Dutch Bangla Bank Account Form – Fill Out and Use This PDF

	Dutch-Bangia Bank Limited
Account Opening Form	Individual Account
O 0 M M Y Y Y Y
Date ITITIC[IJ	(For Bank use only)
The Manager	Ale No.
Dutch-Bangia Bank Limited
....................................................... Branch

Dear Sir,

l!We request you to open an account in your branch. My / Our full particulars are given below:

1.Title of Account

i.

1

I

ii.

============================================~

1

1

2. Type of Account-please Tick (..J) DExcel

DPower

DPower Plus

D Savings

D Current D SND

DFixed

DFC

D RFCD DNFCD D Others

.

3. Currency-please Tick (..J)

DTaka

DDollar

DEuro

DGBP

D Others

.

4. Operating Instruction-please

Tick (..J) DIndividual

DJoint

DAnyone

D Others

.

5. Particulars of accounts of allied or sister concern of the customer (if any):

SI. No.

Account Number(s)

Type

Title the account

Relationship

01.

02.

6. Other Bank Accounts of the Customer (If any)

Name of the Bank(s)

Branch(es)

Type of Account - please Tick (...f)

a)

a)

D Deposit

Ale

D

Loan Ale

D

Others

b)

b)

D Deposit

Ale

D

Loan Ale

D

Others

7.	Introducer's declaration and information:
	I hereby declare that I personally know the account holder thoroughly. The particulars given in the account opening form are correct
	to the best of my knowledge.
	Name	,,----------------------,			ISignature
	Account Number				with date
					------------~
8.	Initial Deposit		Currency: ,'-	_	Amount: ,		--.J
9.	Particulars of FORI		Amount: I		Currency: I
	Term Deposit (if any)			I Rate of Interest: I	-----------
			period:1		Date of maturity:1	/	/

RenewalIRedemptioninstructions D Renew Principal & Redeem Interest D RenewPrincipalwithInterest D Redeem Principal & interest D No instructions

RenewalI Redemptionpayoutmode

DBycash		D By Banker'sCheque	D Transferto Account
InterestTransferAccountNo I		I RedemptionTransferAccountNo·1
Unless instruction to the contrary is received, the Bank will renew
principal plus interest at the interest rate prevailing on maturity date.
Pay in Mode: D Cash	D Transfer from DBBL Account ,			~
DCheque No		Drawn on	Bank	Branch

Page No. 01

10. Particulars of Deposit Under Special Scheme

	NameofSchemel,-------------------------------------------------------------~
Tenure	One time Deposit (If any)	No. of Installments	Installment Type	Installment Amount	Payable on maturity

D Monthly

D Quarterly

D Yearly

11. Sources of Fund

Particulars	Nominee -1	Nominee - 2

Name

Date of Birth

Percent of Share

Father's Name (with prefix')

Mother's Name (with prefix')

Spouse Name (with prefix')

PermanentAddress

Profession

Relationship with the AlC Holder

National 10 Card Number, if not minor

Signature of Nominee(s), if not minor

In the event that the nominee remain(s) a minor at the time of account holder's death following person is authorized

to receive / draw the amount of deposits held by the bank on behalf of the minor.

Pa e No. 02

14. In case of Account Holder(s) being minor:

As a duly appointed guardian(s) of the account holder. I/we hereby declare that the account holder is a minor. His/Her particulars are given in a separate elF. The account will be operated under my/our signature(s) as a legal guardian(s) until the account holder becomes a major or I/we declare otherwise.

Name of Account Holder (Minor): 1------------------

Date of birth: 1

_

Note: For Minor and Guardian - "Two Personal Information Forms" are to be filled up and Guardian must sign both the forms

15.Declaration and Signature of account Holder(s):

l!We hereby confirm that IIwe have read and understood all the terms & conditions related to opening account and agree to abide by the same. I !WE solemnly declare that the information given above including nominee particulars is correct. l!We shall also submit any additional information/documents as and when required

	Signature	:1.	2.	_
Date: -1--1----	Applicant's Name: 1.		2.

For Bank's Use only

Comments (If any)

(Signature with	date)			(Signature with date)	(Signature with date)
Account Opening	Officer			Authorized officer	Approved by Manager/Branch Incharge
(Seal with name & designation)				(Seal with name & designation)	(Seal with name & designation)
Account No.
1st Applicant	10				IC
					IC
2nd Applicant	10
					IC
Mandatee	10
Authorised Signatory-1	10				IC
					IC
Authorised Slgnatory-2	10
Chainnan	10				IC
Managing Director	10				IC
Director-1	10				IC
				I.
Oirector-2	10		L-		IC
Sector Code for SBS -1			'---	1
Initial Deposit			-	1
Cheque No			10	bolh	number Inclusive issued.

