BRAC BANK
InstitutionalAccount Opening Form
Please complete all details in CAPITAL letter and strike outX the fields/ bOxes which are notapplicable.
Manager
Dear Sit,
1. AccOunt Title:
4. Mode of Operation:
5. Initial Deposit:
/we are appiyng to open an account in your branch, I/we have provided the detailed information of My/Our Institution and ACCOunt in the following.
2. Type of Account: Savings Current SND FC D ERQ NITA Others (please specify):
3. Currency: Taka
1. Organization Name:
6. Purpose of Account Opening:
2. Trade License Number:.
3. Registration Number..
a. Registered Address:
Branch
Registration Authority and Country...
4. Communication:
b. Business/Office Adddress:
(a) Address
c. Factory/industry Address:
(d) E-nail Address
6. TIN/e-TIN NO.
Singly
a
(C) Mobile No.: (1 Preferred No.)
5. VAT Registration Number/BIN:
USD
ure ond Pil
7. Type of Concern: Joint Venture
Account Opened By
b
9. Nature of Business (In details):
Euro
Jointly
8. Iype of Business: O Trading O Service
Educational Institution
In Words:.
Account Number
Section 1: Account Related Information
Pound
Anyone
Date:
CIF:
Others.
As Per Board Resolution Others.
Section 2: Organization Related Information
(b) Telephone No. : () ..
Private Ltd. Public Limited Trust
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Cash Cheque Others.
Issuing Authority:
Date:
(2 Optional No.)....
Date:
NGO/NPO
Religious Establishment Others (please specity):
(2)
Www.bracbank.com
Club/Society
10, Annual Turnover:
Account Approved By
Manufacturing O Others (please specity)
Incase of having existingAccount in BRAC Bank Limited:
CIF:
1. AccOunt Aprolicant's Name: Mr./Mrs./Ms:
2. Relationship with A/C: O Director O Signatory BeneficialOwner O Trustee Others
3. Date of Birth:
4. Resident Status:Resident
5. Fathets Nanme:
6. Mother's Name:
(Instructions of the Guidelines for Foreign Exchange Transactions' need to be followed by the Bank where applicable)
7. Spouse's Name:
8. Nationality:
(In case of foreigners copy of passport with visa must be obtained)
11. National ID No.:
10. Gender: Male Female Other
13. (a) Present Address:
13. (b) Permanent Address:
13. (c) Ofice Address:
14. Phone/ Mobile No.
15. Passport No.:
Place of Birth:..
Non-resident
13. (d) Preferred Contact Addess: (a) (b) Dc)
Signature and Seal:
Name:
Section 3: Individual Information
16. Birth Registration Certificate No./ Other ID*:
Designation:
Date:
nature and PIN
Account Opened By
* in case of NID or Passport is not avgilable and subject to appropriate approval.
Road/House/Area/Block
Issue Date:
9. Occupation (In Details):
12. TIN/e-TIN No.:
Upazila/ Thang
E-Mail Address:
Expiry Date:
2 of 9
City/District Post Code
www.bracbank.com
Please attach photograph here
Division
Issuing Authority:
Country
Account Approved By
Accountholder's Declaration:
/We confirm that / we have understood and agreed with all the following points:
1. /We hereby declare that the information /we have provided in the acCOunt oDening form are all coect. IWe shall provide any futher intormation
if needed.
2. \/We have prOVided all the required documents to open the occount ond the information in those docCuments are correct to fhe best of my/our
knowledge.
3. We hereby also acknowledge that |/we have read, understood and agreed to the Terns &Conditions governing customer aCCOunt(s) as indicated
in the Annexure-A of this Account Opening Form.
Signature and Seal
4. Ihereby consent for BRAC Bank Limited to treat myaccount as per the directions of FATCA. BRAC Bank Limited or any ofits affiliates (including
branches) can share my/our entity information with domestic or oversees or tax authorities where necessary to establish my tax liability in any
jurisdiction (if required). Where reguired bydomestic or overseas or tax authorities, Bank may withhold from my account(s) such amounts as may be
required according to applicable laws, regulations and directive. Iundertake to notify BRAC Bank Limited within 30 calendar days if there is a change
in any information which Ihave provided tothe Bank.
