Katsumi TAMURA Personal Information

Standard Chartered Account Opening - Annexure: Personal Information © Copyright 2008 – 2020 Standard Chartered Bank. All rights reserved. Annexure_PersonalInformation_Bangladesh_2020_v1 Page 1 of 2 Please complete in BLOCK LETTERS and " ✓ " where applicable. (This form should be filled up & attached with the main part of Non-Individual Account Opening Application Form) Photo Date: INFORMATION RELATED TO INDIVIDUAL 1. Account Title: 2. Name of Individual (in English): Name of Individual (in Bengali): 3. Relationship with the Account (Please tick in relevant box): 1 st Applicant 2 nd Applicant 3 rd Applicant Director Partner Sole Proprietor Minor Guardian Attorney Holder Account Operator / Signatory Trustee Beneficial Owner (BO) Others 4. Father’s name: 5. Mother’s Name: 6. Husband’s / Wife’s Name: 7. Nationality: (For foreign nationals, passport with valid visa / work permit (where applicable) must be mandatorily provided) 8. Resident Status: Resident Non-Resident (Where applicable, Bangladesh Bank’s Guidelines on Foreign Exchange Transactions has to be followed) 9. Date of Birth (dd/mm/yy): 10. Gender: Male Female Third Gender 11. Place of Birth (With country): 12. Occupation & Designation: 13. Identification Document: a) National ID Number: b) Passport Number: Expiry Date: c) Birth Registration Certificate Number: d) Others (has to be mentioned specifically): 14. Electronic-Tax ID (E-TIN): (Any one document must be provided from the list of documents referred in (a) to (c). For non-residents and foreign nationals, copy of the passport with relevant visa must be provided. For minor, Birth Registration Certificate with an additional photo ID of customer/authentication certificate with photo from reputable individuals of the society. These ‘reputable individuals’ are: First Class gazetted officers, City Corporation Mayors, Members of Parliament, Notaries Public and Foreign Embassy high-officials. This Authentication Certificate must contain the photograph (with attestation on top) of the customer/account operator.) 15. Present Address: Upzilla/Thana District Post Code Nearest Landmark Country 16. Permanent Address: Upzilla/Thana District Post Code Nearest Landmark Country 17. Contact: Address: Present Permanent Office Tel: Mobile (1): Mobile (2): Email: Account Opening - Annexure: Personal Information Form © Copyright 2008 – 2020 Standard Chartered Bank. All rights reserved. Annexure_PersonalInformation_Bangladesh_2020_v1 Page 2 of 2 I/We hereby declare that the information provided in this form is true. I/We will provide the information/document(s) to the Bank as and when required. Signature: Signature: Name: Name: Date: Date: Signature: Signature: Name: Name: Date: Date: FOR BANK USE Comments: Account Number: Unique Customer ID No (Relationship No): Name, Seal and Signature of the account opening official Name, Seal and Signature of the approving official (Branch Manager)