KNOW YOUR CUSTOMER FORM

First name Last name ‫ﺍﻷﺳﻢ ﺍﻷﺧﻴﺮ‬ ‫ﺍﻷﺳﻢ ﺍﻷﻭﻝ‬

Customer Name: * * :‫ﺃﺳﻢ ﺍﻟﻌﻤﻴﻞ‬

Date of Birth: Place of birth: :‫ﻣﻜﺎﻥ ﺍﻟﻤﻴﻼﺩ‬ :‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬

Profession: :‫ﺍﻟﻮﻇﻴﻔﺔ‬
Nationality: * * :‫ﺍﻟﺠﻨﺴﻴﺔ‬
Proof of Identiy: * Passport Number: :‫ * ﺭﻗﻢ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬:‫ﺃﺛﺒﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ‬
ID Number: :‫ ﺭﺧﺼﺔ ﻗﻴﺎﺩﺓ‬/‫ﺑﻄﺎﻗﺔ ﺷﺨﺼﻴﺔ‬
Address: * * :‫ﺍﻟﻌﻨﻮﺍﻥ‬

PO BOX: :‫ﺻﻨﺪﻭﻕ ﺍﻟﺒﺮﻳﺪ‬

City: :‫ﺍﻟﻤﺪﻳﻨﺔ‬
State: :‫ﺍﻟﺪﻭﻟﺔ‬

Telephone No. :(‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ )ﻣﻨﺰﻝ‬

Mobile No.* *:(‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ )ﻣﺘﺤﺮﻙ‬
Fax No. :‫ﻓﺎﻛﺲ‬
e-mail address: :‫ﺍﻟﺒﺮﻳﺪ ﺍﻷﻟﻜﺘﺮﻭﻧﻲ‬

Name of the Agent: :‫ﺃﺳﻢ ﺍﻟﻮﻛﻴﻞ‬

Proof of Identiy: Passport Number: :‫ﺭﻗﻢ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬ :‫ﺃﺛﺒﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ‬
ID Number: :‫ ﺭﺧﺼﺔ ﻗﻴﺎﺩﺓ‬/‫ﺑﻄﺎﻗﺔ ﺷﺨﺼﻴﺔ‬

Property Name: * * :‫ﺃﺳﻢ ﺍﻟﻤﺸﺮﻭﻉ‬

Unit number: * * :‫ﺭﻗﻢ ﺍﻟﻮﺣﺪﺓ‬

Amount Paid in cash: * * :‫ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤﺪﻓﻮﻉ‬

Payment description: * * :‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﺪﻓﻌﺔ‬

Source of Cash: * * :‫ﻣﺼﺪﺭ ﺍﻷﻣﻮﺍﻝ‬

Customer ‫ﺗﻮﻗﻴﻊ‬
Signature: * * :‫ﺍﻟﻌﻤﻴﻞ‬

Date: :‫ﺍﻟﺘﺎﺭﻳﺦ‬

Mandatory field * * ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﺰﺍﻣﻴﺔ‬

Disclaimer :‫ﺃﻗﺮﺍﺭ‬
The Customer acknowledges that all details mentioned above is correct ‫ﻳﻘﺮ ﺍﻟﻌﻤﻴﻞ ﺑﺄﻥ ﺟﻤﻴﻊ ﺍﻟﺘﻔﺎﺻﻴﻞ ﺍﻟﻤﺬﻛﻮﺭﺓ ﺃﻋﻼﻩ ﺻﺤﻴﺤﺔ‬
and the customers is fully responsible if otherwise ‫ﻭﺃﻧﻪ ﻣﺴﺆﻝ ﻣﺴﺆﻭﻟﻴﺔ ﻛﺎﻣﻠﺔ ﺇﺫﺍ ﺛﺒﺖ ﺧﻼﻑ ﺫﻟﻚ‬

P.O BOX 2195, Executive Heights, TECOM area, Near Greens, Sheikh Zayed Road, Dubai, UAE
Tel:+971 4 3731000 Fax:+971 4 3731290