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Branch

Applicant/Guardian/Beneficial Owner Personal Information Form

For Bank’s use only

A/C No.
Photograph
Unique Customer Identification Code

Group Code

1. Involvement with A/C 1st Applicant 2nd Applicant 3rd Applicant Guardian Beneficial Owner

Minor Account Holder Others.........................

2. Resident Status a. Resident b. Non-Resident

3. Name of Account
Holder/Beneficial Owner/
‡gvt kwidzj Bmjvg evsjvq
Account Operator
MD. SHARIFUL ISLAM English Block Letter

4. Father’s Name Md. Shakerder Ali

5. Mother’s Name Most. Rezia Begum
6. Spouse’s Name Shirazum Monira
7. Nationality Bangladeshi Foreign Citizen Dual Citizen 8. Date of Birth d
0 d1 m
0 m
2 y
1 y9 y9 2y
9. Gender Male 10. Source of Fund Salary
11. Occupation (details Service Business Land Lord Professional Others.....................................................................
with designation)
Name of the Jahangirnagar University Designation Assistant Professor (Since 14/10/2020)
Organization

12. Monthly Income 13. TIN No.

BDT 58,000 (If available)

14. a) Present address:

Road/Village Plot/Flat # 134/7/D, Darussalam PO Mirpur
Thana Darussalam District Dhaka
Contact no. 01670152474 E-mail sharifjumkt39@gmail.com
14. b) Permanent address:
Road/Village H # 20, Kalachand Para PO Pabna Sadar
Thana District
Pabna Sadar Pabna
Contact no. 01714750262 E-mail sharifjumkt@gmail.com
15. Identification NID Passport Birth Certificate Others
Documents:
(a) Identification No. 19927625504000069
(b) Information of
Introducer: Name

Account/NID No. Signature

(with birth date) (with date)

Signature of Applicant/Guardian/Beneficial Owner

(With Name & Date)
A/C Opening Officer BM/OM
(With Name Seal, Signature & Date) (With Name Seal, Signature & Date)