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The Hongkong and Shanghai Banking Corporation Limited
Uttara
For Bank's use only
Personal Information Form: Wholesale Banking
Account No:
1. Name of Account (in English Block Letters)
2. Name of Individual for whom this form is
applicable (in English Block Letters)
HSBC
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 Name
9. Nationality
Yonekatsu ITO
8. Husbands'sWife's Name Yanti |TO
Chieko ITO
Beneficial Owner / Signatory
Attorney Holder
Japanese
10. Gender (put / mark): Male
11. Residence Status (put mark)
Branch
(Foreign nationals must submit a photocopy of their passport and visa)
13. Electronic-Tax ID (E-TIN) No (f available)
YOKOGAWA BRIDGE CORP. (DHAKA BRANCH)
18. Permanent Address
MR. HAYAHITO ITO
(If necessary, bank staff must follow the guidelines for foreign exchange transactions)
14. Monthly Income (Only for Beneficial Owner)
Key Controller
Account Holder Guardian
5. Country of Birth
12. Occupation (details with designation) Service (Country Manager)
17. Present Residential Address
Female Transgender
Resident / Non-resident
15. Detail of Source of Fund (0nly for Beneficial Owner)
16. ldentity No: National ID No Passport No Driving License No Birth Certificate No
TZ1298354
b) E-mail:
Japan
Chiba Prefecture, Chiba-City,Sonnou-cho, Inage-ward, 1002-8.
19. Contact Details a) Telephone No.: +81-70-2469-4021
Chiba Prefecture, Chiba-City,Sonnou-cho, Inage-ward, 1002-8.
ha.itoh@yokogawa-bridge.co.jp
Shareholder
Others
Others (Please mention ldentity No below)
issues by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh (November 2020)
Sole Proprietor
e Note: Please print this page and submit with the Appendix for adding additional Connected Parties, as applicable.
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