The Hongkong and Shanghai Banking Corporation Limited Date D D M M Y Y Y Y

Incorporated in the Hong Kong SAR with limited liability

Dormant/Unclaimed Account Activation Form

The Manager
HSBC, Bangladesh Branch

I/We have been informed that my/our Account Number mentioned below has been held as dormant/unclaimed due to non-transaction for
an extended period of time.

My/Our photo ID of Passport/NID/Smart Card number is/are ……………………………………………………........................…………………

The reason for not operating the account is …………………………………………………………….....................……………………………….

I would appreciate if you please re-activate the above mentioned account by conducting required transactions the same amount to the
above mentioned account(s)
I/ We hereby declare that the information provided above is correct and I/we shall not hold HSBC or any of its employees liable if there is
any negligence on my/our part to fill this form duly. Please process my/our request as mentioned above.
Yours faithfully

SV SV

Signature of 1st Applicant Signature of 2nd Applicant

Name: .................................................... Name: ....................................................

PV PV
Phone: ................................................... Phone: ...................................................

To be filled up by the bank (Please tick (ü) where applicable

n Account Level Dormancy/Unclaimed status
n Relationship Level Dormancy/Unclaimed Status (please mention the customer number

1.

2.

3.

n Government Issued Photo ID Received

n Cheque Received/Internal Voucher (Debit and Credit) processed
n Deposit Slip Received

Instruction Received by: BM’s endorsement:

(Seal with name, designation and date) (seal with name, designation and date)

Issued by the Hongkong and Shanghai Banking Corporation Limited in Bangladesh [October 2019] Page 1 of 1
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Issued by the Hongkong and Shanghai Banking Corporation Limited in Bangladesh [October 2019] Page 1 of 1