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 PLC.
FI Code: 054 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:
*Name:
(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:
*Date of Birth (DDMMYY):
*Gender:
Male/Female
*District of Birth:
*Country of Birth:
*Permanent Address:
*District:
*Street name & number:
Postal code:
*Country:
*Present Address:
*District:
*Street name & number:
Postal code:
*Country:
Other ID:
*ID Type:
Passport/Driving License/Birth Registration
ID number:
ID issue date:
ID issue country:
*Sector Type:
Public/Private
*Sector code:
Telephone number:
Date: Signature of the Customer
Seal and signature of the Seal and signature of the
Manager authorized officer
'*' indicates mandatory field