#ffi%

ffi<ilqm
ffi
<tqq1.17.1 k
Errqrfri -ifrn*r< F;itr.<4'rffi

L.- L-.
I F-2 (Revised)

xnmqr {q6ft R{R RItErlT Tirsr

Mudaraba Savings Account Opening Form 1 6t 8s5{

<lfuRrR
Individual Account

1",6 qqrtrR'r qrefr RrR (MSA-General)

fi,ludaraba Savings Accor.urt (MSA-G ener.al) Korgaon Bazar,
C {qr{m qrefr RrR (MSA-Starr)
{g*utOutlet
[l[ u dara b a S avi il_es A cco !-u,t i h,,l S A- _s taffi
O TqKKf qqrft frflr @5A-RDS)
\,liiLhrirlra Sln ints ,{ccourrl tNlS {-RDS)

O @Tnil-{tqqsftfuF (sMSA)
StLrdcrtt \'lLrdirral.,a Slr ing: .,\cctrrrnl tSlrlS.,\ 1

e) {tr<RT fufi
frrDt Rqi< (N,rsNe)
Mudaraba Special Notice Accounr (MSNA)

o {nTFT slf<q q$ft fr{l< 04FSA)

\lrrti.rr.ublr Farnr.-rs -\iri irrts .,\uroLrrrt (l\1 l;S,\ I

o {4rsrdr?<rqFm NT qrlRrr< 6,rrcDA)

Mudaraba Foreign Curency Deposit Account (MFCDA)

O Tnffiffirm qxrrfu qq6fr frqR (MTESA)

Mudaraba Industrial Employees' Savings Accorrt (tvflpsa)

Rflrda aix '-61;r

Name of theAccount d

frryl-Ea'
Account No

RBfll-rslsrm qtfu m'rs

Unique Customer ID Code
I T lllt
 .{l

ffif
Islami
<l'rqoeqq]rq{frfrFu
Bank Bangladesh Limited
frIrf C{FIfitqGIFf W (Accmnt Qeuing Foru)

fid (DJ') IIE iltorrh)

<l-{?T'ts.
The \,lanug.'r
I ?u4Et <r:<. 4?.1w:';&
lsianr [].rn( iiirrc,rd::h L,nnitecl
1

.........rr?i ( Brancli )
'{ } F,-1 i fi }r fi a f,.'a s.'45 r ut qahir'rA'15
F;I-<.
Srr
s.?.=-4qq4-fT
A>sa la;ru Alaikurn

Trfu/q]r-<l'qTrf{l< -tT:lfr ,!68 ftqK ({lqlT qdf qrr<q:r o<E I qlllz/qlilrl-- fEsiK q"- s <J,Guls ffi oqj et(qrgFF etrdq +<fu
=r.fu"tr "R,trl
detaileil pcrsonal infblmalion u ith rrecessarv docunrents belou:

qlT{hITE Rqt{ {f<ry ERR lAccount's info rm ati on, appli ed for) :

). feqtTT{ ilt:' (4r(a1RI):..

o
Nanrc of the Accourrt (ln Banglal

i<rr6l-r-., ( B lock Letter ) :

MD EHRN MIR
ln English.
t. ftfi:<{ ercfu (fi-o (/)
ft-d) t//Arl<i, " >qevr fu-ryr< ( VSA-Ccncral) :rq,,<t<t qepfif ftw< 1Ms.+-statrl
\ature ol Accr)unt lpleasc tickl: Nludaraba Savings Accuunl ( N4SA-General) Mudaraba Sar ings AccoLrnt I MSA-Stali)

TqKKr rftii Fltr{ qmfuqq ( MSA-RDS ) {r'rs Xqlrrfl q'acii ft{K (SMSA)
Mudaraba Savings Account ( MSA-RDS ) Studerlt Mudaraba Sar ings Account (SMSA)

rynr+r<rkrm o'rftq qreftfuqm (N,{sN,AI yr<r+r onfr<-a rreit Fqr< (vrrsnt

Mudamba Special Notice Sar ings Account (MSNA) Mudaraba Farmer Savings Account (l\4FSA)
ymro t+ra, to gt qrT full< TMFCDA) {F <m tsFil{ tq q{flf-Tq ltpii kryr< t n,t t r s n )
N,ludaraba Foreiqn f ureirer Deposit Acccrunt (MFCDA) M utlaraba lndustrial Emplovees' Savrnqs Account ( 14IESA)

c. fiqr< (?rrflK Bml] tfi-+ 1/;fra1, <i<ql v6 qInnr c<FrR'H w+rri rBrg:rop+): ....................
Purpose of A'C opening (please tick) Busincss Savings Coliection Rcnriftance Others (Mention)
8. {5t1ft-5 1"',)fr+I, U4I'I tBr.<'r ' "frus wrn-dr.
C'urrency (please tick ;: Tak a L)ollar Euro Polrnd Others

o fqr< "rfrur+*r
q(€.-rs rilTqT ifro
1;;fral, -G* d'?rolr< fi Fr+ qoq4 .{cFIT qifus q"i qanm.......................
Declaration regarding Accotuit operation: (pleasc tickl: Singty Jointly Either or Survivor Others

