Company Details Form - C - BMI

Employer’s address
(office telephone/fax no)
Number of dependents
Tax status
Please name the banks
with which you transact
Are you an employee
of a broker/dealer
or a financial
institution
Yes No Are you related to an
employee of a broker/
dealer or a financial
institution
Yes
No
If yes, provide the name
of the institution and the
relationship
Are you maintaining any
other private banking
accounts
Yes No If yes, provide the name
of the institutions
Are you a senior officer,
Director or a significant
Shareholder of a public
company
Yes No If yes, please provide
details
Do you hold positions in
the Government agencies/
Parliament/Armed Forces/
related to Royalty
Yes No If yes, provide details
I certify that the above information is accurate and can be relied upon by BMI Bank in determining the suitability of
investments and offering advice for my account.
Date
Signature
Place
Relationship manager
Signature