Name:
Designation:
Date:
Account Title:
Signing Authority &Acceptance of Terms &Conditions
Signature and Seal
FATCA status of above mentioned entity:
Name:
Designation:
Is the Country of Formation/Incorporation/Registration in United States?
Date:
Is any of Registration/Business/Office/Communication address in United States?
Yes, provide details and share W9 form
Is Owner/Signatory/Director/Beneficial Owner (BO) a U.S. person?
Signature and Seal
Indicia of U.S. Status
Name:
Designation:
Date:
Assessment of Customer's FATCA Classification: Entity
Account Opened By
Is anyof the Owner/Signatory/Director/BO US citizen or Green Card holder or resident of the US?
If any of the above questions are answered
Is anyof the Owner/Signatory/Director/BO has a U.S. address or U.S. phone number or U.S. e-mail address?
Does the entity receive payments sourced from U.S.? That is interest, Dividend, Rent,
Payment for services and any other Fixed Determinable,Annual, Periodical (FDAP] income.
Signature and Seal
Name:
Designation:
Date:
Signature and Seal
Name:
Type of Organization:
Designation:
Date:
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Signature and Seal
Name:
Designation:
Date:
Signature and Seal
Name:
Name:
Designation:
Date:
www.bracbank.com
Status (Check "")
Yes
Yes
Yes
Yes
we hereby confim the infomation provided above is true, accurote and complete. In any event if this statement is identified as false, I/we hereby consent
for BRAC Bank Limited to treat my account as per the directions of FATCA.
Yes
Yes
Signature and Seal
Designation:
Date:
No
No
No
No
No
No D
Account Approved By
BRAC BANK
AccOunt Name (BLOCK LETTERS)
A/C Nunmber
D Singly D Jointly
Authorised Signature
Either or Survivor
Signing Authority
CIF
As Per Resolution D Other
4 of 9
Date
SOL ID
Verified &Approved
Annexure - A
1. GOVERNING LAW PEGULATONS AND RULES: These tens ond con¡tions shal appy to such occounts
dscreton commerce anye3o ochon o proceedngs arsng out of mne Tems on any omer cout mibuna or ofher aopropnote forum and the user hereby consents to hat jurisdichon.
2. ACCEPANCE OF RULES: Any Deson'slcoenng and account shol be deemed to have reod. understood and accepted the terns and conditions herein govening the account.
Terms & Conditions:
deolings
3. NFORMATnON ABOUT CUsTOMER: 1She Bonks DoiCy m¡ t wi ofer ngh qu¡ty servces to Customes but not to those who are engaged in iega o ofher analogous actvhies that ore hamtu to the wetare of
mececoe ot me county reretore necesory tor me Sonk to cbtan nfomaton about ts customers that ore rue and comect he customer agrees to provide the Bark such infomaion. paicuios ond
ocuments a3 he ank ma egure tom tmeto tmenconnechon wtn hecustomer s fngncia condtion. backgound and dealngs with bonks and business he customer contims that alintomation potcular
anddocument tha ne cusomer provoedore mue conect and compete and hat mere s any change to he ntomation povded, he customer wil mmedictey inform the Bank in wating The customer
ahorzes me Bork to coton ony ntomaton m¡t he Bonk conscers necessory to ofmer bonks organzotons ond souces mat provde intomaton relatve to the customer's financial condmons his the BonkS
Doicy to mantonconfoentoty of customer ntomoton. Howeve me iaw and reguatons in Bnglodesh may require disclosure oft customer infomaton to Government orgonization and/or regulatory organizaion
such as me Bongoses Bank, ony person to whom me bank s regured or authorzed or authorzed by law or court order to make such dsciosure. to any bank or financial instution with which the custome has
ings reggdess of wremenerecpentneoch casesiocated in Bongiodesh o in another county, and regarddess of whether such infonation wil, following dscosure, be held, proceeds, used or disclosed
by such recoent n 3ongoces or anome county The Bank may aso conscer shang customer intomation wih other organizations in any way that t considers sutabie in order to improve banking services. he
cusomer aunorzeshe onk to dsciose or share ntonaton at he sole dscreton of the bonk and indemnifes the Bank tom any accidental disclosure of intorrnation duing the process of printing. transpotation
and fing of infomation
4. FEES: The Bonk shal De entted wihout notce to ley or impose al customary banking and ofther charges and expenses (ncluding collection fees and legal expenses) as per bank's schedule of chages in respect
of any account or in respect of any oher bankng tocites provided to he customer by the Bank and to debit the relevant accounts) in accordance with the bank's nomal banking prOcedure. Such charges dre
not retundobie upon temination of anyo all of a customer's accounts) Bank reserves the right to charge the schedule of charges from time to time without prior notice.