U <lTsrs "rfuFli.iE
Is
ftql< wp fu tfro 1r'; fr+1,
Accounr maintained iu Bank (ilany) (please tick) Yes
,1No
Gg< EIt qrq,
lfyes
-{rr.(f4il TN qr{K dl5l RcKq"' affidigftryrr{ er6fulftT (r' )ftnl
Bank's Nanre Branch's Name Accnunt No- Nautre olaccount opi'ratcd (piease lick r

6) s) s) qnrfr{K n ffimrfl/qrqfu{l< sldJ i.l.(

?i) , Nlft {)

rt)
Deposit
q$ fu<
dC

Deposit AiC
c5nTFs,]<
*'
ln\,r'\lrnL nlll i,nn q/('

ftfrfT,,16lqftq6
- lnr"*t."n,
U
|--.'r
I orrr A C
ffiafiur/sqfTsF
Others
qil1.l,
Others

wilFll
fl) fl) Deposit Au'C lil\esilIentloanA( Othcrs

(@tr
 .I}
qttrlETiF|ft{<ffr€{Gct (If the spplicsnt is minor) a

q qfr ffiioftT{t11arf-nmqil'rq s< ?T{ ofusrro,liis:< srt a6f 66"x +<fu cq, lqqr<<T4,,ft4<qi}qq amlqo E*p7ra er,srqifs-g<r q'.{3'
-um f EaK .(fu? <fu qrq;rg oq ;afif) {r1-* o{f q1oT r ftTKtflA qtaEFF {r qs{r flris faqar qNK s-.'to "1T{6 6sT{qr 4t rqTl "Rfs fui<fr c<t
qfusmo fifqrd qTK Tf$fr "fF<DrfrE {C{ r I. bcing the legrl guarclian of the account holdcr. rnentioncd belou. declare that the irccounL

majority (atlult) or any, iurlher declaration is gii en b1, rne. the account u iLI be operatcd b1' n't. berng the lcgal gtiardian.

s. ftfl<flai (;tl<lro) €{;il{ Nanrc of the accourrt holder (nrinor):..,..... ...,.,.....8;1 =rfu<Fgo Date ol'Binh Age:.

l
{. fu'K{Tft d]l
(dr<r6r6) €F Nantc of the account holdcr'(nrinor'):,...-....
tt. frql<{fr (ilf<fE'o) {{;rN Nanre of the account holder (trlint-.r):........ Nla HHffi3]:t"ix,ilii.
>. qfugf<p<;rl:i \iu'nc ol the guardian:......-..... ..... af<mro< htzcr TPrf (Retation u,ith tlre r-niuor):......

qe-r'ee]<?-6K aTEF< ( SignatLlr-e ot'the guarclian ):

(illrl{s ,!<i qtvsi<o-Gerir< Fdt '<rfu ctstB s-qTr={fif' rF{:i T{cr o<rE a(< €<( Ug-{ +<ra1 qfueI<iq{ aFF{ T{(g eT{)
CIF form rnust Lrc filled in lbr both thc ntinor( s)ancl thc'gtLlrdian- Both the lbrrns ltlr.rst ire sigrrei-1 bt tlle- gua;:di;irr.

qffisg{Irrr I'ormrtion uf the Introducer)

e(*nro, IYID, MO-N-*I LI-RV I- E

Name (ln Bangla) ( ln Englislr t

(q) ftqltr+d {Fr (Name of Accountl a-lc?-6irE r I rr Lrgli:lr r,........ ... M 5A

(ai)kni<;R, 7_25 3;-itg *f4;,g rrA at,
Account No. \elrorrrl lD \o-

(s) .rF*dr{ (Branch *..n''"r,.....Kfl RGIAo-N BA 2ft3 A6 E T BRNKIN6I

(g) mffi:flItm ETrtr:r (\4eclia o1'Contnturriuation)' dfurrna iTcl cph.ncl:.......... crmltn4q (Mobile Nr',),.0-X9.tL.6lS9(.0

(E) E,n.rptovee 1D N(). (4kb-?&-f{oril <rf(r6{ StalFqF) ... .{5.[6{ I|r?r T@rd (Rclatiort u ith thc custo]ner):.......

