INDIVIDUAL INFORMATION FORM

THIS IS A MACHINE READABLE FORM. It should be completed in "ENGLISH CAPITAL" letters. Date D D MM Y Y Y Y

FOR BANK USE ONLY

Unique Customer ID

A/C No.

Relation with the Account 1st Applicant 2nd Applicant 3rd Applicant

Director A/C Operator Partner

Please affix here a recent
Beneficial Owner Minor Guardian Passport size photograph
duly attested by A/C holder
Trustee Attorney Holder Proprietor

Others Please Specify

Account Name

Customer’s Name

Father’s Name

Mother’s Name

Spouse Name

Date of Birth D D MM Y Y Y Y Gender

Religion Male Female Third Gender

National ID Card No.* Resident Status

Birth Certificate No.* Resident Non-Resident

Passport No.* Issue Date D D MM Y Y Y Y

Place of Issue Exp. Date D D MM Y Y Y Y

Driving License No. Exp. Date D D MM Y Y Y Y

Other Photo ID E-TIN

Nationality Bangladeshi Others Please Specify *Foreigners will provide VISA and Passport copy.

Place of Birth (Dist/City) Country of Birth

Profession Monthly Income

(For Individual A/C Only)

Name of the Employer/ Designation

Organization

Nature of Business

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Present Address (Residence)

Postcode Country Landmark

Professional Address

Postcode Country Landmark

Parmanent Address

Postcode Country Landmark

Phone No.(Residence) Office

Mobile 0 1 Fax No

E-mail ID

Emergency Name
Contact

Address

Email

Mobile 0 1

Relationship with A/C

Operator or A/C Holder

Credit Card Information of A\C Holder (If any)

Issued By (Local)

Issued By (International)

1. Are you a U.S. Resident Yes No 2. Are you a Yes No 3. Do You hold a U.S. Permanent Yes No
U.S. Citizen Resident Card (Green Card)?
I/We hereby consent for The City bank Limited or any of its affiliates (include branches) (here in after collectively referred to as “Bank”) to share my/our information with domestic or overseas
regulators or tax authorities or other concerned authorities where necessary and/or required by applicable laws, agreement with regulators or authorities and/or directives.

Where required by domestic or overseas regulators or tax authorities or other concerned authorities, I/we consent and agree that the Bank may with hold, and pay out, from my/our account
(s) such amounts as may by required according to applicable laws, regulations, or authorities and directives and Bank shall not be held liable for any consequences thereof. In the event of any
loss suffered by bank due to my/our failure or inaction or misrepresentation, I/we shall hold the Bank fully indemnified and harmless against all such losses arising thereof. Proof of address
required (of any one).

Signature with Date Signature with Name Seal Signature with Name Seal

Applicant’s Name Account Opened By Approved by BM/Designated Officer

*Any one photo ID must be Submitted. *In case of Birth Certificate, provide additional Photo ID as per Bangladesh Bank guideline.

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