collection
5. CREDITS TO THE ACCOUNT: The Bonk octs ony as the cOlecting ooent and assumes no responsibility for the realizgtion of any Itens deposited with the Bank for collection. IhUS, proceeds of Cheques or other
instrumernts deoosted gre not avalable tor withdrgwal until colected by the Bank The Bank reserves the right to debit any occount that may have been inodvertently credted with an subsegquenty unpaid on
www.bracbank.com
be immedatey reported to the Bank and confmed in writing without any delgy.
6. ISSUE AND SAFETY OF CHEQUES: Cheaues willony be ssued to the customer when alldocumentotion considered necessary by the Bank has been obtained subject to such fees as May be stipulated by BRAC
Bank Lmted from tme to tme t is the responsibity of the occount holder(s) to ensue that cheques in their possession are kept in a secured place. The customer must at all imes exerCise due core To proreCT
cheques povment orOers o othe orders or nstrurment from coming into the pOSsession of unguthorized persons and to prevent ony cheques, orders or other instruments or instruction from being ahered or torged
inamanner which may tocitate ttaud. in such events. the Bank is not responsible tor any loss suftered bythe customer or any other person. Any loss or misuse of cheques. payment orders or other instrument must
7. CHANGEOF TERMS AND CONDTIONS: The Bank shal have the absolute discretion to odd/ amend/supDlermentl delete the present tems and conditions at any time relating to the Account and/or he services
Dovded foin connecton wth the same The Bank may give notice of such change where itconsiders aporopriate on the Website or to the account holder(s] by ordinary mail. However, the customer shal be
responsible for regularty revewing these terms and conditions including amendments thereto on the Website or by checking their mail.
8. NOTICE: Notces n respectof the Account, the servces and facilities provided in connection with/ for the Account may be given by BRAC Bank Limited either through email or posting a lefter to the Customers
oddress BRAC Bonk Lmted mayaiso give any notice by posting the notice on the Website and the same willbe deemed to have been received by the Customer upon its publication on the Website. All notices in
Connection witth the Services or the ACcount by the Customer to BRAC Bank Limited shall be in writing and sent to the oddress as provided below ond all notices shall be deemed to be received by BiAC Bank Limed
ony upon ocknowedgmentof recept of the same in writing by BRAC Bank Limited. BRAC Bonk Limited, Anik Towe, 220/B, Tegaon A, Tejgoon-Gulshan Link Road,Dhaka-1208, Bangladesh.
9. CLOSURE OF ACcOUNTS: The Bank reserves the right to close any account o related services without aiving pior nohce if the conduct of the account is unsatisfactory in the opinion of the Bank or for any offher
reason(s) whatsoever. The bonk shall pay to the customer allavailable and finaly collected balance ofter ol dues to the Bank have been recovered/ realized at the time of the closure of the accounts.
10. MINIMUM BALANCEAND INTEREST PAYMENT: The minimum veroge monthly balance as prescribed by the Bank from time to time is required to be maintained in Current, Savings ond other gccounts. The Bank
reserves the right to change the minimum balance requirement. If the balance fals below the reguired minimum for a period, the Bank may not credit any interest for thot period.
11. PERIODIC STATEMENTS AND ADVCES: The customer may be provided with accOunt statement on monthly, half yeory or yearty basis. The customer is required to promptty notify the Bank of the failure to receive
an expected statement or advice. If the acCOunt holder does not bring the erors, discrepancies or iegulartes to the notice of the Bank in witing within Fifteen (15) calendar days after the mailing of statement/
advice, t wllbe construed that the transoction shown on the account statement/ odice are corect and complete.
