The Hongkong and Shanghai Banking Corporation Limited

w` nsKs GÛ mvsnvB e¨vswKs K‡cv©‡ikb wjwg‡UW

Branch kvLv

CUSTOMER INFORMATION FORM (KYC PROFILE FORM)

MÖvnK cwiwPwZ m¤úwK©Z dig
(Applicable for Personal Account Opening)
(e¨w³K wnmve †Lvjvi †ÿ‡Î e¨envh©)

(For Bank’s use only) (e¨vs‡Ki e¨env‡ii Rb¨)

Account Number wnmve b¤^i

Unique Customer I.D. Code BDwbK Kv÷gvi AvBwW †KvW

1. Name of Account wnmv‡ei bvg

2. Type of Account wnmv‡ei cÖK…wZ

3. Customer’s Profession (mention in details) MÖvn‡Ki †ckv (we¯ÍvwiZ)

4. Customer’s Approximate Monthly Income (in BDT equivalent) MÖvn‡Ki gvwmK m¤¢ve¨ Avq (mgcwigvb UvKvq)

5. Source(s) of Initial and Ongoing Fund/Regular Income (mention in details) A‡_©i/Av‡qi Drm/Drmmg~n (we¯ÍvwiZ)

6. Documents collected to verify the sources of fund A‡_©i Drm wbwðZ Kivi †¶‡Î †hme `wjjvw` msMÖn Kiv n‡q‡Q
(a)
(b)
(c)
Whether the aforementioned documents have been verified msM„nxZ `wjjvw` hvPvB Kiv n‡q‡Q wK bv

 Yes nu¨v  No bv

7. How the Accountholder’s address has been verified (mention in details) wnmveavixi wVKvbv (mg~n) wKfv‡e hvPvB Kiv n‡q‡Q (we¯ÍvwiZ)

8. Whether the account’s Ultimate Beneficial Owner has been selected (Beneficial Owner) wnmv‡ei cÖK…Z myweav‡fvMx wba©viY Kiv n‡q‡Q wK bv
 Yes nu¨v  No bv  Not Applicable cÖ‡hvR¨ bq
If the answer is Yes, the information for every Ultimate Beneficial Owner needs to be collected according to Appendix-1(KA)
DËi nu¨v n‡j cÖ‡Z¨K cÖK…Z myweav‡fvMx m¤úwK©Z Z_¨vw` cwiwkó-1(K) †gvZv‡eK msMÖn Ki‡Z n‡e

Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [May 2017] Page 1 of 6
9. Proof of Identity (put  mark) cwiwPwZcÎ (wUK w`b)
Copy Received Verified
Kwc M„nxZ hvPvBK…Z
(a) Passport No.   (if applicable)
cvm‡cvU© b¤^i (cÖ‡hvR¨ †¶‡Î)
(b) National ID No.   (if applicable)
RvZxq cwiPqcÎ b¤^i (cÖ‡hvR¨ †¶‡Î)
(c) Birth Certificate No.   (if applicable)
Rb¥ wbeÜb mb`cÎ b¤^i (cÖ‡hvR¨ †¶‡Î)
(d) Electronic-Tax ID No. (E-TIN)   (if applicable)
B‡jKUªwbK-U¨v· AvBwW (E-TIN) b¤^i (cÖ‡hvR¨ †¶‡Î)
(e) Driving License No.   (if applicable)
WªvBwfs jvB‡mÝ b¤^i (cÖ‡hvR¨ †¶‡Î)
(f) Other   (if applicable)
Ab¨vb¨ (cÖ‡hvR¨ †¶‡Î)

10. In case of non-residents and foreign citizens, reason for opening an account (Non-resident) Awbevmx Ges we‡`kx‡`i †ÿ‡Î wnmve †Lvjvi D‡Ïk¨

(a) Type of Visa wfmvi cÖK…wZ Expiration Date †gqv` DËx‡Y©i ZvwiL

(b) Do you have work permit as well as the permission to open a bank account from concerned authority (if applicable)?
Kg©vbygwZ cÖv߇`i wnmve †Lvjvi †ÿ‡Î Kg©vbygwZcÎ I e¨vsK wnmve †Lvjvi Rb¨ h_vh_ KZ©„c‡ÿi Aby‡gv`b i‡q‡Q wK bv (cÖ‡hvR¨ †ÿ‡Î)
 Yes nu¨v  No bv
(In case of non-residents, photocopies of their passports and in case of foreign citizens, photocopies of their passports along with visas must be collected)
(Awbevmx evsjv‡`kx‡`i †¶‡Î Avewk¨Kfv‡e cvm‡cv‡U©i Kwc Ges we‡`kx‡`i †¶‡Î Avewk¨Kfv‡e wfmvmn cvm‡cv‡U©i Kwc msMÖn Ki‡Z n‡e)

