APPENDIX-2 cwiwkó-2

The Hongkong and Shanghai Banking Corporation Limited

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

NOMINEE INFORMATION
bwgwb msµvšÍ Z_¨vewj
(Applicable only for Personal Account, and if the no. of Nominees exceed to more than one, then each Nominee will have to fill up a separate Nominee Information Form)
(ïaygvÎ e¨w³K wnmv‡ei †ÿ‡Î cÖ‡hvR¨ n‡e Ges G‡Ki AwaK bwgwb n‡j GKvwaK bwgwb dig c~iY Ki‡Z n‡e)

Date ZvwiL
D D M M Y Y Y Y

Photograph
(For Bank’s use only) (e¨vs‡Ki e¨env‡ii Rb¨) (Attested by the client)
Account Number wnmve b¤^i (Please staple it)
Qwe
(K¬v‡q›U KZ…©K mZ¨vwqZ)
Unique Customer I.D. Code BDwbK Kv÷gvi AvBwW †KvW (`qv K‡i ÷¨vcj&& Kiæb)

I/We do hereunder appoint the following individual(s) as my/our nominee, who shall, in the event of my/our death,
receive/draw the amount of deposits held by the Bank in my/our account. I/We reserve the right to cancel or change this
nomination at any time. I/We also acknowledge that the payment made by the Bank to him/her shall constitute a full discharge
by the Bank of its liability in respect of such deposits. I/We declare that everything done by the Bank in pursuance of this
authority shall be binding upon me/us until the Bank receives any notice from me/us in writing to the contrary.
Avwg/Avgiv G wnmv‡ei A_© Avgvi/Avgv‡`i g„Zy¨i ci wb‡¤œv³fv‡e wb‡¤œi ewY©Z e¨w³/e¨w³MY‡K cÖ`v‡bi Rb¨ g‡bvbxZ Kijvg| Avwg/Avgiv DwjøwLZ g‡bvbqb †h †Kvb mgq evwZj ev cwieZ©‡bi AwaKvi msiÿY Kwi|
Avwg/Avgiv GB g‡g© Av‡iv m¤§wZ Ávcb KiwQ †h, Avgvi/Avgv‡`i wb‡`©kbv †gvZv‡eK e¨vsK A_© cÖ`vb Ki‡e Ges GRb¨ e¨vsK †Kv‡bvfv‡e `vqe× n‡ebv| Avwg/Avgiv GB g‡g© †NvlYv KiwQ †h, Avwg/Avgiv Ab¨ †Kv‡bv
wb‡`©kbv bv †`qv ch©šÍ eZ©gvb wb‡`©kbv Abyhvqx e¨vs‡Ki †h‡Kv‡bv wm×v‡šÍi `vq Avgvi Dci eZ©v‡e|

1. Name of Account wnmv‡ei bvg

2. Account Number wnmve b¤^i

3. Name of Nominee (as in NID/Passport/Driving License) bwgwbi bvg (RvZxq cwiPqcÎ/cvm‡cvU©/WªvBwfs jvB‡bÝ Abyhvqx)

Title  Mr.  Mrs.  Ms.

4. Father’s Name wcZvi bvg

5. Mother’s Name gvZvi bvg

6. Husband’s/Wife’s Name ¯^vgx/¯¿xi bvg

7. Date of Birth Rb¥ ZvwiL

Issued by The Hongkong and Shanghai Banking Corporation Limited in Bangladesh [May 2017] Page 1 of 4
8. Present Address eZ©gvb wVKvbv

9. Permanent Address ¯’vqx wVKvbv

10. Profession †ckv

11. Nominee’s Proof of Identity bwgwbi cwiwPwZcÎ

(a) National ID No. RvZxq cwiPqcÎ b¤^i Date of Issue Bmy¨ ZvwiL

(b) Passport No. cvm‡cvU© b¤^i Valid till †gqv` Date of Issue Bmy¨ ZvwiL

(c) Birth Certificate No. Rb¥ wbeÜb mb`cÎ b¤^i

(d) Electronic-Tax ID No. (E-TIN) B‡jKUªwbK-U¨v· AvBwW (E-TIN) b¤^i

(e) Driving License No. WªvBwfs jvB‡mÝ b¤^i Valid till †gqv`

(f) Other (please mention in details) Ab¨vb¨ (wbw`©ófv‡e D‡jøL Ki‡Z n‡e)