12. DEPOSTS, WITHDRAWALS AND BANKING FACILITIES: The Bank shall meet its obligations exclusively at the branch ofice where the customer maintains the account. When oppropriate telecommunication is
possible. deposts or withdrawals of money may be made at any of the Bank's branches in Banglodesh subject to the terms and conditions of the bank. The customer shalilensure that there are sufficient funds (or
pre- amanged credts) for the Bank to honor cheques presented to the Bank or for debits to the account in occordance with instructions made by the custorner for his/ her account, provided always trhat the Bank
may. at its, sole disCretion cary out the i ct ction r n notwithstanding such ingdequocy and may do so wíthout seeking pior approval from or notice to the customer and the customer shal be responsible to repay the
resuiting overdraft, advance or credit thereby for all related charge
13. SUSPICIoUS TRANSACTIONS: The Bank may refuse to process any transaction on any occount of the customer it the Bank suspects fraud or ilegality herein. The decision of the Bank with regard to whether the
transaction is or is ikely to be invoved in fraud or illegality or irregularity shall be final and concluSive and binding on the customer.
14. INSTRUMENTS DEPOSITED: The Bonk shall not accept stale or post- dated instrument for deposit. The Bank may refuse to accept on instrument payable to 'Cash if the instrument is not payatble to "Bearer". The
Bank willretuse to occept an instrurment for deposit if the payee's nome is not identical to the name of the customer in the Bank's record.
15. ORDER TO STOP PAYMENT OR AMEND INSTRUCTION: A customer may place a stop payment order for a cheque in writing. The Bank wil not make the payment if it has reasonable opportunity to act on such order.
16. GUARANTOR'S LABILITY: In case of detault of any loan with the bank the bank shall preserve the ight to deduct the outstaonding amount fron the account of such accountholder/ customer, who is the guarontor
in the paticular loan with the bank.
12. SERVICE DISRUPTION: The customer ogrees that the Bank will not be liatble for any loss or any damage if it is unable to provide services in connection with any customer accounts due to postal, courier, electrical.
mechancal. telecommunications, or computer failure or an act of God. catastrophe, war, cMl or industhal dsturtbance.
18. NO LIABILITY FOR LOSS The customer agrees that the Bank willnot be liable for any loss, damage or liablity incurred by the customer in connection with any of its accounts with or services provided or agreed to
be provded by the Bank of ingcton on part of the Bank or any of ts officers. ogents, employees and epresentatives. The customer agrees not to hold the Bankliable for any loss or domage arising from: (A)
non-discovery of any forgeies or frauds, except to the extent that the Bank has acted with gross negligence. (B) the Bank closing the customer account for whatever reason whatsoever. (C) directy or indirecty. the
eror, failure, negligence, act or omission or any other person, system., institution or payment inftastructure.
19. INDEMNITY: The custormer shallkeeo trhe Bank indemnified at al time against all loss, costs, damages, expenses (including legal fees). claims or demands orising in any way in connection with the customer's
occounts or, inentorcing hese terms and condi'ons and in recovering of any amount due to the Bank or incured by the Bank in many legal proceedings of whatever nature.
20. WAVER: NO forbeargnce nealigence or waver by the Bank in enforcement of any to these tems and conditions shllprejudice the Bank's right to enforce the same thereafter. No waiver by the Bank shall be
eftectve unless t is in wrtng and duy signed by the authorized signatories of the Bank.
21. FORCE MAJEURE: Banks obligations contained herein wil be subject to any occumence resuiting in prevention from or delay or interuption in performing ts obligations if such prevention, delay or interuption is
due to Force Maeure event. lwhich would include anyevent beyond the reasonoble controlof BRAC Bank Limited, including, without limitation., unavailatbility of any communication system, sabotage, fire, flood.
exploson, octs of God, Cvil commotion, strikes or industrial action of any kind, i d. riots, insurection, war or acts of government, changes in legislation and other allied acts of regulatory naturelthen BRAC Bonk Limited
shal not be deermed to be in detault so long as any such cause or the effect thereof persists (provided that this shallnot prevent the a
22. DEATH OR INCOMPETENCE: The Customer ogrees to notity BRAC Bank Limited promptly if any of the joint Account holders or authoized signatory of the Account dies or is declared incompetent by a court. BRAC
Bank Limted mayoloce afreeze on the Account and stop alloperations when any of the joint Account Holders or authorized signatories dies or is declared incompetent. BRAC Bank Limited may retain the freeze
on the Account unti it establishes the identy and credentials of the successor/beneficiary to its satisfaction.
