s Name ^vgx/ xi bvg 7. Date of Birth Rb ZvwiL Age eqm 8. Occupation ckv 9. Present Address ez gvb wvkvbv 10. Permanent Address vqx wvkvbv 11. Identification of Nominee bwgwbi cwiwpwz A. National ID Card No. K. RvZxq cwipqcî b ^i B. Passport No. L. cvm cvu b ^i C. Birth Registration Certificate No. M. Rb wbeüb mb`cî b ^i D. Electronic Tax ID (E-TIN) No. N. B jkuªwbk-u v AvBwW (E-TIN) b ^i E. Driving License No. O. WªvBwfs jvb mý b ^i Expiry gqv` Expiry gqv` P9 of 28
F. Others (should be specified) P. Ab vb (wbw` ófv e D jøl Ki Z n e) Any one of the document mentioned in serial KA to GA must be submitted. In case of account opening with Birth Registration Certificate, additional photo ID of Nominee to be provided. In case of Non Residents and Foreigners copy of passport must be submitted. If photo ID is not available, Letter of Introduction from an Honorable Person 1 of the society acceptable to the Bank needs to be submitted. Such Letter of Introduction or Identification Certificate must contain nominee s photograph (with attestation on top of the photo). Besides that to verify nominees identity Bank may seek to its satisfaction, documents and information in addition to Serial GHA to CHA listed documents mentioned in this form. K n Z M 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`vbc~e K wnmve Lvjvi ÿ Î Rb wbeüb mb`c Îi AwZwi³ bwgwbi Av jvkwpîmn Ab h Kvb cwiwpwzcî cö`vb Ki Z n e bb- iwm W U Ges we `wk bvmwik `i Î cvm cv U i Kwc Avewk Kfv e cö`vb Ki Z n e Av jvkwpîmn cwiwpwzcî 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 1 KZ K cö`ë cwip qi cöz qbcî cö`vb Ki Z n e D³ cwiwpwzcî ev cöz qbcî bwgwbi 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 bwgwbi cwiwpwzi wel q wbwðz niqvi j ÿ e vs Ki mš wó mv c ÿ Dc ii N n Z P 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 12. Relationship with A/C Holder wnmveavixi mv _ m úk 13. Percentage kzkiv nvi 14. If Nominee/Nominees is/are minor at the time of death of the account holder/holders information of recipient(s) of deposit as per Bank Companies Act, 1991 Section 103 (2) : bwgwb bvevjk n j Zvi/Zv `i bvevjk _vkv Ae vq wnmveavix/wnmveavixm Yi g Zz i ÿ Î e vsk Kv úvwb AvBb, 1991 Gi 103 (2) aviv Abyhvqx Avgvb Zi UvKv MÖnYKvixi Z_ : Name bvg Father/Husband Name wczv/ ^vgxi bvg Date of Birth Rb ZvwiL Present Address ez gvb wvkvbv Age eqm Permanent Address vqx wvkvbv As per SL # 11, Information related with identification of Legal Guardian µwgk 11 Abymv i ˆea Awffve Ki cwiwpwzcî msµvší Z_ Relationship with Nominee bwgwbi mv _ m ck If any NRB is nominated and becomes beneficiary of the account, the Foreign Exchange Regulation Act will be applicable while remitting the money. Kv bv Awbevmx K bwgwb Kiv n j Ges H Awbevmx mswkøó wnmv ei A_ cövß n j cövß A_ we ` k cöi Yi ÿ Î we` gvb ˆe `wkk gỳ ªv wbqš Y AvB bi wewa weavb cö hvr n e Nominee s Signature & Date (optional) bwgwbi ^vÿi I ZvwiL (Hw QK) 1st Applicant s Signature, Name & Date 1g Av e`bkvixi ^vÿi, bvg I ZvwiL 2nd Applicant s Signature, Name & Date 2q Av e`bkvixi ^vÿi, bvg I ZvwiL P10 of 