Are You suprised ? - Islami Bank Bangladesh Limited

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Bmjvgx e¨vsK evsjv‡`k wjwg‡UW Islami Bank Bangladesh Limited ----------------------- kvLv c„ôv bs - 4 GB AskUzKy ¯^vwiZ nIqvi ci ¯‹¨vb Ki‡Z n‡e| Specimen Signature Card of A/C No : ...........…………………………………………………………………… Title of Account : ………………………………………………............……………………………………..……… Full Name of the Signatory 1. 2. 3. Special Instruction (if any) : Specimen Signature Photograph Signature admitted by Authorised Officer/Manager m¤¢ve¨ †jb‡`‡bi AbywgZ gvÎv (Transaction Profile) 01. wnmve wk‡ivbvg (evsjvq) t ...................................................................................................................................................... (Bs‡iRx‡Z) t ...................................................................................................................................................... 02. wnmv‡ei aiY I Znwe‡ji Drm t ......................................................................................................................................... 03. wnmve ev m~Î (Reference) b¤î t ......................................................................................................................................... †jb‡`‡bi weeiY †jb‡`‡bi msL¨v (gvwmK) m‡e©v”P †jb‡`‡bi A¼ (cÖÖwZwU †jb‡`‡bi) †gvU cwigvY (gvwmK) Rgv t bM` Rgv (AbjvBbmn) UªvÝdvi/BÝUªy‡g›U Gi gva¨‡g Rgv d‡ib †iwgU¨vÝ Rgv ißvbx Avq n‡Z Rgv Ab¨vb¨ (wbw`©ófv‡e) †gvU m¤¢ve¨ Rgv D‡Ëvjb t bM` D‡Ëvjb (AbjvBb/ G.wU.Ggmn) UªvÝdvi/BÝUªy‡g›U Gi gva¨‡g D‡Ëvjb ißvbx Avq n‡Z D‡Ëvjb d‡ib †iwgU¨vÝ D‡Ëvjb Ab¨vb¨ (wbw`©ófv‡e) †gvU m¤¢ve¨ D‡Ëvjb 04. †jb‡`bK…Z A‡_©i Drm t ...................................................................................................................................................................... Avwg/Avgiv wbgœ¯^viKvix (MY) G g‡g© wbðqZv cÖ`vb KiwQ †h, m¤¢ve¨ †jb‡`‡bi AbywgZ gvÎv Avgvi/Avgv‡ì cÖwZôv‡bi ¯^vfvweK cÖK…Z †jb‡`b| Avwg/Avgiv Av‡iv wbðqZv cÖ`vb KiwQ †h, cÖ‡qvRb‡ev‡a Avwg/Avgiv m¤¢ve¨ †jb‡`‡bi AbywgZ gvÎv ms‡kvab/nvjbvMv` Kie| ..................................................... ...................................................... MÖvn‡Ki ¯^vi, ZvwiL I mxj (cÖ‡hvR¨ †‡Î) MÖvn‡Ki ¯^vi, ZvwiL I mxj (cÖ‡hvR¨ †‡Î)
ZvwiL t MÖvnK cwiwPwZ m¤úwK©Z dig (KYC Profile Form) c„ôv bs - 5 (e¨w³ I cÖwZôvb Dfq wnmve †Lvjvi †‡Î cÖ‡hvR¨ t e¨vsK KZ…©K c~iYxq) wnmve b¤î t 1. wnmve wk‡ivbvg (evsjvq) t ................................................................................................................................................ (Bs‡iRx‡Z) t ................................................................................................................................................ 2. eëmv‡qi cÖK…wZ Ges Znwe‡ji Drm t ................................................................................................................................... 3. Znwe‡ji Drm wKfv‡e wbwðZ Kiv n‡q‡Q Ges eëmvwqK m¤úK© ¯’vcbK‡í eëmv‡qi cÖK…wZ wek`fv‡e D‡j−L KiZt eëmv‡qi mv‡_ †jb‡`‡bi cwigvY mvgÄm¨c~Y© wKbv Zv eY©bv Ki‡Z n‡e t ......................................................................................................................... ..................................................................................................................................................................................... 4. wnmv‡ei cÖK…Z myweav‡fvMx (Beneficial Owner) m¤úwK©Z Z_¨vw` (†Kv¤úvbxi †‡Î wbqš¿YKvix †kqvi †nvìvi Ges 20% ev Gi AwaK GKK †kqvi †nvìvi Gi we¯—vwiZ Z_¨vw`) : ..................................................................................................................................... ...................................................................................................................................................................................... 5. cÖ‡Z¨K MÖvnK †_‡K wb‡æv³ cÖgvYc‡Îi d‡UvKwc M„nxZ n‡q‡Q wKbv (wUK wPý w`b) t †gvU t ...................... (.................) wU MÖnxZ n‡q‡Q| cvm‡cvU© †fvUvi AvBwW RvZxq cwiPq cÎ U¨v· mb` (TIN) f¨vU †iwRt b¤î WªvBwfs jvB‡mÝ| 6. Awbevmx (Non-resident) Ges we‡`kx‡ì wnmve †Lvjvi KviY m¤ú‡K© wbwðZ nIqv| wfmvi cÖK…wZ [AvevwmK/KvR (Work)] : 7. MÖvnK wK K‡ib/cÖwZôvbwU wK ai‡bi eëmvq wb‡qvwRZ i‡q‡Q µwgK bs cÖK…wZ wi¯‹ †j‡fj †¯‹vi 1 Ry‡qjvix/¯^‡Y©i eëmv D”P 5 2 gvwb †PÄvi/Kzwiqvi mvwf©m G‡R›U D”P 5 3 wi‡qj G‡÷U G‡R›U D”P 5 4 wbg©vY cÖKí †cÖv‡gvUvi D”P 5 5 Ad‡mvi K‡c©v‡ikb D”P 5 6 wPÎKjv/Gw›U‡Ki wWjvi D”P 5 7 †iu‡¯—viv/evi/bvBU K¬ve/AvevwmK †nv‡Uj Gi gvwjK D”P 5 8 Avg`vbx/ißvbx G‡R›U D”P 5 9 bM` A_© jMœxKvix eëmvqx (gv‡m 25 j UvKvi ) D”P 5 10 †kqvi/÷K wWjvi D”P 5 11 Rbkw³ ißvbx eëmv D”P 5 12 wewfbœ Ae¯’v‡b Kvh©µg D”P 5 13 Pjw”PÎ cÖ‡hvRbv/cwi‡ekbv ms¯’v D”P 5 14 A‡¯¿i eëmv D”P 5 15 †gvevBj †dvb Acv‡iUi D”P 5 16 evwl©K 1 †KvwU UvKvi AwaK A_© jMœxKvix eëmvqx D”P 4 17 Uªv‡fj G‡R›U D”P 4 18 cwienb Acv‡iUi ga¨g 3 19 A‡UvwWjvi (wiKwÛkb Mvox) ga¨g 3 20 wjwRs/dvBb¨vÝ †Kv¤úvbx ga¨g 3 21 †dªBU/wkwcs/Kv‡Mv© G‡R›U ga¨g 3 22 BÝy¨‡iÝ/†eªvKv‡iR G‡RÝx ga¨g 3 23 ag©xq cÖwZôvb/ms¯’v ga¨g 3 24 we‡bv`bKvix cÖwZôvb/cvK© ga¨g 3 25 †gvUi cvU©m Gi eëmv ga¨g 3 26 ZvgvK I wmMv‡i‡Ui eëmv ga¨g 3
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