If the account is used as settlement account for loan, please fill-in the following:

loan/Contract No.	loan Type	GuarantorID	GuarantorAmount	Economicpurposecode	SecurityCode
input by		Checked and authorized by			.
Branch Manager I Authorized Officer					.
					Page No. 03

Dutch-Bangia Bank Limited

Photograph (Attested by the Introducer)

(CIF - Customer Information Form)

(For Bank use only)

Date~

The information is given below for:

		Address
* Present Address	(Residence)	* Permanent Address
IHouse No. :	----'----------------
IRoad No. :
IVillage

IDistrict

PostaVZip Code:

ICountry :

IPhone (Residence):

Iphone (Office) :

IMobile

IE.mail

Other Information

Birth / Reg. Date						Reg. No. ITIIJJTI
Sex	DMaie	D	Female
Marital Status	D Single	D	Married	D	Divorced D	Widowed
Page No. 04

Dutch-Bangia Bank Limited

KYC Profile Form

For Individual and Non-Individual Accounts	(For Bank use only)

1.Title of Account

2.Type of Account

3.Account or Reference No.

4. Name of NC Opening Officer

I Designation I

5.Nature of Business and sources of Fund

6.Describe how the sources of Funds have been verified. It should be clearly stated whether the transactions are in keeping with volume and nature of business.

7.Information about Beneficial Owner of Account

(in case of Company, detail information of regulalory

Shareholder and 20% or above single shareholder)

8.Passport Number

9.National ID Number

10.TIN

11.VAT Registration Number I

=========================

12. Driving

License

Number

I------------------~===---~----~=-~==~

13. In case

of non-resident

/ Foreigner

a) Reasons for opening

the Account

b) Type of Visa

14. Occupation / Nature

of Business of the Individual/Organization.

(please tick)

SI.

CategorylNature

of business

Risk Level

Score

01.

Jewellery/Gold

Traders

High

5

02.

Money Exchange /Courier Service Agent

High

5

03.

Real

Estate

Agent

High

5

04.

Construction

Proiect

Promoter

High

5

05.

Offshore

Corporation

High

5

06.

ART! Antique

Dealers

High

5

07.

Restaurant/Bar/Night

Club/Hotel

& Motel owner

High

5

08.

ImportlExport

Agent

High

5

09.

Cash

money

Lender

(of taka 250.000 monthly)

High

5

10.

Share/Stock

Dealer

High

5

11.

Manpower

Export

Business

High

5

12.

Operations

in Multiple Locations

High

5

13.

Film

ProducerlDistributor

High

5

14.

Arms

Dealer

HIgh

5

15.

Mobile

Phone

Operator

HIgh

5

16.

Money

lender

(of more than taka

one crore yearly)

wgn

4

17.

Travel

Agent

111gn

4

Page No. 07

SI.

CategorylNature

of business

Risk Level

Score

18.

Transport

Operator

Medium

3

19.

Auto

Dealer

(Reconditioned

Cars)

Medium

3

20.

Non-banking

financial

Institution

(NBFI)

Medium

3

21.

Freight/Shipping/Cargo

Agent

Medium

3

22.

Insurance/Brokerage

Agencies

Medium

3

23.

Religious

Institutions/Organizations

Medium

3

24.

Entertainment

Organization!

Amusement

Park

Medium

3

25.

Motor

Parts Business

Medium

3

26.

Tobacco

& Cigarette

Business

Medium

3

27.

Auto

Primary

(New Car)

Low

2

28.

Shop

Owner

(Retail)

Low

2

29.

Business

-Azent

Low

2

30.

Small

Trader

(Turnover

less

than

Tk. 50.00 lac per annum)

Low

2

31.

Self Employed Professional

Low

2

32.

Corporate

Customer

Low

2

33.

Construction

Material

Business

Low

2

34.

ComputerlMobile

Phone

Dealer

Low

2

35.

Software

Business

Low

1

36.

Manufactures

(other than Arms)

Low

1

37.

Retired Persons

Low

0

38.

Service

Low

0

39.

Student

Low

0

40.

Housewife

Low

0

41.

Farmer

Low

0

42.