28 Applicant s Signature verified by Bank Official s Signature with Name Seal MÖvn Ki ^v i hvpvbkvix e vsk Kg KZ vi bvghy³ wmjmn ^v i 1. Member of Parliament, Mayor of City Corporation, Deputy Mayor and Councilors, 9th grade or higher grade Gazetted Officers of National Pay Scale, Teacher of Public University, Chairman and Vice Chairman of Upazila Council, Chairman of Union Council, Mayor and Councilors of Pourashova, Professors of Private Universities, Principal of Private College, Head Master of Private High School, Editor of National Daily Newspaper, Notary Public and 7th grade or higher grade National Pay Scale Officers of Semi Government/Autonomous/Government Organization s and 9th grade or above grade National Pay Scale officers of Bangladesh Bank will be treated as Honorable Persons. 1. 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, emikvwi wek we` vj qi Aa vck, emikvwi K j Ri Aa ÿ, emikvwi D P we` vj qi cöavb wkÿk, RvZxq ˆ`wbK cwîkvi m úv`k, bvuvwi cvewjk, AvavmiKvwi/ ^vqëkvwmz/ivóªvqz ms vi RvZxq ezb ji 7g ev Z`~aŸ MÖ Wi Kg KZ vmy Ges `k e vs Ki RvZxq ezb ji 9g I Z`~aŸ MÖ Wi Kg KZ vmy K evsv e
Foreign Account Tax Compliance Act ( FATCA ) ˆe `wkk wnmve Ki cwicvjb AvBb...Branch/kvLv Account Opening Form Supplement (use additional copies, if required) wnmve Lvjvi cwic~ik dig (hw` cö qvrb nq, Z e AwZwi³ Kwc e envi Kiæb) This form must be completed by any individual/non-individual/entity who wishes to open a Bank Account/have been maintaining one. GB dig Kv bv e w³/a-e w³/cöwzôvb Øviv m cbœ Ki Z n e whwb/hviv GKwU e vsk wnmve Lyj Z Pvb/wnmve Pvjv Qb Account Number wnmve b ^i Name bvg Country of Residence/Registration evm vb/wbeüb-gi `k Country of Birth/Incorporation Rb /wbmgeüb `k Please check Yes or No for each of the following questions wb œwjwlz cökœ wji Rb nü v ev bv wuk w`b : Yes (nü v) / No (bv) 1. Are you a U.S. Resident? Avcwb wk GKRb gvwk b wbevmx? 2. Are you a U.S. Citizen? Avcwb wk GKRb gvwk b bvmwik? 3. Do you hold a U.S. Permanent Resident Card (Green Card)? Avcbvi Kv Q wk GKwU Av gwikvq vqxfv e emev mi KvW (wmöb KvW ) Av Q? 4. Is your entity a foreign entity where there is substantial US ownership? Avcbvi cöwzôvb wk GKwU we `wk ms v hlv b D jøl hvm gvwk b gvwjkvbv Av Q? i.e.10% or more (for company/non-individuals) A_ vr 10% ev Zvi ewk ( Kv cvwb/ae w³i Î) I/we hereby confirm the information provided above is true, accurate & complete. Avwg/Avgiv G g g wbwðz KiwQ h, Dc i `Iqv Z_ mz, mwvk I m c~y Subject to applicable local laws, I/we hereby consent for Prime Bank Limited, Bangladesh or any of its affiliates (including branches) (Collectively the Bank ) to share my/our information s with domestic/u.s. regulators or tax authorities where necessary to establish my/our tax liabilities in any jurisdiction. cö qvrbxq Î cö hvr vbxq AvBb mv c, h Kv bv GLwZqv i Avgvi/Avgv `i Ki `vq wba vi Yi Rb Avwg / Avgiv cövbg e vsk wjwg UW, `k ev Gi mn hvmx cöwzôvb (kvlv-mn) (mw wjzfv e Òe vskó) Avgvi/Avgv `i Z_ ^ `wk/gvwk b wbqš K `i ev U v KZ c i m ½ Av`vb-cÖ`vb Kivi e vcv i m wz w`w Q Where