Individual information of Mr. Kazuma Hashimoto

n case of having existing Account in BRAC Bonk Limited: :IF: I I I I I I I I I I . Account Applicanrs Name: Mr./Mrs./Ms: ....................................................................................................... .. WWI/ t I I< 11111 <!l�'i'ITTJ: .....••....•• , , , . , ......................................................................................... , .................. , ............. , .. .... Please attach pholoq1111 ,1, , ,. •11, 2. Relationship with NC: D Director D Signatory D Beneficial Owner D Trustee D others ............................ .... 3. Dote of Birth: I I I I I I I I I Place of Birth: ..................... . ....................................................................... . t Resident Status: D Resident D Non-resident (nstructlons or !he 'Guldelres for Foreign Excll0nge Tronsoct1ons· need to be tOIOWed bv !he Bonk where oppllcoble) 5. Fathers Nome: ................................................................................................................................................................................................................. ,. Mothers Nome: ............................................................................................................................................................ ................................................... 7. Spouse's Nome: ................................................................................................................................................ ...... .. ........................... ........................ 3. Nationality: .......................................................... 9. Occupation (In Details): ....................................................... . .. .. . ................................................ (In case ol foreigners = ol passport wrth vtso mJS1 be obloned) 10. Gender: □ Mole □ Female □ other ................................................................................................................ ...................................................... 11. Notional ID No.: .................................................................................. 12. TIN/e-TIN No.: ................................. .............................................................. Rood/House/A,eo/Block Upozlo/Thono City/OiSfnCf Post CW• Counf!y 13. (a) Present Address: ,_ L-- 13. (bl Permanent Address: 13. (c) Office Address: 13. (d) Preferred Contact Address: 0 (a) D (bl D (c) 14. Phone/ Mobile No.: ............................................................................. E-Mail Address: .................................................................................................. 15. Passport No.: ................................ Issue Dote:J L - -'- 1 _,__,l __. --1.--1.--1.--'I Expiry Date:!._ _._I �I,__,·l__.__.___.,__.___,l tssuing Authority: ........................... 16. Birth Registration Cert i ficate No./ other ID*: .................................................................................................................................................................... • In case of NID Of Passport Is not ovollOble onc:I subject to oppropnote oppiovot. Signature and Seal: Name: Designation: Dote: Signature Of'\d PIN ---------------------- ---------- Account Opened By S1gnmure or1d PII\J Account Approved By Mr. K a z uma H ashimoto ✓ Mr. Kazuma Hashimoto