Others

(Bank

will rate the risk according

to nature)

For table 16 to 21 upper limit will be considered as same category. Example: 50 lac will be under the category of 0-50 class

15. Net worth of the Customer (Please tick)
	Amount	(Taka)			Risk Level	Risk	Rating
	1-50 lac				Low		0
	50 lac to 2 crore				Medium		1
	Above	2 Crore			High		3
16.Procurement of accounts (Please tick)
	Procurements				Risk Level	Risk	Rating
	Relationship		ManagerlBranch		Low		0
	Direct Sales		Agent		Medium		1
	Internet				High		3
	Walk-in!Self		motivated		High		3
17. Estimated monthly transactions (Please tick)
	Transactions		in Current Account	Transactions in Savings		Account
		(figure in Lac)			(figure in Lac)	Risk Level			Risk Rating
			0-10	0-5			Low		0
			10-50	5-20			Medium		1
		Above 50			Above 20		High		3

18. Estimated number of monthly transactions (Please tick)

No. of transactions	in Current	No. of transactions	in Savings
Account		Account		Risk Level	Risk Rating
0-100		0-20.		Low	0
100 - 250		20-50		Medium	1
Above 250		Above	50	High	3

Page No. 08

19. Estimated monthly Cash Transactions (please tick)
	Transactions in Current Account		Transactions in Savings Account
		(amount in Lac)	(amount in Lac)		Risk Level	Risk Rating
	1 -10		1-2		Low	0
	10-25		2-7		Medium	1
		Above 25	Above 7		High	3
20. Estimated number of monthly Cash Transactions (please tick)
	No. of transactions in Current		No. of transactions in Savings
		Account	Account		Risk Level	Risk Rating
	0- 15		0-5		Low	0
	15-30		5-10		Medium	1
		Above 30	Above 10		High	3
21. Overall Risk Grading (Please tick)
		Total Risk Rating	Risk Assessment
		AbovelEqual 14	High
		Below 14	Low

Remarks

(*Customer may also be graded in high risk category according to subjective consideration with reason when the risk grading is below 14.

22. Address(es) of Account Holder(s) verified or not?	DYes

23.H yes, How!

24.Politically Exposed Person(s) (PEPs): (According to A.M.L. Circular -14)

a) Approval obtained from Senior Management	DYes		D	No
l_b_)_S__ceoms_O_f_VV_e_al_th	I==~------		==~-------------------------------
Ic) Customer(s) interviewed personally	DYes
Prepared by		Verified by
(Account Opening OfficerlRelationship Manager)		(Head of Branch/Operation Manager)
Signature		Signature
withdate		withdate
Name		Name
NameSeal		NameSeal
25. When the account related information is reviewed and updated last		B		_

Compliance Officer

Dutch-Bangia Bank Limited

KYC Profile Form

IApplicable for Special Scheme/Term Deposit I

1.Title of Account

2.Type of Account

3.Account or Reference No.

4. Name of Opening Officer I

ALCI~~~~~~~~~~~~~~

5.Sources of fund & how it was verified.

6.Information about Beneficial Owner of Account

(in case of Company, detail information of regulatory

Shareholder and 20% or above single shareholder)

7.	Passport Number			Photocopy obtained?	DYes	DNo
8.	National ID Number			Photocopy obtained?	DYes	DNO
9.	TIN			Photocopy obtained?	DYes	DNo
10.VAT Registration Number		I		Photocopy obtained?	DYes	DNo
11.Driving License Number		============================
				Photocopy obtained?
		1	_		DYes	DNo

12.Customer's Occupation.

Comments (if any)

Comments (if any) on Customer risk by subjective consideration

(Account Opening Officer I Relationship Manager)

Authorized Officer

Signature	Signature
with date	with date
Name	Name
Name Seal	Name Seal

Page No. 10

TERMS AND CONDITION

1.The law, rules, regulations of Bangladesh Bank, customs and procedures applicable to the scheduled bank In Bangladesh shall apply to and govern the conduct of accounts opened with the Bank,

2.Any person opening an account shall be deemed to have been read, understood and accepted the rules governing the account.

3.Each account will be given one account number. This number Is to be property quoted on all letters and lor documents addressed to the Bank and on all deposit slips. The bank will not be responsible for any loss or damage occurring as result of wrong quotation to account number.

4.Interest ICommissions I Service or Maintenance of account charges shall be levied by the Bank from time to time and as per Bangladesh Bank Regulations. Bank shall also have the right to fully recovered all costs and expenses (Including legal fees) arising In any way In connection with the above accounts.These terms and conditions or In enforcing these terms and conditions and In recovering of any amount due to the bank or Incurred by the bank In any legal proceedings of whatever nature.

S.The funds available in any of the account holder's account (the customer) with the Bank will be considered by the bank to be a security for any comrnitmenttsl, and or obligation(s) present and or future of the customer to the Bank, In the event of dishonor or non-fuijillment of such obligation(s) and or commitment(s), the Bank is entitled without giving prior notice to the customer to utilize such funds against the obligation(s) and or commitment(s) of the customer to the Bank.

6.Whilst the Bank maintains strict confidentiality In all relating to accounts and business, Bank shall always be entitled to disclose any Information concerning customers business and accounts held with the bank to any of the following:

a)Any regulatory, supervisory, governmental or quasi governmental authority with the jurisdiction over the bank.

b)Any person to whom the bank Is required or authorized by law or court order to make disclosure.

