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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:
Managing Director
*Name:
Mr. Khondoker Salahuddin Ahmed
(Name has to be filled up according to NID/ other ID document)
Father’s Title:
*Father’s Name:
Khondoker Ziauddin Ahmed
Mother’s Title:
*Mother’s Name:
Mrs. Sufia Ahmed
Spouse’s Title:
Spouse’s Name:
NID Number:
-
-
-
-
2
6
9
6
6
5
4
3
2
3
2
7
0
ETIN:
1
1
2
1
7
2
2
9
8
4
6
8
6*1Date of Birth (DDMMYY):
0
1
0
7
1
9
6
8
*Gender:
✓Male
*District of Birth:
Dhaka
*Country of Birth:
Bangladesh
*Permanent Address:
*District:
Dhaka
House # 21 (6th Floor)
Gaus Nagar, new Eskaton Road
Postal code:
1000
*Country:
Bangladesh
*Present Address:
*District:
Dhaka
House # 21 (6th Floor)
Gaus Nagar, new Eskaton Road
Postal code:
1000
*Country:
Bangladesh
Other ID:
*ID Type:
Passport
ID number:
BL0307924
ID issue date:
13 July 2016
ID issue country:
Bangladesh
*Sector Type:
Private
*Sector code:
Telephone number:
01711538447
√
Date: 27.02.2022 Signature of the Customer
Seal and signature of the Seal and signature of the
Manager authorized officer