[From the list of documents described in points (a) to (c), you must provide at least one document. However, if a birth certificate is provided, it must
accompany a photo identification document of the accountholder. Non-residents and foreign nationals must submit copies of their passports along
with the relevant visas. If a photo identification document is not available, then the applicant will be required to provide a bank acceptable identification
document issued by society’s well-renowned persons* as per bank’s satisfaction. The said identification document/certificate will need to be attested
together with a photograph of the applicant (attestation covering the front page of photograph). Additionally, in order to fully verify the identity of the
customer/applicant, the bank reserves the right to ask for additional documents/information upon its satisfaction, including but not limited to the
documents/information mentioned in the points (d) to (f) or any points of this form.]
[a n‡Z c b¤^i µwg‡K ewY©Z `wjjvw` n‡Z Avewk¨Kfv‡e †h‡Kvb GKwU `wjj cÖ`vb Ki‡Z n‡e| Z‡e Rb¥ wbeÜb mb` cÖ`v‡bi †ÿ‡Î Rb¥ wbeÜb mb`c‡Îi AwZwi³ bwgwbi Av‡jvKwPÎmn Ab¨ †h‡Kvb cwiwPwZ
cÎ cÖ`vb Ki‡Z n‡e| bb-†iwm‡W›U Ges we‡`kx bvMwiK‡`i †¶‡Î cvm‡cv‡U©i Kwc Avewk¨Kfv‡e cÖ`vb Ki‡Z n‡e| Av‡jvKwPÎmn cwiwPwZ cÎ bv _vK‡j †m wel‡q e¨vs‡Ki mš‘wó mv‡c‡ÿ Zv‡`i wbKU MÖnY‡hvM¨
mgv‡Ri MY¨gvb¨ e¨w³* KZ…©K cÖ`Ë cwiP‡qi cÖZ¨qbcÎ cÖ`vb Ki‡Z n‡e| D³ cwiwPwZ cÎ ev cÖZ¨qbcÎ MÖvnK/wnmve cwiPvjbvKvixi Av‡jvKwPÎmn (Av‡jvKwP‡Îi Dc‡ii c„‡ô mZ¨vwqZmn) n‡Z n‡e| GQvov,
cÖ‡Z¨K e¨vsK h_vh_fv‡e MÖvn‡Ki cwiwPwZi wel‡q wbwðZ nIqvi j‡ÿ¨ e¨vs‡Ki mš‘wó mv‡c‡ÿ Dc‡ii e b¤^i µwg‡K ewY©Z `wjjvw`mn AwZwi³ Av‡iv †Kvb `wjjvw` Ges GB di‡g DwjøwLZ Z_¨vw`i AwZwi³
Z_¨ msMÖn Ki‡Z cvi‡e|]
Note: If a Birth Certificate is provided, a Government issued photo identification document needs to be provided along with it as per Bank’s internal policy.
wet `ªt Rb¥ wbeÜbcÎ Rgv`v‡bi †ÿ‡Î e¨vs‡Ki wbqg Abyhvqx miKvi cÖ`Ë mwPÎ cwiPqcÎI Rgv w`‡Z n‡e|
*Society’s well-renowned persons include Member of Parliament, City Corporation Mayor, Deputy Mayor and Councillors, Gazetted Officers who fall
under the 9th grade or above on the National Pay Scale, Public University Teacher, Sub-District Chairman and Vice Chairman, Union Parishad
Chairman, Municipality Mayor and Councillors, Private University Professor, Private College Principal, Private High School Headmaster, Editor of
National Daily Newspaper, Notary Public, Officers of Semi-Government/Autonomous/State-owned Institution, who fall under 7th grade or above on
the National Pay Scale, and Bangladesh Bank Officers who fall under 9th grade or above on the National Pay Scale.
*MY¨gvb¨ e¨w³ ej‡Z msm` m`m¨, wmwU K‡c©v‡ik‡bi †gqi, †WcywU †gqi I KvDwÝjiMY, RvZxq †eZb †¯‹‡ji 9g I Z`~aŸ© †MÖ‡Wi †M‡R‡UW Kg©KZ©v, cvewjK wek¦we`¨vj‡qi wkÿK, Dc‡Rjv cwil‡`i †Pqvig¨vb
I fvBm †Pqvig¨vb, BDwbqb cwil‡`i †Pqvig¨vb, †cŠimfvi †gqi I †cŠi KvDwÝjiMY, †emiKvix wek¦we`¨vj‡qi Aa¨vcK, †emiKvix K‡j‡Ri Aa¨ÿ, †emiKvix D”P we`¨vj‡qi cÖavb wkÿK, RvZxq ˆ`wbK cwÎKvi
m¤úv`K, †bvUvwi cvewjK, AvavmiKvix/¯^vqËkvwmZ/ivóªvqZ¡ ms¯’vi RvZxq †eZb †¯‹‡ji 7g ev Z`~aŸ© †MÖ‡Wi Kg©KZ©vMY Ges evsjv‡`k e¨vs‡Ki RvZxq †eZb †¯‹‡ji 9g I Z`~aŸ© †MÖ‡Wi Kg©KZ©vMY‡K eySv‡e|

