The original file is kept in the office. This is the text saved from it.
1 page
100%
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. Noboru Ide
(Name has to be filled up according to NID/ other ID document)
Father’s Title:
*Father’s Name:
Suguru Ide
Mother’s Title:
*Mother’s Name:
Motoko Ide
Spouse’s Title:
Spouse’s Name:
NID Number:
ETIN:
7
6*1Date of Birth (DDMMYY):
0
7
0
1
1
9
7
2
*Gender:
✓Male
*District of Birth:
Nagano
*Country of Birth:
Japan
*Permanent Address:
*District:
Fushimi-ku, Kyoto
44-6, Mogamicho
Momoyama
Postal code:
*Country:
Japan
*Present Address:
*District:
Fushimi-ku, Kyoto
44-6, Mogamicho
Momoyama
Postal code:
1212
*Country:
Japan
Other ID:
*ID Type:
Passport
ID number:
MU8299500
ID issue date:
13 September 2018
ID issue country:
Japan
*Sector Type:
Private
*Sector code:
Telephone number:
+81-75-606-1011
√
Date: 27.02.2022 Signature of the Customer
Seal and signature of the Seal and signature of the
Manager authorized officer
'*' indicates mandatory field
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:
Chairman
*Name:
Mr. Yasushi Takeda
(Name has to be filled up according to NID/ other ID document)
Father’s Title:
*Father’s Name:
Mother’s Title:
*Mother’s Name:
Spouse’s Title:
Spouse’s Name:
NID Number:
ETIN:
7
6*1Date of Birth (DDMMYY):
*Gender:
✓Male
*District of Birth:
Nagano
*Country of Birth:
Japan
*Permanent Address:
*District:
Kyoto city,
8 Izumo Matsunoshita-cho
Kita-Ku, Kyoto
Postal code:
*Country:
Japan
*Present Address:
*District:
Kyoto city,
8 Izumo Matsunoshita-cho
Kita-Ku, Kyoto
Postal code:
*Country:
Japan
Other ID:
*ID Type:
Passport
ID number:
ID issue date:
ID issue country:
Japan
*Sector Type:
*Sector code:
Telephone number:
+81-(0)72-621-8187
√
Date: 27.02.2022 Signature of the Customer
Seal and signature of the Seal and signature of the
Manager authorized officer
'*' indicates mandatory field