required by domestic or U.S. regulators or tax authorities, I/we consent and agree that the Bank may withhold from my/our account(s), such amounts as may be required according to applicable laws, regulations and directives. Avwg/Avgiv GB g g m wz cö`vb KiwQ h, cö hvr AvBb, wewa I wb ` k gvzv ek ^ `kx A_ev gvwk b wbqš K U v KZ c i `vwe Abyhvqx e vsk cö qvrbxq cwigvy A_ Avgvi/Avgv `i wnmv e wmz K i/a i ivl Z cvi e I/we undertake to notify the Bank within 30 (thirty) calendar days if there is a change in any information which I/we have provided to the Bank. Avgvi/Avgv `i Øviv e vs K cö`vbk Z h Kv bv Z_ cwiez b n j 30 (wîk) cwäkv w`e mi g a Zv e vsk K Rvbv ev Signature ^v i... Signature ^v i... Signature ^v i... Date ZvwiL... Date ZvwiL... Date ZvwiL... Signature verified by (name, designation with signature & seal) ^v i hvpvbkvix (bvg, c`wemn ^vÿi I wmj)... P11 of 28
...Branch/kvLv Transaction Profile (Personal/Non-Personal A/C) m ve jb ` bi AbywgZ gvîv (e w³k/ae w³k wnmve) 1. Title of Account In (Block Letter) A/C No. wnmve b ^i Unique Customer Identification Code BDwbK Kv gvi AvBwW KvW For Bank s Use (e vs Ki e env ii Rb ) Annexure-3 cwiwkó-3 2. Monthly Estimated Income gvwmk m ve Avq Deposit (Rgv) Withdrawal (D Ëvjb) wnmv ei bvg (q) 3. Monthly Estimated Turnover (for Organization) gvwmk m ve Uvb Ifvi (cöwzôv bi Î) Cash (Including Online & ATM) bm` (AbjvBb I GwUGg-mn) Transfer/Payment by Instruments UªvÝdvi/BÝUªy g U-Gi gva g cwi kva Foreign Outward Remittance d ib AvDUIqvW iwgu vý Settlement of Import expenses Avg`vwb eve` cwi kva Deposit/Transfer to BO (Capital Market Account) (cyuwr evrvi) wnmv e Rgv/ vbvšíi Others (specify)... Ab vb (wbw` ófv e) Total me gvu I/We the undersigned hereby acknowledge that the transactions limit is my/our organization s usual transactions. I/we do hereby acknowledge that if necessary, I/we will change/update the transaction profile. Avwg/Avgiv wb œ ^vÿikvix(my) G g g wbðqzv cö`vb KiwQ h, m ve jb ` bi AbywgZ gvîv Avgvi/cÖwZôv bi ^vfvwek I cök Z jb `b Avwg/Avgiv Av iv wbðqzv cö`vb KiwQ h, cö qvrb ev a Avwg/Avgiv m ve jb ` bi AbywgZ gvîv ms kvab/nvjbvmv` Kie Signature ^v i Name bvg Date ZvwiL Particulars weeiy Particulars weeiy Cash (Including Online & ATM) bm` (AbjvBb I GwUGg-mn) Transfer/Deposit by Instruments UªvÝdvi/ BÝUªy g U-Gi gva g Rgv Foreign Inward Remittance d ib BbIqvW iwgu vý Export Revenue ißvwb eve` cövß Deposit/Transfer from BO (Capital Market Account) (cyuwr evrvi) wnmve n Z Rgv/ vbvšíi Others (specify)... Ab vb (wbw` ófv e) Total me gvu Particulars weeiy Account Holder/Account Operator MÖvnK/wnmve cwipvjbvkvix Estimated No. of Monthly Deposit gvwmk m ve Rgvi msl v Estimated No. of Monthly Withdrawal gvwmk m ve D Ëvjb msl v Account Holder/Account Operator MÖvnK/wnmve cwipvjbvkvix For Bank s use only ïay e vs Ki e env ii Rb Estimated Amount of Total Monthly Deposit gvwmk m ve gvu Rgvi cwigvy Estimated Amount of Total Monthly Withdrawal gvwmk m ve gvu D Ëvj bi cwigvy Maximum Amount in a Single Monthly Deposit GKK m ev P Rgvi cwigvy Maximum Amount in a Single