11. Whether the client is a Politically Exposed Person (PEP)/Influential Person (IP)/Head of International Organization or Senior
Official and whether the client is a family member or close associate of Politically Exposed Persons (PEPs)/Influential
Persons (IPs)/Head of International Organizations or Senior Officials (according to the definition in BFIU Circular)?
Politically Exposed Persons (PEPs)/(IP)/MÖvnK/cÖfvekvjx e¨w³/AvšÍR©vwZK ms¯’vi cÖavb ev D”P ch©v‡qi Kg©KZ©v Ges Zv‡`i cwiev‡ii m`m¨ wK bv (weGdAvBBD KZ©…K RvwiK…Z mvKz©jv‡i ewY©Z msÁv Abymv‡i)

 Yes nu¨v  No bv
If the answer is Yes DËi nu¨v n‡j
a. Whether approval is taken from Senior Management wmwbqi g¨v‡bR‡g›U n‡Z Aby‡gv`b †bqv n‡q‡Q wK bv
 Yes nu¨v  No bv
b. Whether face to face interview is taken of customer MÖvn‡Ki gy‡LvgywL mvÿvrKvi †bqv n‡q‡Q wK bv
 Yes nu¨v  No bv
12. Have the screening been performed on the name of the customer in light of relevant acts, regulations, circulars
and been confirmed whether there was any match found according to resolutions issued by United Nations
Security Council, covering the list of persons or organizations, in suspicion of any terrorist activities, terrorist
financing and funding to manufacture or distribution of weapons for mass destruction and according to the list of
individuals or entities, banned by the Bangladesh government?
mswkøó AvBb, wewagvjv I mvKz©jv‡ii Av‡jv‡K MÖvn‡Ki bvg RvwZms‡Ni wbivcËv cwil‡`i wewfbœ †i¸‡jk‡bi AvIZvq mš¿vmx Kv‡h©, mš¿vmx Kv‡h© A_©vq‡b I e¨vcK aŸsmvZ¥K A¯¿ we¯Ív‡ii A_©vq‡b RwoZ m‡›`‡n
ZvwjKvfy³ †Kvb e¨w³ ev mËv Ges evsjv‡`k miKvi KZ©„K ZvwjKvfy³ †Kvb e¨w³ ev wbwl× †NvwlZ mËvi bv‡gi ZvwjKvi mv‡_ hvPvB-evQvBc~e©K †Kvbiƒc wgj cvIqv wM‡q‡Q wK bv

 Yes nu¨v  No bv
If yes, then what action has been taken? DËi nu¨v n‡j G welqK M„nxZ e¨e¯’vi weeiY

13. Risk Grading wi¯‹ †MÖwWs

(a) What does the client do/What kind of work is he/she involved in? MÖvnK Kx K‡ib/Kx ai‡Yi †ckvq wb‡qvwRZ i‡q‡Q?
Serial No. Nature Risk Score
µwgK bs cÖK…wZ wi¯‹ †¯‹vi

1. Jewelry/Gold Business/Valuable Metal Business 5

Ry‡qjvwi/¯^‡Y©i e¨emv/g~j¨evb avZzi e¨emv (5)

2. Money Changer/Courier Service Agent/Mobile Banking Agent 5

gvwb †PÄvi/Kzwiqvi mvwf©m/†gvevBj e¨vswKs G‡R›U (5)

3. Real Estate Developer/Agent 5

wi‡qj G‡÷U †Wfjcvi/G‡R›U (5)

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 Serial No. Nature Risk Score
µwgK bs cÖK…wZ wi¯‹ †¯‹vi

4. Construction Project Promoter/Contractor 5

wbg©vY cÖKí †cÖv‡gvUvi/wVKv`vi (5)

5. Dealer of Art/Antiques 5
wPÎKjv/A¨vw›U‡Ki wWjvi (5)

6. Owner of Restaurant/Bar/Night Club/Residential Hotel/Parlor Business 5

†iu‡¯Íviv/evi/bvBU K¬ve/AvevwmK †nv‡Uj/cvj©vi e¨emv (5)