12. Relationship with the Accountholder wnmveavixi mv‡_ m¤úK©

13. Percentage (%) kZKiv nvi

14. In the event of death of accountholder while nominee remains minor, details of the authorized guardian to receive
deposits [as per The Bank Company Act, 1991-103(2)] bwgwb bvevjK n‡j Zvi/Zv‡`i bvevjK _vKv Ae¯’vq wnmveavix/wnmveavixM‡Yi g„Zz¨i †¶‡Î e¨vsK
†Kv¤cvwb AvBb, 1991 Gi 103 (2) aviv Abyhvqx Avgvb‡Zi UvKv MÖnYKvixi Z_¨:

(a) Name (Guardian of Nominee) bvg (bwgwbi AwffveK)

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 (b) Father’s/Husband’s Name wcZv/¯^vgx Gi bvg

(c) Date of Birth Rb¥ ZvwiL

(d) Present Address eZ©gvb wVKvbv

(e) Permanent Address ¯’vqx wVKvbv

(f) Proof of identity of legal guardian of nominee bwgwbi ˆea Awffve‡Ki cwiwPwZcÎ msµvšÍ Z_¨

(i) National ID No. RvZxq cwiPqcÎ b¤^i Date of Issue Bmy¨ ZvwiL

(ii) Passport No. cvm‡cvU© b¤^i Valid till †gqv` Date of Issue Bmy¨ ZvwiL

(iii) Birth Certificate No. Rb¥ wbeÜb mb`cÎ b¤^i

(iv) Electronic-Tax ID No. (E-TIN) B‡jKUªwbK-U¨v· AvBwW (E-TIN) b¤^i

(v) Driving License No. WªvBwfs jvB‡mÝ b¤^i Valid till †gqv`

(vi) Other (please mention in details) Ab¨vb¨ (wbw`©ófv‡e D‡jøL Ki‡Z n‡e)

