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The Hongkong and Shanghai Banking Corporation Limited
Uttara
Personal Information Form: Wholesale Banking
For Bank's use only
Account No:
HSBC
1. Name of Account (in English Block Letters)
2. Name of Individual for whom this form is
applicable (in English Block Letters)
Name of Individual in Bangla:
3. Relationship with Account (put / mark):
Director
Minor Accountholder
6. Father's Name
4. Date of Birth 23rd February 1970
7. Mother's Namne
9. Nationality
Beneficial Owner
Attorney Holder
Yonekatsu |TO
8. Husbands's/Wife's Name Yanti ITO
Chieko ITO
Japanese
10. Gender (put / mark): / Male
11. Residence Status (put / mark)
Branch
(Forelgn nationals must submit a photocopy of their passport and visa)
13. Electronic-Tax ID (E-TIN) No (lf available)
18. Permanent Address
14. Monthly Income (Only for Beneficial Owner)
YOKOGAWA BRIDGE CORP. (DHAKA BRANCH)
17. Present Residential Address
MR. HAYAHITO ITO
/ Signatory
Account Holder
Female Transgender
Resident
(If necessary, bank staff must follow the guidelines for foreign exchange transactions)
12. Occupation (details with designation) Service (Country Manager)
15. Detail of Source of Fund (Only for Beneficial Owner)
b) E-mail:
5. Country of Birth Japan
VNon-resident
16. ldentity No: National |D No Passport No Driving License No Birth Certificate No
TZ1298354
Key Controller
Guardian
19.Contact Details a) Telephone No.: +81-70-2469-4021
Chiba Prefecture, Chiba-City,Sonnou-cho, Inage-ward, 1002-8.
Chiba Prefecture, Chiba-City, Sonnou-cho, Inage-ward, 1002-8.
ha.itoh@yokogawa-bridge.co.jp
Shareholder
Others
Others (Please mention ldentity No below)
lssued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh (November 2020)
Note: Please print this page and submit with the Appendix for adding additional Connected Parties,
Sole Proprietor
applicable.
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