7. Import/Export Agent 5
Avg`vwb/ißvwb (5)

8. Manpower Export Business 5

Rbkw³ ißvwb e¨emv (5)

9. Arms Business/Arms Dealer 5

A‡¯¿i e¨emv (5)

10. Garments Business/Garments Accessories/Buying House 5

Mv‡g©›Um e¨emv/Mv‡g©›Um G‡·mwiR/evwqs nvDR (5)

11. Pilot/Flight Attendant 5

cvBjU/d¬vBU G‡Ub‡W›U (5)
12. Trustee 5
Uªvw÷ (5)

13. Share/Stock Business Investor 5

†kqvi/÷K e¨emvq wewb‡qvMKvix (5)

14. Software Business/Information Technology (IT) Business 5

mdU&Iq¨vi e¨emv/Z_¨ I cÖhyw³i e¨emv (5)

15. Expatriate 5
GKm&c¨vUwiAvU (evsjv‡`‡k Kg©iZ we‡`kx e¨w³) (5)

16. Travel Agent 4

Uªv‡fj G‡R›U (4)

17. Businessman with annual cash investment greater than BDT 1 Crore 4
evwl©K 1 †KvwU UvKvi AwaK A_© jMœxKvix e¨emvqx (4)

18. Freight/Shipping/Cargo Agent 4

†d«BU/wkwcs/Kv‡Mv© G‡R›U (4)

19. Auto Business (New/Reconditioned Cars) 4

A‡Uv e¨emv (bZzb/wiKwÛkvb Mvox) (4)

20. Business (Leather and Leather Products) 4

e¨emv (Pvgov I PvgovRvZ cY¨) (4)

21. Housing Construction Materials Business 4

evwo wbgv©Y mvgMÖxi e¨emv (4)

22. Professional (Journalist, Lawyer, Doctor, Engineer, Chartered Accountant) 4

†ckvRxex (mvsevw`K, AvBbRxex, Wv³vi, BwÄwbqvi, PvU©vW© GKvDb‡U›U) (4)

23. Director (Private/Public Limited Company) 4

wW‡i±i (cÖvB‡fU/cvewjK wjwg‡UW †Kv¤úvwb) (4)

24. Senior Official of Multinational Company 4

eûRvwZK cÖwZôv‡bi EaŸ©Zb Kg©KZ©v (4)

25. Housewife 4
M„wnYx (4)

26. Information Technology (IT) Service 4

Z_¨-cÖhyw³ †ÿ‡Î PvKzwi (4)

27. Sportsperson/Media Celebrity/Producer/Director 4

†L‡jvqvo/wgwWqv †mwj‡eªwU/cÖwWDmvi/wbg©vZv (4)

28. Freelance Software Developer 4

wd«j¨vÝ mdU&Iq¨vi †W‡fjcvi (4)

29. Business-Agent 3
e¨emv-G‡R›U (3)

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 Serial No. Nature Risk Score
µwgK bs cÖK…wZ wi¯‹ †¯‹vi

30. Public Service 3

miKvwi PvKzix (3)

31. Landlord 3
evwoIqvjv (3)

32. Thread Businessperson/Jute Businessperson 3

myZv e¨emvqx/SzU e¨emvqx (3)

33. Transport Operator 3

cwienb Acv‡iUi (3)

34. Tobacco and Cigarette Business 3

ZvgvK I wmMv‡i‡Ui e¨emv (3)

35. Amusement Park 3

we‡bv`bKvix cÖwZôvb/cvK© (3)

36. Motor Parts/Workshop Business 3

†gvUi cvU©m/IqvK©mc Gi e¨emv (3)

37. Private Service Managerial 3

cÖvB‡fU mvwf©m g¨v‡bRvwiqvj (3)

38. Teacher (Public/Private/Autonomous Educational Institutions) 2

wkÿK (miKvwi/†emiKvwi/¯^vqËkvwmZ wkÿv cÖwZôvb) (2)

39. Job (Private) 2

PvKzix (†emiKvwi) (2)

40. Small Businessman (Annual Turnover below BDT 50 Lakh) 2

¶z`ª e¨emvqx (evwl©K Uvb©Ifvi 50 jÿ UvKvi bx‡P) (2)