(E) qiF< 1oft=eat SignatLrre (r.r ith Date):...............

qitRfgqfWGff E-U (For Brnk's use only) t

"rffim iary'<,.,p46 e'i<. . ........... dTb-sn :r+l?l o-.6s' flf{E{ eqrfi q(?0T: .. .. . .. .. . ... .
A./C opening datc o1 !ntroducer Number ol'introdtrction gir,en bv the intloduccr

qrli F{flF{e]ii G",Krs q{T:rcrs1< <ru? +z<E qqrl:iq Sc,'eenir,g qfuv< $(I({ qIg.r-erft #IlTn or<Fi q<( qt:m(
"rfit{EEr6-ral{ E?ll-4lE
efsj_lmo{86T.ftfl<(?lEIlTFdr"rffias6Erc<r;aiFa,;=qj?><qeqs<l CTrs4ir< l.theundersignccl.haveirlilledtlrcrhore
alccortLlt ma\, bc'accclllr I

el-',c-j-S{+1ft< t r,'. ri 1'y i n g r F.nr p1 oy ee I D N o ..... Esr{-d-flfts$s6r OET$qa{q{s( e ufr{)

Verifying Oflicer (Seal rvith Natre, Signaturc & Datc)

* q.rr<r+otfr <lr<rqE r6ia ffie €rao EF. 6ar< c<tq-:r 6:fur{ trgD qtrtm qffi sIs-R kqr< carEr rrcg '[16<

* qtz<q-rodl <nqzs:I Errplr,ryee ar.,d HItlVl svslerr q< t)at| ( ard efoliril x,f.'f(tF fizm carcn GTF 'iTr{
If th.e applicant is empiovee ot the Bank. account nray be opened atier ver-ification of data card rhrotrgh HRI'"1 sr:terr

qfrftq(EltlrErff gnformation of Nominee) :

b. .qrfrfSw{r et frnrm{ srd qxi<aqrqrcq-< Iyr< fl-{ nr.frcst< f;lHIF Ttrsro qEfFEJ Fd{ nrIInE <-r+n ffifq{Tr Wtr, :rFrFr{r{ C{ crt{

cril <lfuE qF|$K we<$q $k qfivffiTr {1 {6f 'qrfl }rqG e-r"l{ sr& c{. qTl</q1-irTrq{ ftfli{:{r GrElr<?F affr(qr.r. {,T(s
ER:r6 qr< {
as-t-deiz{ r ;rftil f{-q fifiirg q@g Drcf ffir+'n firf{ qta]r< Ere<tfroftq< Trttt <B;I rcirc<;I I/We nor-ninate the fbllor;r,ing
person to rcceive the balance held in my/our account after my/our death. I/Wc retain the right to cancel or change this nomination at any
time. I /We hereby accord my lour consent fhar the Bank shall not be tiable in any manner whatsoever to make payment as per rny/our
instmction. T[e nominee in his own rcsponsibility will distlibute the rernaining balance among successors as per law of inheritance.

ffi
 r)
-a7-7? ;-,; . \.::t -, :,- _ - WZffiffi t<) ful<;l (\umber oi the -\ccount I

-
^--I; < ^-- I \.,11-1p--; I \-1_ ......... (s) Fpr*qrrr ather's \ame) . ... ...
(:trTgKETF (\lother's \.:i.]; : ......... (r) +6-,m* (Name of the spo.,.";,..fl.

{E } ("rr rOc.)pdtiur'r r (q) Qqf<<tft-{ arrrl q-;f (aslation with A,,C holder)
\.4
;<E;' n;ra / ErQfr\ fltffiq / Afardfr<r-Efrg qEfu ffi'i (National ID ,/Passport i Birth iegistration
=E
Certit-rcate Dnr in_s Lic:l.e L i \ \o,:.4.8J 4.647r. .e.A. A.a.A.... ..... ...(ot"f x<Xos:FI) (Please e

(.le) sarEri 1>Tlfie1a -J-< <3r Others (mention specifically).

oQ,- 09- 797c,

i -

.
r -Ect-i i-= D:.- . i B,ntr -\ge:

f-i \-- : :r.rnenr .00...r,....ffi7ft PI, ffi

c- &rfr-,ffi{rflilsl ,r.3
F n
"n
. z-=:; ?-- p, e s e,t u 00..,.,. ....fffi .?fl.g.r. Bifi. v $..ffi,fu ffi I'gl
; ;* r<-<o <Ff 1'ts+<'f {rc<) If nominee is more than one (in Percentage):.......................