23. VARIATIONS: The Bank reseves the night to alter or armend these terms and conditions at any time by giving nof less than Fourteen (14) days notice to the customer spacing the eftective date of amendment. I
the custorner uses any Bankingtociny after the etectve date of the amendment, the customer shallbe deemed to have received notice of the amendment and to have consent to such amendment and decided
to continue to use the Banking facilities upon the revised terms and conditions. The customer further acknowledges that in the event of any changes being communicated to him/ her, the bank is not obliged to
obtain the custorner's signature for receipt of such conmunication.
24. ACCEPTANCE OF TERMS AND CONDITIONS: We have signed the applicotion fom as a token of acceptance of the atoresaid tens and conditions
Account Opened B
Signing Authority &Acceptance of Terms &Conditions:
We hereby gcknowedoe that lwe have read, understood and agreed to the Terms &Conditions related to account(s) and shall compy with the aforementioned terms and conditions. I/we hereby conscious
declare that the intormation that l/we have provided in the account form to open the account are all corect. In addition to the inforrmation furnished herewith in the account opening form, we shall provide any
further relevont and necessary intormation/ documents as may be required by the bank as and when requlred
5 of 9 Account ApprOved By
ts and services as offered by the Bank to its customers, existing or new, from time to time. The terms and
oTosheren shal be govemed by the iaws rules and regulonons of he Centra Bank of Banglodesh, Government of Banglodesh and the Bank's policies ond practices. BRAC Bank Limited may in its absolute
tthe accrual of interest on any outstanding amount which would have been payable
Dut for this provision) ang durngcreasonable perod thereafter within which any such obligotions are not capable of being fulfilled. BRAC Bank Limited shall not be liable for any action or claim, from any party, arising
out of its ingbility to pertorn the obligations for the reasons stated herein.
Account Title
Account Number
Estimated Monthly Turnover
DEPOSITS:
Cash (Including Online & CDM)
Transfer/hrough Instruments
Foreign Inward Remittance
Eonings from Export
Deposit/Transfer from BO (Capital Market) Account
Others (Please specity)
Total Probable Deposit
WITHDRAWALS:
Descriptions
Cash (Including Online & ATM)
Transfer/Through Instruments
Foreign Outward Remittance
Payments Against Import
Deposit/Transfer to BO (Capital Market) Account
Others (Please specify)
Total Probable WitthdraWal
Descriptions
Board Resolution
Documents Required
Anyother accOunt with BRACBank: Yes| No If yes, accOunt nunmber:
Mernorandun & Articies of Association
Cetficate of Registration/incorporation/Commencement
Constution/By Laws/Partnership Agreenent
Signature:
Photo ID and Photograph of All Signatories
Narme and Seal:
No
Designation:
Date.
AccOunt Opening Officer
PIN NO.
Customer Acquisition Channel:Relationship Manager Branch Staff CampaignSales Sales ReferalWalk in Others.
Cheque Book: Yes
Business
Name and Seal:
Designa1on:
For Bank Use Only
Transaction Profile
Date.
PIN NO.
Source of Funds:
No. of Estimated
Monthly Deposit(s)
D Yes
Yes
O Yes
D Yes
Account Approving Officer
Signature:
No. of Estimated
Monthily Withdrawal(S)
Submission
D Yes O No
O No
O No
ONo
Documents Required
|Signature Card
Account Type:
|Photocopy of up-to-date Trade License
|Photocopy of TIN certificate
Signature:
Cheque Book requisition slip
Others:
Estimated Total Amount
of Monthly Deposits)
Estimated Total Amount
of Monthly Withdrawal(s)
|Designation
Date.
|Name and Seal:
|PIN NO.
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Data Entry Officer
Operations
Estimated Maxirmum Deposit
Amount at a Time
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Estimated Maimum
Withdrawal Amount at a Time
Date.
