GUYANA BANK FOR TRADE AND INDUSTRY LIMITED

NEW ACCOUNT APPLICATION FORM - COMPANIES

NAME OF ACCOUNT:

Type of Account:

SAVINGS
CURRENT
SPECIAL INVESTMENTS
FIXED DEPOSITS
FOREIGN CURRENCY

MONTHLY
1 MTH 3 MTHS
USD
CAD

QUARTERLY
6 MTHS 12 MTHS
EURO
STG

COMPANY INFORMATION KINDLY COMPLETE IN BLOCK LETTERS

*Name of Company:

*Address of Company:

Phone#:

Resident

Fax#:

Email:

Non-Resident

Expected Monthly Deposit:

TIN #:

Delivery Mode of Mails:

Direct Banking:

Mail

(Y/N)

Mobile Banking:

Hold

Email

(Y/N)

The undersigned declares and confirms that the information given in this application for bank service(s) is true
and correct and the undersigned further confirms and declares that the undersigned is not engaging in money
laundering, terrorist financing, drug trafficking, fraud or any other crime or illicit activities. The undersigned
shall refrain from using the account for money laundering, terrorist financing, criminal activities or for furthering
criminal purposes of conducts.
The undersigned promises to abide by the terms of the account agreement and to disclose to the Bank, if and
when applicable, the source of all funds for deposit to the account. Furthermore, the undersigned consents to
the Banks due diligence and verification procedures and to the retention by the Bank of this application, all
supporting documents and all transactional documents related to the account.
The Bank may at any time without prior notice suspend or close your Account and the Bank will not be liable to
you or any other person for Loss suffered or incurred by you or such other person as a result of the Bank acting
pursuant to this clause. The Bank will notify you as soon as practicable of any such suspension or closure. Upon
closure of your Account, the Bank will pay you an amount equal to the credit balance (if any) on the Account
after deducting any sums due from you.
All cheque books, ATM cards and other materials provided by the Bank to you in relation to the Account remain
the property of the Bank at all times and must be returned to the Bank on demand and upon any Account
closure.

_____________________________________________________________________________________________
Signature
Full Name in Block Letters
Date

GUYANA BANK FOR TRADE AND INDUSTRY LIMITED

ACCOUNT NO. :
NAME OF COMPANY:

SIGNATORY INFORMATION: - KINDLY COMPLETE IN BLOCK LETTERS

Are you a GBTI customer?

Title:
(Mr./Mrs./Ms./Dr.)

* Residential

Yes

No

First Name:

Last Name:

Other:

Address:

Mailing Address:

Proof of Address Documentation:

Phone# - Work:
Cell:

Fax:

E-mail:
Residency Status:

Resident
Non-Resident

* Language:
Marital Status:
Sex:

(M/S/W/C/D)

Dual Citizenship:

Country of Residency:____________

Country of Birth: _________ Citizenship:__________

(Y/N)

State Countries:

__________________
__________________

Green Card Number:

Date of Issue:

________________

________________

Social Security Number:

_________________

SSN Country:

_________________

Tax Registration Number:

_________________

*Date of Expiry:
_________________

National Identification #:

Date of Issue:

* Date

of Birth:

Passport #:

Date of Issue:

* Date

of Expiry:

Passport Country of issue:

TIN #:
Occupation/Title:
Educational Status:

Name of Employer:
Employer Tel No.:
Tenure:

Character References:

Signing Instructions:
The undersigned declares and confirms that the information given in this application for bank service(s) is true and
correct and the undersigned further confirms and declares that the undersigned is not engaging in money
laundering, terrorist financing, drug trafficking, fraud or any other crime or illicit activities. The undersigned shall
refrain from using the account for money laundering, terrorist financing, criminal activities or for furthering criminal
purposes of conducts.
The undersigned promises to abide by the terms of the account agreement and to disclose to the Bank, if and
when applicable, the source of all funds for deposit to the account. Furthermore, the undersigned consents to the
Banks due diligence and verification procedures and to the retention by the Bank of this application, all supporting
documents and all transactional documents related to the account.
___________________________________________________________________________________________
Signature
Full Name in Block Letters
Date

AUTHORISED BY:

Date: (...//)
D

GUYANA BANK FOR TRADE AND INDUSTRY LIMITED

Addendum Companies

NAME OF ACCOUNT:

ACCOUNT #:

GIIN (Global Intermediary ID Number)

_______________________________________

EIN:

_______________________________________

TRN/TIN:

_______________________________________

Exempt Beneficial Owner Status:

_______________________________________

Federal Tax Classification:

_______________________________________

Treaty Benefits:

Yes

No