7.Account holders must provide maximum security to the Cheque Books In their possession and the bank Is not responsible for any. loss occuring due to inadequacy of security, any cheque book loss of misuse must be immediately reported to the Bank with subsequent confirmation in writing without any delay.

8.The Bank reserves the right to close any account without giving prior notice If the conduct of the account is unsatisfactory In the opinion of the Bank or for any other reason(s) whatsoever. The opinion passed by the Bank In the regard shall be final and conclusive and binding upon the customer.

9.The balance In the account(s) is payable solely at Dutch -Bangle Bank Limited and shall be governed by and subject to Laws with effect In Bangladesh. As used herein 'laws' will included Bank Circulars, Modifications, Regulations and Orders of the Government and Bangladesh Bank Including Practies of Banking.

10.The Bank reserves the right to amend the present rules at any time In any manner with or without giving prior notice to the account holder(s) separately or to the public. The cheque book will not be Issued unless and untill all the required formalities are completed.

ACKNOWLEDGEMENT

IIwe hereby acknowledge that I / we have read and understood the terms and conditions stated above and agree to comply with them.

1.1---=---Signature(s)1 of Applicant(s)2·1~:--

l!We have enclosed the following documents with the application form; (Please tick)

DAccount Opening Form: To be filled In and signed by each account holder

Dlatest passport size photograph (2 copies) for each account holder attested by the Introducer

DAccount payee cheque in favour of the Account holder or cash deposit

DCopy of passport I National indentity card I Motor driving license/Office IDlWard Commissioner certificate with PhotoiGazzetted officer certificate with PhotoiOther ID with Photo acceptable to the bank

DIntroduction of account holder (Mandatory): To be signed by Introducer with ID and account number

D1 copy of nominee's photograph (attested by the account holder)

DMinor account additionally require: 1 copy passport size phtoograph

DForeign citizens In Bangladesh additionally require Photocopy of passport with valid visa and work permit

In case of Proprietorship Account:

DAttested copy of valid Trade license

DAttested copy of passport of the proprietor I NationallD Card I Motor driving license

DCompany seal & TIN Certificate

In case of Partnership Account:

DPartnership Letter

DCopy of notarize Partnership Deed certified by all the Partners or Registered Partnership Deed (registered with the register of Joint Stock Companies and firms) dully certified by the Register of Joint Stock Companies and Firms

DPartnership Resolution signed by all the Partners to open account with DBBl Indicating type of account and mode of operation In case of Private I Public Limited Company Account:

DMemorandum and Articles of Association -duly certified by the Register of Joint Stock Companies and Firms

DCertificate of Incorporation - duly certified by the Register of Joint Stock Companies and Rrms

DBoard Resolution - duly certified by the Chairman I Scretary of the Company

DFORM XII and Schedule X - duly certified by the Register of Joint Stock Companies and Firms

DCertificate of Commencement of Business - duly certified by the Register of Joint Stock Companies and Firms (only Incase of Public Limited Company)

In case of Club I Society :

DCertified copy of Registration Certi1icate

DCertified copy of Charter /Bye-Laws and RegUlations I Constitution of the relevant organization

DCopy of Resolution of Managing Committee !Executive Cornmtttee for opening Account ~ DBBl and operation of account - duly certified by the Chairman I Secretary

DList of Members of Managing Committee !Executive Committee - duly certi1ied by the Chairman ISecretary

In case of Non-Govemment School I College! University I Madrasha I Muktab :

DCertified copy of Registration Certificate

DCopy of Resolution of Managing Committee I Governing Body authorizing opening and operation of account with DBBl -duly certified by President ISecretary of management committee

DUst of Members of Managing Committee 19oveming Body-duly certified by a Gazetted Officer

In case of Sector Corporations :

DCertified copy of the relevant Presidential Order IAct of Parliament establishing the Corporation

DResolution of Board of Directors ICompetent Authority to open Account ~ DBBl

DCertified list of Board of Directors (If any)

In case of Local Authomies, City Corporation etc :

DCertified copy of the Statute lany other Law by which the body Is created and governed

DResolution of Municipal Committee I Managing Body (if any) to open Account with DBBl - duly certified by Chairman /Mayor I Competent Authomy

DUst	of Members of such Committee I Body - duly certified by Chairman I Mayor ICompetent Authomy

Please bring all the originals' documents for verification at the time of opening the Account.

Page No. 11

Charges/Renewal Fee	Free of charges.
Options	I want to get DBBL SMS & Alert Banking Password	DYes	o No.
	My mobile number is

Date----------

	Customer	Signature
	For Bank use only
The Customer request is communicated to:
i) Card Division (for DBBL cards) on	vide letter #	.
i) IT Division (for IB & SMS/Alert) on	vide letter #	.

Page No. 12

Authorized Signature