Rate of Interest (p.a.):
Signature
PIN NO
Name and Seal:
Designation:
Submission
D Yes
O Yes
O Yes
Data Verifying Officer
D Yes
O Yes
O No
O No
ONo
DNo
O No
D No
DBRAC BANK
Know Your Customer (KYC) - Institutional
Name of Account Opening Officer:
1. Account Title:
2. Type of Account:
3. Nature of Entity (Details):
4. Net Worth of the Entity:
5. Source(s) of Fund (Details)
6. Documents that Have been
Obtaineed to Ascertain
Source(s) of Fund:
Have the obtained documents been verified?
7. How has/have the Address(es) of the
Entity been Verified? (Details):
Document Copy of the Institution:
8. Whether the Beneficial Owner(s] of the AccOunt has/have been identified?:
9. Electronic-Tax ID (E-TIN) No.:
10. VAT Registration No.:
11. Entity Registratiorn No.:
12. Other Documents:
13. PurpOse of opening accOunt by
foreign cornpanylentity, (If applicable):
Ifves, infomation about each of the beneficial owners of the account must be collected in individual information form:
(the information ofcontrolling shaeholders and shareholders holding 10% or more shares of the company are to be obtained and preserved in individual infommation form and KYC to be completed.)
(a) Narme of the Concerned
Regulatory Authority
(b) infornation Regarding Perrnission:
Yes
if yes, please provide the following details:
Account Number
(a) Has approval been taken frorn the senior nanagement?:
(b) Has a face to face interview of the client been taken?:
No
If yes, steps taken in this regard
CIF:
Yes
7 of 9
O YES
YES
Branch Name:
YES
No
14 Is/Are ony Politically Exposed Person (PEP)/Influential Person (|P)/chief or senior officials of an international organization and their famiy members or close
associates is/are invOved with the clien? (as per the definition in the circular issued by BFIU)? (If applicable:
YES
Copy Obtained
NO
ONO
NO
www.bracbank.com
Verified
D NO
If Applicable
If Applicable
15. While screening, in liaht of rclevant acts, rules, and circulars, whother the customer's nme matched with the suspected indviduals or entities as
listed under various resolutions of the Urnited Nations Securily Council for tenorist activiies, financing of tenorismand financing the proliferation of
weapons of rnass destruction and banned list of individuals Or entiies by the goverDment of the People's Republic of Bangladeshn?:
If Applicable
If Applicable
Risk Related to Client's Business
SI.
2
3
5
7
14
15
16
17
18
19
20
No.
3
5
S
2
Jewelry/Gold Trade/Costiy Metal Trade/Gems Trade
No.
No.
3
Money Changer/Couner Service/Mobile Banking Agent
Real Estate Developer/Agent
SI
Promoter of Construction Projects/Contractor
Art and or Antique Dealer
2
No.
3
Restaurant/Bar/Night Club/Residential Hote/Parlor Business
Import/Export and Import/Export Agent
Manpower Export Business
21 Business (Petrol Pump/CNG Station)
22 Ship Breaking Business
b
Fire Amms Dealer
23 Bankleasing/Finance Company
24 Business (Indenting)
Gaments BusinessGaments Accessories/Packaging/Buying House
25 Business (OutsOurcing)
Share/StoCk Dealer, Broker, Porttolio Manager, Merchant Banker
Software Business and Infonation Technology (I)
Offshore/Non-resident Coporation
NGONPO
26 Law Fin/Engineeing Fim/Consultancy Fim
Risk Assessment Form for the Client:
Movie/Cinemna Produce/Distributor
Mobile Phone Operator/ntemet or Cable TV Operator
Broker dealing with buying and seling of Land or house (lnstitutional)
2 Curent Account
Insurance/Brokerage Agency
Religious Instutio/Organization and Educational Institution
Trust
4 Deposit Scheme (Up to BDT 12 Lac)
Category
Savings Account
FDR
FC AccOunt
Deposit Scheme (More Than BDT12 Lac)
SND ACCOunt
Product Service and Channel Risk
By the Branch Manager/ Relationship Manager
By Sales Representetive
Walk In
Internet/Non-Face to Face
Type of On Boarding
Non Residence Risk: Client
Resident Bangladeshi
Non Resident Bangladeshi
Geographical Risk
Foreign Citizen/nstitution
Yes
For Foreign Citizens/linstitutions:
No
Place of Birth/Residence based Risk Categorization:
Does the client be a Registration/Origination of a counly which fals
under the FATF list of "Jurisdiction Under Increased Monitoring' and
"High Risk Juriscdictions Subject to aCall for Action" or, does the clinet
falls under the UN or any other Sanctioned List.