Monthly Withdrawal GKK m ev P D Ëvj bi cwigvy Account Holder/Account Operator MÖvnK/wnmve cwipvjbvkvix Transaction Profile reviewed as per instruction from Bangladesh Financial Intelligence Unit `k dvbb vwýqvj B Uwj RÝ BDwbU-Gi wb ` kbv gvzv ek MÖvn Ki m ve jb ` bi AbywgZ gvîv (Transaction Profile) ch v jvpbv Kiv n jv Reason for changing/not changing customer s Transaction Profile : MÖvn Ki m ve jb ` bi AbywgZ gvîv (Transaction Profile) cwiez b Kiv/bv Kivi KviY : Authorized Bank Officer s Signature & Date with Name Seal cöz qbkvix e vsk Kg KZ vi bvghy³ wmjmn ^v i I ZvwiL P12 of 28
2. Type of Account wnmv ei cök wz KYC Profile Form MÖvnK cwiwpwz m úwk Z dig Applicable for opening Personal Account e w³k wnmve Lvjvi ÿ Î e envh 1. Title of Account In (Block Letter) wnmv ei bvg (q) 3. Customer s Occupation (in detail) MÖvn Ki ckv (we ÍvwiZ) 4. Customer s Approximate Monthly Income MÖvn Ki gvwmk m ve Avq 5. Source(s) of Fund (in detail) A _ i Drm/Drmmg~n (we ÍvwiZ) 6. Documents Collected for Verifying Source of Fund A _ i Drm wbwðz Kivi Î hme `wjjvw` msmön Kiv n q Q 1.... 2.... 3.... Documents Collected Verified Yes (nü v) No (bv) msm nxz `wjjvw` hvpvb Kiv n q Q wk bv 7. How the customer s Address(es) are verified (Details)? wnmveavixi wvkvbv (mg~n) Kxfv e hvpvb Kiv n q Q (we ÍvwiZ)? 8. Beneficial Owner Determined : wnmv ei cök Z myweav fvmx (Beneficial Owner) wba viy Kiv n q Q wk-bv : Yes (nü v) No (bv) Not Applicable cö hvr bq [If yes please provide information of Beneficial Owner as per Annexure 1 (KA)] [DËi Ônü võ n j cö Z K cök Z myweav fvmx m úwk Z Z_ vw` cwiwkó-1 (K) gvzv ek msmön Ki Z n e ] 9. Identification cwiwpwz a. Passport Number K. cvm cvu b ^i b. National ID Number L. RvZxq cwipqcî b ^i c. Birth Registration Certificate Number M. Rb wbeüb mb`cî b ^i d. Electronic Tax ID (E-TIN) No. N. B jkuªwbk-u v AvBwW (E-TIN) b ^i e. Driving License Number O. WªvBwfs jvb mý b ^i...branch/kvlv f. Others P. Ab vb 10. In case of Non-resident and Foreigners- Purpose of Opening Account : Awbevmx (Non-resident) Ges we `wk `i ÿ Î wnmve Lvjvi D Ïk : A/C No. wnmve b ^i Unique Customer Identification Code BDwbK Kv gvi AvBwW KvW For Bank s Use (e vs Ki e env ii Rb ) Copy Received Kwc M nxz Copy Verified Kwc hvpvbk Z (If Applicable) (cö hvr Î) (If Applicable) (cö hvr Î) (If Applicable) (cö hvr Î) (If Applicable) (cö hvr Î) (If Applicable) (cö hvr Î) a. Type of VISA wfmvi cök wz Expiry gqv` b. Copy of Work Permit letter and approval of the competent Authority for opening Bank Account obtained? Kg vbygwz (Work Permit) cövß `i wnmve Lvjvi ÿ Î Kg vbygwz (Work Permit) cî I e vsk wnmve Lvjvi Rb h_vh_ KZ c ÿi Aby gv`b (cö hvr ÿ Î) i q Q wk-bv? Yes (nü v) No (bv) For Non-Resident Bangladeshi copy of passport and for Foreigners copy of passport along with visa must be collected. (Awbevmx `wk `i Î Avewk Kfv e cvm cv U i Kwc Ges we `wk `i Î Avewk Kfv e wfmvmn cvm cv U i Kwc msmön Ki Z n e) P13 of 28