11 ;-.fr a,-drd6 sl6q-< {66s qqtx Rqmqft /fuKffir'iIqr {9j]I CFc <lTcF' a+]-ffi qtq, >sl:
f )
{(E E.]-{ / e1-51
qEla1s{ Etot ECq-dfr-{ ERI (lnformation of the receiver of deposit in favour of the minor while Account Holder erpiers keeprng the

nominee in the age of minor as per Section 103 (2) of Bank CompanyAct, 1991):

i) aN (Name):

ill Flgf / {fr eTaE (Name of the Fatheri Husband)

iii) s-{qfr{ (Date of Birlh):

ivl r6lf+ t+tqt (Present Adress):

^.r/A
v) {ft fu (Pennanent Adress)

vi) .+-fr=+'<'qffc<?<<sBr=t{CT.< "ifrEGi"fE{(@]-gu{I (lnformation regarding identity of legal guardian as per serial no, 'Jha'):

vii) ;tfrfr< Wnl +-"k( lRelation with Nominee):

/6P{
ql6<q-{stft/R{RT[ft -d.tlT-{
I Mcl Mttn .urul Haqu g
,Ia tl l(
bth;
sufr{)
Signature of Applicant/A/C holder

a cata qffiro qfrft c{t {i:E ,i sffi qqEE frqtrE{ qd Et"r <E ffe qd fttqTt cef+ct< rrrE frqtTrd 1qInp15 g ftro"t qttcq* ffi fr<la er.zIlsr {.-<
\ lfthe nominee is non-resident and when Lhe person is entitled to get the amount ofthe account, in that case the existing rules ofForeign Erchange Regulation
Act sha[[ be applicable for remitting the fund outside the country.

x 4fuft ,{olka qr{ Ff,fl{ et q!.-t Tdffit FK {{ q"\r"K C]I?t >t({s; Tir(g Rr<
Ifthe norninees are more rhan one, photocopy ofthis part ofthe AOF to be attached with the original form.
,i e{TEq{fr{f,draq'rq eE|{TisRaK cqfqF 6rysqqfi-a6qTd.n"tcq<qfufr-s.tq+,frW< qffi-<qtmoG-qr'{ m con qfrffi'"iqq6FitrtrrEiEF I

In case of opening of account providing only Birth Registration Cerlificate, the custoruer must submit, any photo paste ID.
* faffilaptkco< c+rq {rqrtf, ?E{fu e{q{frFt I

Copy of passporl along with valid VISA to be enclosed.

drelfrf q{l € \{[{fuSSq (lnitiel Deposit tt Source of tjund)

)r. srqfro cnr{ qfr:[Ffa.......... Qaef q{EI <;Fi IfrT (./) fr-{l ,6* 65-$ EIE'Fr<
.\mount of initial deposit Nature of deposit Cash Cheque Transfer

,tao qnT {rf,, O,O q( (lf deposit by cheque, cheque No)

>>. etrfuEsc 11frffi c ffis):

Source ofFund (Specified and detailed)
CCilail?;ccil"TrQ); U'F r

t-t -a_- t-l -a_. t-I.=a--a=a--f rea r

 lr

ql{frf <rRrFR{Fffir (Modern Banking Facility)

51. o-5i< .T!.ft( c{<l : ffifqr++r frrars qT{Fis-<rGR. fl{t <;T(r+-{ 6w8flft er*t erco iq+ tfrs ("/) ft-{
\locern Banking Service : I,TV'e like to avail the following modern Banking senices as per Bank's norms :

p,/OnJrne Sewice ,z
AIM Sen'ice 9- i-Banking /SMS S".ui"" Others

€ TIT'{ (Dcchrotion & tiisn$turr) :

CqtqEIt

)o. qfrlqlq<.l qE qc:( fiTTe-l eW{ q<E m, qfrlqtra| QqR qicls qTeT 1ffiAiffi "rcgE e<( E-o Fmtq+frAffi 6{c{ t{cg <Ffi
en-f,d ffifqT{t {6lrq ffilT"fi +-<E m, EI$FM scBIfr qEI q<( q|frffi q[s E?RIfr-r qfufrG a1qrf,{ flRq] fllEtr{o sq qFrflfr q-{{fiq
j ssFt I I/We, here by, am.iare confirming that I/we have read all rules/ conditions concemed with the account and will be obliged to abide by
those rules/conditions. I/We, am./are also declaring with conscious mind that the information mentioned above are correct and I/we will
provide all information /documents as per requirement of the Bank in addition to the documents provided.
I