Risk
Score
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
4
Score
1
4
3
3
5
3
Score
2
3
5
3
Score
2
3
5
SI.
No.
27
28
29
30
31
33
34
35
3
32 | Freight/Shipping/Cargo Agent/C&F Agent
37
38
39
40
41
42
43
44
45
46
47
48
49
SI.
No.
2
SI.
No
2
3
4
SI.
Fuel and Electicity Generation Company
Print/Electronic Media
No.
Trvel Agent/Tourisrn Company
8 of 9
Merchant, investing more than BDT 1O Million
Chain Store/Shopping Mall
Auto Dealer (Brand New/ Reconditioned)
Business (Leather & Leather Products)
Construction Material Business
Business - Agent
Yarn/Gament Waste Business
Transport Operator
Cold Storage
50 Manufacturers (Other thanAms)
Business (Manufacturing and Marketing of Pharnaceuticals)
Business (Acvertisement)
51 Others (Please specify details) Score:1-5
Servce Provider
Category
Tobacco and Cigarette Business
AmuSement Park/Entertainment Organization
Motor Parts Trader/ Workshop
Poutry/Dairy/ FishingFan
Agro Business/Rice MillBusiness/Beveage
Small Business (lnvestment is less than BDT 50 Lac)
Computer/Mobile Phone Dealer
Yes
No
As per BFIU Circula, any Director, Beneficial Owner is a PEPs/ IPs/
Country Chief or Higher Official of any Intemational Organization.
No
As per BFIU Circular, is any Director, Beneficial Owner is a famiy
member or Close Associates of a PEPS/ IPs/ Country Chief or Higher
Official of any Intemational Organization.
Under BDT 10 Lac
Relationship Risk
Transaction Related Risk
From BDT 10Lac to BDT 50 Lac
From BDI 50 Lacto 5 Crore
More than BDT 5 Crore
Yes
2 No
(Yearty Average Transaction of the Client)
www.bracbank.Com
Did the client pIOvide authentic sOurce of Fund?
Transparency Risk
Risk
Score
4
4
4
4
3
3
3
3
3
3
3
3
3
3
2
2
Score
5
5
Score
Score
5
Comment:
Prepared (Account Opening Otficer/
Relationship Manager) by:
Signature:
(with sea)
Name:
Date:
Seal:
(*Even if the risk rating isless han 15, taking the high risk of the beneflcial owner into consideration, and stating the reason, a custorner may be categorized as a high risk
Customer based on subjective judgment)
Reviewed & Updated by:
Signature:
(with seal)
Sum of Risk Score
Name:
>=]5
<15
Date:
Risk Rating
Slgnature:
(with seal)
Name:
Signature of the approving high official for PEP/ IP/ Higher Official of International Organization
Overall Risk Rating
Date:
Reviewed &Conflrmed (Branch Anti Money Laundering
Compliance Offlcer) by:
High
Date:
Low
9 of 9
www.bracbank.com
BRAC BANK
Account Number:
Account Title:
Type of Organization:
FATCAstatus of above mentioned Entity:
Is the Country of Formation/Incorporation /Registration United States?
Is any of Registration/Business/Office/Communication address is in United States?
Assessment of Customer's FATCA Classification: Entity
Is Owner/Signatory/Director/Beneficial Owner (BO) a U.S. person?
Indicla of U.S. Status
Is any of the Owner/Signatory/Director/BO US citizen or Green Card holder or resident of the US?
Is any of the Owner/Signatory/ Director/BO has a U.S. address or U.S. phone number or U.S. e-mail
address?
Does the entity receive payments sourced from U.S.? That is Interest, Dividend, Rent, Payment for
services and any other Fixed Determinable, Annual, Periodical [FDAP] income.
