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Annex - N
CIB ONLINE INQUIRY FORM – 1
Individual’s (Borrower/Co-borrower/Guarantor/Owner) Information
Name of Bank/FI: Prime Bank Limited
FI Code: Branch Code: FI Subject Code:
*Type of Financing:
*Total Requested Amount/Credit Limit:
Installment contract data:
* Number of Installment:
* Installment Amount:
Periodicity of payment:
Role in the Institution:
Chairman
Managing Director
Sponsor Director
Elected Director
Nominated Director (by Govt.)
Nominated Director (by Pvt. Institution)
Shareholder
Partner
Owner of Proprietorship
✓Others
(If the individual is an owner/director/partner of any company then select a role)
Individual Subject Data:
Title:
Manager
*Name:
S.M. KAFEE BIPUL
(Name has to be filled up according to NID/ other ID document)
Father’s Title:
*Father’s Name:
S.M. KAMAL
Mother’s Title:
*Mother’s Name:
SHAMMIKA PARVIN
Spouse’s Title:
2/1/1980
Spouse’s Name:
MRS. NADIA HOSSAIN
NID Number:
-
-
-
-
6
1
2
2
2
0
4
1
3
6
5
0
1
ETIN:
6
4
7
5
1
6
4
3
5
2
8
2
*Date of Birth (DDMMYY):
0
1
0
2
1
9
8
0
*Gender:
✓Male
*District of Birth:
Dhaka
*Country of Birth:
Bangladesh
*Permanent Address:
*District:
Dhaka
House # 245
Free School Street, P.O: Dhanmondi,
P.S: Kalabagan
Postal code:
1209
*Country:
Bangladesh
*Present Address:
*District:
Dhaka
House # 245
Free School Street, P.O: Dhanmondi,
P.S: Kalabagan
Postal code:
1209
*Country:
Bangladesh
Other ID:
*ID Type:
Passport
ID number:
EB0308824
ID issue date:
ID issue country:
Bangladesh
*Sector Type:
Private
*Sector code:
Telephone number:
01712-050522
√
Date: 16.04.2024 Signature of the Customer
Seal and signature of the Seal and signature of the
Manager authorized officer.