Beneficial Owner Information Form

BENEFICIAL OWNER INFORMATION FORM
Date D D M M Y Y Y Y Account Number
1) Title of Account
In English (Block Letter) :........................................................................................................................................................................................
evsjvq :.........................................................................................................................................................................................
2) Name of the Beneficial Owner
In English (Block Letter) :.....................................................................................................................................................
1 copy of
evsjvq :......................................................................................................................................................
recent coloured
3) Date of Birth : D D M M Y Y Y Y 4) Gender: Male Female Others :..................... passport size
photograph
5) Father’s Name :......................................................................................................................................................
6) Mother’s Name :......................................................................................................................................................
7) Spouse’s Name :.............................................................................................................................................................................................
8) Nationality :..................................................................... Resident Non-Resident
9) Occupation :.................................... 10) Monthly Income :....................................... 11) Sources of Income :................................................
12) Tax ID Number (TIN), if available :...................................................................................................................................................................................
13) a) Present Address
House Name :......................................................... Flat No. :................................. Road No./Name :..............................................................................
Village/House/Holding No./Area :............................................... Block/Sector/Section :............................ Police Station :.......................................................
Post Office :............................................... Post Code :................... District :........................................ Country :............................................................
Phone/Mobile Number :......................................................... e-mail ID :..........................................................................................................................
b) Permanent Address (If different from Present Address)
House Name :......................................................... Flat No. :................................. Road No./Name :..............................................................................
Village/House/Holding No./Area :............................................... Block/Sector/Section :............................ Police Station :.......................................................
Post Office :............................................... Post Code :................... District :........................................ Country :............................................................
14) ID Document : NID Passport Birth Registration Certificate Others (Please Specify)*
ID Number :......................................................................................................................................................................................................................
Signature of Applicant............................................................
Date :............................................................
* Only applicable for Financial Inclusion Products and acceptable to the Bank.
Initial of Assigned Officer ........................................................ Initial of BOM/BRM ...........................................................

Beneficial Owner Information Form

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BENEFICIAL OWNER INFORMATION FORM

Date D D M M Y Y Y Y Account Number

In English (Block Letter) :........................................................................................................................................................................................

In English (Block Letter) :.....................................................................................................................................................

6) Mother’s Name :......................................................................................................................................................

7) Spouse’s Name :.............................................................................................................................................................................................

8) Nationality :..................................................................... Resident Non-Resident

12) Tax ID Number (TIN), if available :...................................................................................................................................................................................

13) a) Present Address

House Name :......................................................... Flat No. :................................. Road No./Name :..............................................................................

Village/House/Holding No./Area :............................................... Block/Sector/Section :............................ Police Station :.......................................................

Phone/Mobile Number :......................................................... e-mail ID :..........................................................................................................................

b) Permanent Address (If different from Present Address)

House Name :......................................................... Flat No. :................................. Road No./Name :..............................................................................

Village/House/Holding No./Area :............................................... Block/Sector/Section :............................ Police Station :.......................................................

Initial of Assigned Officer ........................................................ Initial of BOM/BRM ...........................................................

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