[From the list of documents described in points (i) to (iii), you must provide at least one document. However, if a birth certificate is provided, it must
accompany a photo identification document of the accountholder. Non-residents and foreign nationals must submit copies of their passports along
with the relevant visas. If a photo identification document is not available, then the applicant will be required to provide a bank acceptable identification
document issued by society’s well-renowned persons* as per bank’s satisfaction. The said identification document/certificate will need to be attested
together with a photograph of the applicant (attestation covering the front page of photograph). Additionally, in order to fully verify the identity of the
customer/applicant, the bank reserves the right to ask for additional documents/information upon its satisfaction, including but not limited to the
documents/information mentioned in the points (iv) to (vi) or any points of this form.]
[a n‡Z c b¤^i µwg‡K ewY©Z `wjjvw` n‡Z Avewk¨Kfv‡e †h‡Kvb GKwU `wjj cÖ`vb Ki‡Z n‡e| Z‡e Rb¥ wbeÜb mb` cÖ`v‡bi †ÿ‡Î Rb¥ wbeÜb mb`c‡Îi AwZwi³ bwgwbi Av‡jvKwPÎmn Ab¨ †h‡Kvb cwiwPwZ
cÎ cÖ`vb Ki‡Z n‡e| bb-†iwm‡W›U Ges we‡`kx bvMwiK‡`i †¶‡Î cvm‡cv‡U©i Kwc Avewk¨Kfv‡e cÖ`vb Ki‡Z n‡e| Av‡jvKwPÎmn cwiwPwZ cÎ bv _vK‡j †m wel‡q e¨vs‡Ki mš‘wó mv‡c‡ÿ Zv‡`i wbKU MÖnY‡hvM¨
mgv‡Ri MY¨gvb¨ e¨w³* KZ…©K cÖ`Ë cwiP‡qi cÖZ¨qbcÎ cÖ`vb Ki‡Z n‡e| D³ cwiwPwZ cÎ ev cÖZ¨qbcÎ MÖvnK/wnmve cwiPvjbvKvixi Av‡jvKwPÎmn (Av‡jvKwP‡Îi Dc‡ii c„‡ô mZ¨vwqZmn) n‡Z n‡e| GQvov,
cÖ‡Z¨K e¨vsK h_vh_fv‡e MÖvn‡Ki cwiwPwZi wel‡q wbwðZ nIqvi j‡ÿ¨ e¨vs‡Ki mš‘wó mv‡c‡ÿ Dc‡ii e b¤^i µwg‡K ewY©Z `wjjvw`mn AwZwi³ Av‡iv †Kvb `wjjvw` Ges GB di‡g DwjøwLZ Z_¨vw`i AwZwi³
Z_¨ msMÖn Ki‡Z cvi‡e|]
Note: If a Birth Certificate is provided, a Government issued photo identification document needs to be provided along with it as per Bank’s internal policy.
wet `ªt Rb¥ wbeÜbcÎ Rgv`v‡bi †ÿ‡Î e¨vs‡Ki wbqg Abyhvqx miKvi cÖ`Ë mwPÎ cwiPqcÎI Rgv w`‡Z n‡e|
*Society’s well-renowned persons include Member of Parliament, City Corporation Mayor, Deputy Mayor and Councillors, Gazetted Officers who fall
under the 9th grade or above on the National Pay Scale, Public University Teacher, Sub-District Chairman and Vice Chairman, Union Parishad
Chairman, Municipality Mayor and Councillors, Private University Professor, Private College Principal, Private High School Headmaster, Editor of
National Daily Newspaper, Notary Public, Officers of Semi-Government/Autonomous/State-owned Institution, who fall under 7th grade or above on
the National Pay Scale, and Bangladesh Bank Officers who fall under 9th grade or above on the National Pay Scale.
*MY¨gvb¨ e¨w³ ej‡Z msm` m`m¨, wmwU K‡c©v‡ik‡bi †gqi, †WcywU †gqi I KvDwÝjiMY, RvZxq †eZb †¯‹‡ji 9g I Z`~aŸ© †MÖ‡Wi †M‡R‡UW Kg©KZ©v, cvewjK wek¦we`¨vj‡qi wkÿK, Dc‡Rjv cwil‡`i †Pqvig¨vb
I fvBm †Pqvig¨vb, BDwbqb cwil‡`i †Pqvig¨vb, †cŠimfvi †gqi I †cŠi KvDwÝjiMY, †emiKvix wek¦we`¨vj‡qi Aa¨vcK, †emiKvix K‡j‡Ri Aa¨ÿ, †emiKvix D”P we`¨vj‡qi cÖavb wkÿK, RvZxq ˆ`wbK cwÎKvi
m¤úv`K, †bvUvwi cvewjK, AvavmiKvix/¯^vqËkvwmZ/ivóªvqZ¡ ms¯’vi RvZxq †eZb †¯‹‡ji 7g ev Z`~aŸ© †MÖ‡Wi Kg©KZ©vMY Ges evsjv‡`k e¨vs‡Ki RvZxq †eZb †¯‹‡ji 9g I Z`~aŸ© †MÖ‡Wi Kg©KZ©vMY‡K eySv‡e|

(g) Relationship with Nominee bwgwbi mv‡_ m¤cK©

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 Legal Guardian’s Signature Awffve‡Ki ¯^vÿi

(In case of non-resident nominee, if proceeds of the relevant account is payable to that non-resident,
Foreign Exchange Regulations Act will be applicable while remitting the funds to overseas)
(†Kvb Awbevmx‡K bwgwb Kiv n‡j Ges H Awbevmx mswkøó wnmv‡ei A_© cÖvß n‡j cÖvß A_© we‡`‡k †cÖi‡Yi †ÿ‡Î we`¨gvb ˆe‡`wkK gy`ªv wbqš¿Y AvB‡bi wewa weavb cÖ‡hvR¨ n‡e)

Nominee’s Signature and Date (optional)

bwgwbi ¯^v¶i I ZvwiL (Hw”QK)

Signature of 1st Applicant Signature of 2nd Applicant Signature of 3rd Applicant

Name: Name: Name:
Date: Date: Date:
1g Av‡e`bKvixi ¯^vÿi, bvg I ZvwiL 2q Av‡e`bKvixi ¯^vÿi, bvg I ZvwiL 3q Av‡e`bKvixi ¯^vÿi, bvg I ZvwiL

Signature verified by Banking Official

Name with Seal and Date
MÖvn‡Ki ¯^v¶i hvPvBKvix e¨vsK Kg©KZ©vi bvghy³ wmjmn ¯^v¶i

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