11. Customer is Politically Exposed Person (PEP)/ Influential Person (IP)/Head or High Official of International Organization and member of their family or close associates (according to definition of BFIU Circular)? MÖvnK Politically Exposed Person (PEP)/cÖfvekvjx e w³ (IP)/ AvšÍR vwzk ms vi cöavb ev D P ch v qi Kg KZ v Ges Zv `i cwiev ii m`m ev close associates wk-bv (wegdavbbd KZ K RvixK Z mvk yjv i ewy Z msáv Abymv i)? If Yes (DËi Ônü võ n j) Yes (nü v) No (bv) a. Whether Approval Obtained from Senior Management? wmwbqi g v br g U n Z Aby gv`b bqv n q Q wk-bv? Yes (nü v) No (bv) b. Whether Customer(s) Interviewed Personally? MÖvn Ki m ½ gy LvgywL mvÿvrkvi bqv n q Q wk-bv? 12. Have any match been found in screening the customer s name with the listed persons or entities under different resolutions of United Nations Security Council relating to terrorist activities, financing of terrorist activities and financing of weapons of mass destructions and persons listed or banned entities by Government of Bangladesh? mswkøó AvBb, wewagvjv I mvk yjv ii Av jv K MÖvn Ki bvg RvwZms Ni wbivcëv cwil `i wewfbœ iry jk bi AvIZvq mš vmx Kv h, mš vmx Kv h A_ vq b I e vck aÿsmvz K A we Ív ii A_ vq b RwoZ m ` n ZvwjKvfy³ Kv bv e w³ ev mëv Ges `k mikvi KZ K ZvwjKvfy³ Kv bv e w³ ev wbwl NvwlZ mëvi bv gi ZvwjKvi mv _ hvpvb evqvbc~e K Kv bviƒc wgj cviqv wm q Q wk-bv? a. If Yes, measures taken on this : DËi Ônü võ n j G welqk M nxz e e vi weeiy : Yes (nü v) Yes (nü v) No (bv) No (bv) 13. Risk Grading : wi MÖwWs : a. Type of Profession the customer is involved? K. MÖvnK Kx K ib/kx ai bi ckvq wb qvwrz i q Q? SL. No. µwgk bs Nature cök wz Risk Score wi vi 1. Jewelry Business/Gold related Business/Precious Metal Business Ry qjvwi/ ^ Y i e emv/g~j evb avzzi e emv 5 (5) 2. Money Changer/Courier Service/Mobile Banking Agent gvwb PÄvi/Kzwiqvi mvwf m/ gvevbj e vswks G R U 5 (5) 3. Real Estate Developer/Agent wi qj G U W fjcvi/g R U 5 (5) 4. Construction Project Promoter/Contractor wbg vy cökí cöv gvuvi/wvkv`vi 5 (5) 5. Art/Antique Dealer wpîkjv/a vw U Ki wwjvi 5 (5) 6. Restaurant/Bar/Night Club/Residential Hotel/Parlor Business iu Íviv/evi/bvBU K ve/avevwmk nv Uj/cvj vi e emv 5 (5) 7. Import/Export Avg`vwb/ißvwb 5 (5) 8. Manpower Export Business Rbkw³ ißvwb e emv 5 (5) 9. Arms Business A i e emv 5 (5) 10. Garments Business/Garments Accessories/Buying House Mv g Um e emv/mv g Um G mvwir/evwqs nvdr 5 (5) 11. Pilot/Flight Attendent cvbju/d vbu G Ub W U 5 (5) 12. Trustee Uªvw 5 (5) 13. Share/Stock Investor kqvi/ K e emvq wewb qvmkvix 5 (5) 14. Software Business/Information Technology Business mdu&iq vi e emv/z_ I cöhyw³i e emv 5 (5) 15. Expatriate (Foreigners Working in Bangladesh) G c vwuªqvu ( ` k Kg iz we `wk e w³) 5 (5) 16. Travel Agent Uªv fj G R U 4 (4) 17. Businessman Investing Above Tk. 1 Crore Yearly evwl K 1 KvwU UvKvi AwaK A_ jmœxkvix e emvqx 4 (4) 18. Freight/Shipping/Cargo Agent d«bu/wkwcs/kv Mv G R U 4 (4) 19. Automobiles Business (New/Recondition) A Uv e emv (bzzb/wikwûkvb Mvwo) 4 (4) 20. Business (Leather & Leather Goods) e emv (Pvgov I PvgovRvZ cy ) 4 (4) 21. Building Construction Material Business evwo wbgv Y mvgmöxi e emv 4 (4) 22. Professional (Journalist, Lawyer, Doctor, Engineer, Chartered Accountant) ckvrxex (mvsevw`k, AvBbRxex, Wv³vi, BwÄwbqvi, PvU vw GKvDb U U) 4 (4) 23. Director (Private/Public Limited Company) ww i±i (cövb fu/cvewjk wjwg UW Kv úvwb) 4 (4) 24. High Official of Multinational Company eûrvwzk cöwzôv bi EaŸ Zb Kg KZ v 4 (4) 25. Housewife M wnyx 4 (4) 26. Job in Information Technology Z_ -cöhyw³ ÿ Î PvKzwi 4 (4) 27. Player/Media Celebrity/Producer/Flim Maker L jvqvo/wgwwqv mwj eªwu/cöwwdmi/wbg vzv 4 (4) 28. Freelance Software Developer wd«j vý mdu&iq vi W fjcvi 4 (4) 29. Business-Agent e emv-g R U 3 (3) 30. Government Job mikvwi PvKzwi 3 (3) P14 of 28
SL. No. µwgk bs Nature cök wz Risk Score wi vi 31. Landlord evwoiqvjv 3 (3) 32. Cotton/Garment s Left Over Business myzv e emvqx/szu e emvqx 3 (3) 33. Transport Operator cwieny Acv iui 3 (3) 34. Tobacco & Cigarette Business ZvgvK I wmmv i Ui e emv 3 (3) 35. Entertainment Institution/Park we bv`bkvix cöwzôvb/cvk 3 (3) 36. Motor Parts/Workshop Business gvui cvu m/iqvk mc-gi e emv 3 (3) 37. Private Service (Manegerial) cövb fu mvwf m (g v brvwiqvj) 3 (3) 38. Teacher (Govt./Private/Autonomous Educational Institution) wkÿk (mikvwi/ emikvwi/ ^vqëkvwmz wkÿv cöwzôvb) 2 (2) 39. Service (Private) PvKzwi ( emikvwi) 2 (2) 40. Small Trader (Yearly Turnover Below Tk. 50 Lac) z`ª e emvqx (evwl K Uvb Ifvi 50 jÿ UvKvi wb P) 2 (2) 41. Self Employed Professional ^D ` vmx ckvrxex 2 (2) 42. Computer/Mobile Phone Dealer Kw úduvi/ gvevbj dv bi wwjvi 2 (2) 43. Manufacturer (Except Arms) Drcv`bKvix (A e ZxZ) 2 (2) 44. Student QvÎ 2 (2) 45. Retired from Service PvKzwi n Z Aemi MÖnYKvix 1 (1) 46. Farmer/Labourer/Fisherman K wlrxex/kögrxex/grm Rxex 1 (1) 47. Others (please specify) Ab vb (mywbw` ófv e D jøl Kiæb) 1-5 (1-5) (To assess risk grading of the customer, details of customer s type of business, location of business, size of business, beneficial owner of the account, etc and other special areas to be analyzed and considered in order to rate high or low risk type. Similarly, for service holders detail information specially type of job, roles & responsibilities to be obtained to assess risk grading. Considering these issues customer can get higher score than scores mentioned in SL 16-46.) (MÖvn Ki SuywK wbiƒc Yi ÿ Î MÖvn Ki ckvi we ÍvwiZ Z_ we køly K i e emv qi ÿ Î e emv qi cök wz, A _ i gvîv, e emv qi GjvKv, e emv qi AvKvi, wnmv ei cök Z myweav fvmx BZ vw`mn Ab vb we kl w`k we epbvq wb q MÖvnK K D P ev wb œ SyuwK m úbœ wn m e kªwykiy Ki Z n e PvKzwii ÿ ÎI Abyiƒcfv e we ÍvwiZ Z_ jvf K i we kl K i PvKzwii cök wz I `vq `vwq Z i wbwi L SzuwK wbiƒcy Ki Z n e Gme welqmg~n we epbvq wb q MÖvnK f ` 16-46 bs ÿ Î ewy Z vi A cÿv D PZi vi cö`vb Ki Z cvi e ) b. Monthly Income of the Customer L. MÖvn Ki gvwmk Av qi cwigvy Amount (Taka) cwigvy (UvKvq) Risk Score wi vi Up to 1 Lac (1 jÿ ch ší) 0 (0) >1 to 3 Lac (> 1 n Z 3 jÿ ch ší) 1 (1) More than 3 Lac (3 jÿvwak) 3 (3) c. The Account was opened through M. wnmve Lvjvi aib Media gva g Risk Score wi vi Relationship Manager/By Branch (wi jkbwkc g v brvi/kvlv KZ K) 0 (0) By Direct Sales Agent (mivmwi mjm G R U KZ K) 3 (3) Internet (B Uvi bu)/non Face to Face (gy LvgywL bq) 3 (3) Walk-in ( ^cö Yvw`Zfv e) 3 (3) d. Estimated Amount of Monthly Transactions of Customer N. MÖvn Ki AbywgZ gvwmk jb ` bi cwigvy Amount of Transactions in Current Amount of Transactions in Savings Risk Score Account (figure in Lac) Account (figure in Lac) wi vi PjwZ wnmv e jb ` bi cwigvy mâqx wnmv e jb ` bi cwigvy (j UvKvq) (j UvKvq) 0-10 (0-10) 0-5 (0-5) 0 (0) > 10-20 (> 10-20) > 5-10 (> 5-10) 1 (1) > 20 (> 20) > 10 (> 10) 3 (3) e. Estimated Number of Monthly Transactions of Customer O. MÖvn Ki AbywgZ gvwmk jb ` bi msl v No. of Transactions in No. of Transactions in Risk Score the Current Account Savings Account wi vi PjwZ wnmv e jb ` bi msl v mâqx wnmv e jb ` bi msl v 0-15 (0-15) 0-10 (0-10) 0 (0) 16-25 (16-25) 11-20 (11-20) 1 (1) > 25 (> 25) > 20 (> 20) 3 (3) P15 of 28
f. Estimated Monthly Cash Transactions of Customer P. MÖvn Ki AbywgZ gvwmk bm` jb ` bi cwigvy Amount of Transactions in Amount of Transactions in Risk Score the Current Account Savings Account wi vi PjwZ wnmv e jb ` bi cwigvy (jÿ UvKvq) mâqx wnmv e jb ` bi cwigvy (jÿ UvKvq) g. Estimated Number of Monthly Cash Transactions of Customer Q. MÖvn Ki AbywgZ gvwmk bm` jb ` bi msl v No. of Transactions in No. of Transactions in Risk Score the Current Account Savings Account wi vi PjwZ wnmv e jb ` bi msl v mâqx wnmv e jb ` bi msl v 0-10 (0-10) 0-5 (0-5) 0 (0) 11-20 (11-20) 6-10 (6-10) 1 (1) > 20 (> 20) > 10 (> 10) 3 (3) 14. Overall Risk/Risk Rating Assessment (Total Risk Score of above a to g) mvgwmök SzuwK/wi iwus wbiƒcy (Dc ii K n Z Q µwgk ch ší wi v ii hvmdj) Comments gšíe 0-5 (0-5) 0-2 (0-2) 0 (0) > 5-10 (> 5-10) > 2-5 (> 2-5) 1 (1) > 10 (> 10) > 5 (> 5) 3 (3) Total Risk Score wi v ii hvmdj Overall Risk Rating mvgwmök wi iwus >=14 >=(14) High D P <14 <(14) Low wb œ (* Even if risk rating is below 14 considering Beneficial Owners high risk customer can be rated as high risk customer under subjective consideration with clear mentioned reasons) (* wi iwus 14 Gi Kg n ji Beneficial Owner-Gi D P SuywK we epbvq wb q KviY D jølc~e K Subjective we epbvq MÖvnK K D P SuywK m úbœ wn m e wbiƒcy Kiv h Z cv i ) Prepared by (cö ZKvix) Account Opening Officer/Relationship Manager (wnmve Lvjvi Kg KZ v/wi jkbwkc g v brvi) Checked & Verified by ch v jvpbv I wbwðzkvix Kg KZ v BAMLCO (kvlv gvwb jûvwis cöwz iva cwicvjb Kg KZ v) Name (bvg) Signature (with seal) ^vÿi (wmjmn) Name (bvg) Signature (with seal) ^vÿi (wmjmn) Date (ZvwiL) Date (ZvwiL) Signature of Authorized Officer with Name Seal & Date (in case of PEP/IP/High Official of International Organization) (PEP/IP/AvšÍR vwzk ms vi EaŸ Zb Kg KZ v-gi ÿ Î Aby gv`bkvix EaŸ Zb Kg KZ v) bvghy³ wmjmn ^vÿi I ZvwiL 15. Date of Review and Update of Account and Customer Related Latest Information wnmve I MÖvnK msµvší Z_ vw` me kl ch v jvpbv Ges nvjbvmv` (review & update) Kivi ZvwiL P16 of 28 Reviewed & Updated by (signature & date with name seal) (ch v jvpbv Ges nvjbvmv`kvix Kg KZ v) bvghy³ wmjmn ^vÿi I ZvwiL