41. Self-Employed 2
¯^-D‡`¨vMx †ckvRxex (2)

42. Computer/Mobile Phone Dealer 2

Kw¤úDUvi/†gvevBj †dv‡bi wWjvi (2)

43. Producer (Excluding Weapons) 2

Drcv`bKvix (A¯¿ e¨ZxZ) (2)

44. Student 2
QvÎ (2)

45. Retired from Service 1

PvKzix n‡Z Aemi MÖnYKvix (1)

46. Farmer/Labor/Fisherman 1
K…wlRxex/kÖgRxex/grmRxex (1)

47. Others (please mention in details) 1-5

Ab¨vb¨ (mywbw`©ófv‡e D‡jøL Kiæb) (1-5)

(In order to assess the risks associated with the customer, detailed information of the customer’s profession needs to be analysed to classify customer’s
risk as high or low, including (for businesses) the nature of the business, business volume, location, size, ultimate beneficial owner or any other special
factors. Risk needs to be assessed similarly for private services, specially taking into consideration nature of the service and responsibilities. In consideration
of the above terms, depending on the individual cases of customers, the score can be higher than those designated for numbers 16-46.)
(MÖvn‡Ki SuywK wbiæc‡Yi †ÿ‡Î MÖvn‡Ki †ckvi we¯ÍvwiZ Z_¨ we‡kølYKiZt e¨emv‡qi †ÿ‡Î e¨emv‡qi cÖK…wZ, A‡_©i gvÎv, e¨emv‡qi GjvKv, e¨emv‡qi AvKvi, wnmv‡ei cÖK…Z myweav‡fvMx BZ¨vw`mn Ab¨vb¨ we‡kl
w`K we‡ePbvq wb‡q MÖvnK‡K D”P ev wb¤œ SyuwK m¤úbœ wn‡m‡e †kªYxKiY Ki‡Z n‡e| PvKzwii †ÿ‡ÎI Abyiƒcfv‡e we¯ÍvwiZ Z_¨ jvf KiZt we‡kl K‡i PvKzwii cÖK…wZ I `vq `vwq‡Z¡i wbwi‡L SzuwK wbiæcY Ki‡Z n‡e|
Gme welqmg~n we‡ePbvq wb‡q MÖvnK †f‡` 16-46 bs †ÿ‡Î ewY©Z †¯‹vi A‡cÿv D”PZi †¯‹vi cÖ`vb Ki‡Z cvi‡e|)

(b) Customer’s Monthly Income Amount (Monthly Income)

MÖvn‡Ki gvwmK Av‡qi cwigvY
Amount (in BDT) Risk Score
cwigvY (UvKvq) wi¯‹ †¯‹vi

Up to 1 Lac 0
1 j¶ ch©šÍ (0)

>1 Lac to 3 Lac 1

>1 n‡Z 3 jÿ ch©šÍ (1)

More than 3 Lacs 3

3 j¶vwaK (3)

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 (c) Type of Account Opening
wnmve †Lvjvi aiY
Type Risk Score
aiY wi¯‹ †¯‹vi

Relationship Manager/By Branch 0

wi‡jkbwkc g¨v‡bRvi/kvLv KZ©„K (0)

By Direct Sales Agent 3

WvB‡i± †mjm& G‡R›U KZ©„K (3)

Internet/Non Face-to-Face 3
B›Uvi‡bU/Non Face to Face (3)

Unexpected/By Voluntary Approach/Walk-In 3

¯^cÖ‡Yvw`Zfv‡e/Walk-In (3)

(d) Probable Monthly Transaction Amount of Customer

MÖvn‡Ki AbywgZ gvwmK †jb‡`‡bi cwigvY

Transaction Amount in Current Account Transaction Amount in Savings Account Risk Score
PjwZ wnmv‡e †jb‡`‡bi cwigvY (BDT in Lac) (j¶ UvKvq) mÂqx wnmv‡e †jb‡`‡bi cwigvY (BDT in Lac) (j¶ UvKvq) wi¯‹ †¯‹vi

0-10 0-5 0
0-10 0-5 (0)

>10-20 >5-10 1
>10-20 >5-10 (1)

>20 >10 3
>20 >10 (3)

