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Dutch Bangla Bank Ltd

APPENDIX-E: CIB FORMAT
(TO BE FILLED IN CAPITAL LETTER / TYPE)
Tick New

Inquiry Form:-CIB-1A
(For Individu !"In#$i$u$ion%
Amoun$ o& !o n ''!i(d &or:
In figure: 20,00,000 In w!rd : "aka twent# lac !nl#

Renewal
Enhancement

Other $% 2% -% 1% /% 3% 9% 2% 0% $0% $$% $2%

Name !f the Bank & 'inancial In tituti!n: D)TC*-BAN+,A BAN- ,TD. Name !f Branch: )nder Di trict !f

()L*+,N D+,.,
Branch C!de N!% Date

/00$00

Reference N! % !f Branch: DBBL&()L&CIB&0/&$2-0&2003 Reference N! % !f +ead Office B!rr!wer C!de 789:18 5if a6aila7le8 Name !f the 7!rr!wer in full: ,77re6iated name 5in ca e !f indi6idual8:

Date : 4arch $$, 20$1

N&,

'ather: name 5in ca e !f indi6idual8: N&, 4!ther: name 5in ca e !f indi6idual8: N&, +u 7and: name 5in ca e !f married w!man8: N&, ,ddre : 5a8 ;ermanent: 'L," < '$, ORIEN",L DE *=),RE, 1, 4>4EN*I(N(+ RO,D, D+,., 578 Bu ine 5c8 'act!r# : -1, BI?O> N,(,R 52ND 'LOOR8, D+,.,
:

$-%

"ele@h!ne N! %

0/31229

$1% A!ter ID Card N!% $/% "IN N!% 229-$02-02-$

"! the 7e t !f !ur kn!wledge the a7!6e 7!rr!wer !7tained the credit facilitie fr!m different Bank & 'inancial In tituti!n a menti!ned 7el!w: N m( o& $/( B nk# " Fin nci ! In#$i$u$ion# NONE 1i2n $ur( o& *( d o& $/( Br nc/ " M n 2(r Name : M. 3A*ED)R RA*MAN4 15P 6 MANA+ER *eal "el% N!te: : : 02220$/ 5DIR%8 02221-3, 22$22$- EB"%$0$ N m( o& Br nc/ 0i$/ Di#$ric$

*u@@re ing !r di t!rti!n !f an# inf!rmati!n 5related t! 7!rr!wer & !wner8 7# the Bank & 'inancial In tituti!n i @uni ha7le under Banglade h Bank Order $092, Cha@ter IA ,rt%12 Banglade h In titute !f Bank 4anagement $00

Dutch Bangla Bank Ltd

Inquiry Form-CIB-;A
(O0n(r in&orm $ion i& <orro0(r i# in#$i$u$ion%
$% 2% Name !f the Bank & 'inancial In tituti!n: Name !f Branch: +),1*AN BRANC*

D)TC*-BAN+,A BAN- ,TD.

$-% Branch C!de N!%

87=1==
Date: M rc/ 114 ;=1> Date

$1% Reference N! % !f Branch: DBB,"+),"CIB"=8"$2-0";==: $/% Reference N! % !f +ead Office $3% B!rr!wer C!de 5if a6aila7le8 789:18

$9% 'ull name !f the 7!rr!wer: $2% 'ull name !f the !wner: $0% ,77re6iated name !f the !wner

N&,
4R% ',ROO=)E 4,+4OOD 4*% 4,CED, BE()4 N&,

20% 'ather: name5in ca e !f indi6idual8: 2$% 4!ther: name 5in ca e !f indi6idual8: 22% +u 7and: name 5in ca e !f indi6idual8% ;?. Addr(##:

5a8 ;ermanent : 'L," < '$, ORIEN",L DE *=),RE, 1 4>4EN*I(N(+ RO,D, D+,., 578 Bu ine : -1, BI?O> N,(,R 52ND 'LOOR8, D+,., a 5c8 'act!r# : N&, $1% *tatu !f the !wner 5"ick !nl#8: ;r!@riet!r ;artner Chairman*@!n !r&,@@!inted $/% A!ter ID Card N!
$3% Name !f the Bank & 'inancial In tituti!n & In urance C!% 5!f which the a7!6e !wner i Chairman & Direct!r8

4D *@!n !r&,@@!inted

Direct!r *@!n !r& Elected

Direct!rN!minated 57# (!6t%8 57# ;6t% Int%8

Other

"! the 7e t !f !ur kn!wledge the a7!6e !wner: 5a8 O7tained credit facilitie in indi6idual name : >e N! 578 +a g!t !ther 7u ine which !7tained credit facilitie fr!m the Bank & 'inancial In tituti!n a menti!ned 7el!w: NIL N m( o& $/( o0n(r r(! $(d <u#in(## " &irm N m( o& B nk " Fin nci ! N m( o& Br nc/ 0i$/ Di#$ric$ 0i$/ ddr(## In#$i$u$ion# ;RINCE 4,R.E"IN( L"D% D)"C+-B,N(L, B,N. LI4I"ED ()L*+,N BR,NC+, D+,., "! the 7e t !f !ur kn!wledge the a7!6e inf!rmati!n i c!rrect% 1i2n $ur( o& *( d o& $/( Br nc/ " M n 2(r Name : M. 3A*ED)R RA*MAN4 15P 6 MANA+ER *eal :

N!te:

"el% : 02220$/ 5DIR%8 02221-3, 22$22$- EB"%$0$ *u@@re ing !r di t!rti!n !f an# inf!rmati!n 5related t! 7!rr!wer & !wner8 7# the Bank & 'inancial In tituti!n i @uni ha7le under Banglade h Bank Order $092, Cha@ter IA ,rt%12 Banglade h In titute !f Bank 4anagement $$0

Dutch Bangla Bank Ltd

(TO BE FILLED IN CAPITAL LETTER / TYPE)

Inquiry Form-CIB-?A
(In&orm $ion o& 2rou' "r(! $(d <u#in(## conc(rn%
1. ;. ?. >. 8. :. 9. @. 7 Name !f the Bank & 'inancial In tituti!n: D)TC*-BAN+,A BAN- ,TD. Name !f Branch: )nder Di trict !f

+),1*AN BRANC* D*A-A
Branch C!de N!% Date% :

87=1==
Date: M rc/ 114 ;=1>

Reference N! % !f Branch: DBB,"+),"CIB"=8";==:"1@?= Reference N! % !f +ead Office 'ull name !f 7!rr!wer: Name !f the gr!u@: Addr(## o& +rou': 5a8 ;ermanent : : N&, 578 Bu ine : N&, 5c8 'act!r# : N&, R(! $(d <u#in(## conc(rn#: N m(

7.

Bu#in(## Addr(##

;RINCE 4,R.E")N( L"D%

-1, BI?O> N,(,R, D+,.,

;lea e write N, !r N!t ,@@lica7le if the c!ncerned 7!rr!wer i neither a (r!u@ n!r a *u7 idiar# & *i ter c!ncern under declared a (r!u@%

"! the 7e t !f !ur kn!wledge the a7!6e inf!rmati!n i c!rrect% 1i2n $ur( *( d o& $/( Br nc/ " M n 2(r Name *eal "el% N!te: : M. 3A*ED)R RA*MAN4 15P 6 MANA+ER : : 7@@@7184 (DIR.%4 7@@@>?:4 @@1;;1? EXT.101

*u@@re ing !r di t!rti!n !f an# inf!rmati!n 5related t! 7!rr!wer & !wner8 7# the Bank & 'inancial In tituti!n i @uni ha7le under Banglade h Bank Order $092, Cha@ter IA ,rt%12

Banglade h In titute !f Bank 4anagement

$$$