If any of above questions are answered
Yes, provide details and share W9 form
Authorize Signature
Signature :
(with seal)
Name:
Date
Authorize Signature
Signature
(with seal)
www.bracbank.com
Name:
Date
Where required by domestic or overseas regulators or tax authorities, /we consent and agree that the Bank may withhold from my account(s)
Such amounts as may be required according to applicable laws, regulations and directive.
Check "
Yes
Signature :
(with seal)
Name
Yes
/we herebyconfirm the information provided above is true, accurate and complete. In any event if this statement is identified as false, I/we hereby
consent for BRAC Bank Limited to treat my account as per the directions of FATCA.
Date
I/we hereby consent for BRAC Bank Limited or any of its affiliates (including branches) to share my/our entity information with domestic or overseas
regulators or tax authorities where necessary to establish my tax liability in any jurisdiction (if required).
Yes
Status
Yes
I/we undertake to notify BRAC Bank Limited within 30 calendar days if there is a change in any information which l/we have provided to the Bank.
Yes No
Yes
No
No
Authorize Signature
No
No
No
YBRAC BANK Foreign Account Tax Compllance Act (Fatca) Form
Account Number:
Relation with the account: Owner/proprietor/signatory/Director/Beneficial Owner/Mandate/others:
Name
Country of Residence
Country of Birth
1
2
3
4
5
6
7
Are you a U.S. Resident?
Are you a U.S. Citizen?
Indicla of U.S. Status
Do you hold a U.S. Permanent Resident Card (Green Card)?
Name:
Do you have aU.S. address (including P.O. Box) or U.S. phone number or U.S. e-mail address?
Have yougranted Power of Attorney to someone who hasa U.S. address or U.S. phone number or
U.S. e-mail address?
Doyou receive payments sourced from USA? That is Interest, Dividend, Rent, Payment for senvices
(salaries) and any other Fixed Determinable Annual Periodical [FDAP] income.
Are you Citizen/National of any other country except U.S. and Bangladesh?
If yes, please mention:
www.bracbank.com
* Supplement to Account Opening Form
Check ""
Yes
Signature:
Yes
Date
Yes
Yes
Yes
Status
Yes
No
No
No
No
Ihereby confirm the information provided above is true, accurate and complete. In any event if this statement is identified as false.
Ihereby consent for BRAC Bank Limited to treat my account as per the directions of FATCA.
No
Ihereby consent for BRAC Bank Limited or any of itS affiliates (including branches) to share my/ ourentity information with domestic
or overseas regulators or tax authorities where necessary to cstablish my tax liability in any jurisdiction (if required).
No D
Where required by domestic or oversecas regulators or tax authoritieSs, Iconsent and agree that the Bank may withhold from my
account(s) such amounts as may be required according to applicable laws, regulations and directive.
Yes No
Iundertake to notify BRAC Bank Limited within 30 calendar days if there is a change in any information which | have provided to the Bank.
n case of having existing Account in BRAC Bank Limited:
CIF:
1. Account Applicant's Name: M./Mrs./Ms
2. Relationship with AC: Director Signatory Beneficial Owner Trustee Othes
3. Date of Birth:
1. Resident Status:Resident
5. Father's Name:
5. Mother's Name:
(Instructions of the Guidelines for Forelgn Exchange Ironsactions' nced to be folowed by the Bank where applicatble)
7. Spouse's Name:
3. Nationality:
(In case of foreioners Copy of pasport with visa must be obtained)
11. Notional ID No.:
10. Gender: OMale DFemale Dother
13. (a) Present Address:
13. (b) Permanent Address:
13. (c) Office Address:
14. Phone/ Mobile No.:
15. Passport No.
Place of Birth:.
Non-resident
13. (d) Prefered Contact Address: (a) D (b) (c)
Signature and Seal:
Name:
16. Birth Registration Certificate No/ Other ID*:
Designation:
Section, 3:Individual Information
Date:
Sianature and PIN
Account Opened By
* in case of NID o Passpot is not gvailable and subiect to appropriate approval.
ROgd/HOuse/Area/Block
Issue Date:
9. Occupation (In Detals):
12. TIN/e-TIN No.:
Upazila/Thang
E-Mail Address:
Expiry Date:
2 of9
City/Distict POst Code
Please attach photogroph ho:
Divisior
Issuing Authority:
Country
ondPINN
Account Approved By