(e) Probable Monthly Transaction Number of Customer

MÖvn‡Ki AbywgZ gvwmK †jb‡`‡bi msL¨v

Transaction Number of Current Account Transaction Number of Savings Account Risk Score
PjwZ wnmv‡e †jb‡`‡bi msL¨v mÂqx wnmv‡e †jb‡`‡bi msL¨v wi¯‹ †¯‹vi

0-15 0-10 0
0-15 0-10 (0)

16-25 11-20 1
16-25 11-20 (1)

>25 >20 3
>25 >20 (3)

(f) Probable Monthly Cash Transaction Amount of Customer

MÖvn‡Ki AbywgZ gvwmK bM` †jb‡`‡bi cwigvY:

Transaction Amount in Current Account Transaction Amount in Savings Account Risk Score
PjwZ wnmv‡e †jb‡`‡bi cwigvY (BDT in Lac) (jÿ UvKvq) mÂqx wnmv‡e †jb‡`‡bi cwigvY (BDT in Lac) (jÿ UvKvq) wi¯‹ †¯‹vi

0-5 0-2 0
0-5 0-2 (0)

>5-10 >2-5 1
>5-10 2-5 (1)

>10 >5 3
>10 >5 (3)

(g) Probable Monthly Cash Transaction Number of Customer

MÖvn‡Ki AbywgZ gvwmK bM` †jb‡`‡bi msL¨v:

Transaction Number of Current Account Transaction Number of Savings Account Risk Score
PjwZ wnmv‡e †jb‡`‡bi msL¨v mÂqx wnmv‡e †jb‡`‡bi msL¨v wi¯‹ †¯‹vi

0-10 0-5 0
0-10 0-5 (0)

11-20 6-10 1
11-20 6-10 (1)

>20 >10 3
>20 >10 (3)

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14. Overall Risk Assessment (add up all the above Risk Scores)
mvgwMÖK SzuwK/wi¯‹ †iwUs wbiƒcY (Dc‡ii K n‡Z µwgK ch©šÍ wi¯‹ †¯‹v‡ii †hvMdj)

Risk Level Risk Rating

wi¯‹ †¯‹v‡ii †hvMdj mvgwMÖK wi¯‹ †iwUs

>=14 High
>=14 D”P

<14 Low
<14 wb¤œ

Remarks
gšÍe¨

(*In the event that the Beneficial Owner is classified as high risk after subjective analysis and judgment of his/her risk factor,
the customer may fall under the high risk category even if his/her risk score is below 14)
* wi¯‹ †iwUs 14 Gi Kg n‡jI Beneficial Owner-Gi D”P SuywK we‡ePbvq wb‡q KviY D‡jøLc~e©K Subjective we‡ePbvq MÖvnK‡K D”P SuywK m¤úbœ wn‡m‡e wbiƒcY Kiv †h‡Z cv‡i)

Prepared by Reviewed and Approved by

cÖ¯‘ZKvix ch©v‡jvPbv I wbwðZKvix Kg©KZ©v

Signature of Account Opening Officer/Relationship Manager (with seal) Signature of BAMLCO (with seal)
(wnmve †Lvjvi Kg©KZ©v/wi‡jkbwkc g¨v‡bRv‡ii ¯^vÿi (wmjmn) (kvLv gvwbjÛvwis cÖwZ‡iva cwicvjb Kg©KZ©vi ¯^vÿi (wmjmn)
Name Name
bvg bvg
Date Date
ZvwiL ZvwiL

Approval of Senior Bank Official (for PEP/IP/Head of International Organizations or Senior Officials)
Signature with Name, Seal and Date
(PEP/IP/AvšÍR©vwZK ms¯’vi EaŸ©Zb Kg©KZ©v Gi †ÿ‡Î Aby‡gv`bKvix EaŸ©Zb Kg©KZ©v)
bvghy³ wmjmn ¯^vÿi I ZvwiL

15. Last date of reviewing and updating of account and customer related information
wnmve I MÖvnK msµvšÍ Z_¨vw` me©‡kl ch©v‡jvPbv Ges nvjbvMv` Kivi ZvwiL

Updating and Reviewing Official (Signature with Name, Seal and Date)
ch©v‡jvPbv Ges nvjbvMv`Kvix Kg©KZ©v (bvghy³ wmjmn ¯^vÿi I ZvwiL)

Relationship Manager (Signature with Name, Seal and Date)

wi‡jkbwkc g¨v‡bRvi (bvghy³ wmjmn ¯^vÿi I ZvwiL)

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