(-) o
$ 6r{ 6-r{
6T{
f D
qlr{q"d-sft{4T, q]-q< ig stfrrl qlr{c:fflArrTT. -{,lvq e ffiq ql<Effift{{]T, qlqg E glfr{
Nme of theApplicant, Signahle & Date Name of theApplicant, Signature & Date Name of theApplicmt, Signahre & Date

{IRTST<Iit{frdTE;R 11; or Bnnh's usc onlvl :

ryaJ: (Remarks) SBS-2

Tn
r &E aP€
<Rqfrq,t <]t(s
(BB Sector Code)
6q.a-{ afis CIB

Type ofDeposit t a 4

Md Hoque
B.nltltl
tuR ,s sfR-{) q*qlq-{+Ift Tfssl ("fl{l.e{Fr) lamT.s frq-{e.tTF{ e otfr"g
Account with Name, Sig-nature & Date) Authorized offrcer (Head of Branch) (Seal u'ith Name. Signature & Date)

'H
 RCi-{ q$t aG; qt$fif gn1ffi qAq C ustomer In form ation Fo rm (CI F)
l: :- \l,r::::: <k=rl'earl

-?
-
NameortheAccount 6lZ ErdCrr
Account No

(Unique Customer ID Code)

(ftn< c{raF ql-6<q-{-flft e+'fks<lfusmercsrrm+-<rn-?r qEqct (TffitTL<) qfElqM-r< 1qffi+-<cm{qq(rficft?t{(Tg$irce<<)

(Ifthe applicant are more than one, photocopy ofthis part ofAOF to be fi1led in separately by each applicant and to be attached with the original AOF)
o
o
). ERs/ C<frftc'rTlq. s{w 1frEr{-.+-{1.]{ (<tRqts) o
NameoftheCustomer/Beneficialowner/Operator(InBangla)
MD, CHRN MI e
In English

r.. frqfm-{TEqrgr{ (Relation withA/C) :

-/
{qwqrr-cte-orAT 6{qr<T{fl-nT g0rstr<nr+tft 4Ff{$ q&sT-ffi qNEft Rr€K q".frnK
1st applicant 2nd applicant 3rd applicant Minor Guardian Attomey holder Partner
e==afr,crzgifr Rll<{ffi| "TRflSF
qs-+'rgr&fift Bffi q-dTFl
Benet-rcialorrner Operator Director Proprietor Trustee Others
r.<-a?,irif of+6r

.e.
Chief Executive Offrcer

Fqsqm(<REl-{) &..,.........
t{r: Wfrt
Father's Name (In Bangla)
isrdQ-cu (Block Letter) s.
D. SHUKUR ALl
8
In English
E1EK {N (<rR4tS) 3..'..........-............
I
q-
t
Mothet's Name (In Bangla)
?<r*frru ptock Letter)
D BffNU 't
In English
a qtfu€r-< Tlq (<REIT) 8..................'.'....... -J \
Name of the Spouse (In Bangla)

t<<Qto (Block Letter) &......

\v.
In English
qft-sT&..-'.-.............---..
aly
Nationalitv

1. F{oll-ir{ 8...
06-.... o - 7q8B
.... ...... ..
tref t-o ("/)ft-{) ,6^ {kqT Eerfr,
Date of birth

b. q-{cr{ (6ht{q) &. ffi....'qreT.*-*].I+8IA5Yru-675g8.H::::::::::

Place of birth (with country) National
b. ("pfl (ffis urfllTfu qffi qq.l{. +-fis {r{) &...-.......
Occupation ( Please mention in detailed and produce the related documents )
)o. qtfrsqll, ffiqffiqq (Monthly Income, with detailed documents ). "lo
))
Passporl No. (if any) Date of expiry Issuing Authority

Birth Registration Certificate no. Others (Mention specifically)

E-TIN No. No.

)e. (9 {6{l-{6s.rdt (wara-qq') 3.

Present address (Residence)

o 6ta D7
Telephone': (Residence) Office Mobile
({) fu{ trf,;i lft-r (/) ft-ql , ?"iGr -€Self sM eftSl{sqoerg w{rfdr (&s-trs-fl{):.. ............

Nature ofAddress Patemal Rental Provide by Employ. Others (Mention)

 Previous address (Ifthe Residence is less than 03 years)

Telephone : (Residence) Office Mobile

t-r41e. (E-mail) B ......---......--.. (Fax
)8 {ft fr$-lTl (Permanent Address)3
)C. C"f"lIlE 6-s.l-{'f (Business Address) 3 ...............,
* c{ aslT qsfrft;oET{ olCF proof of documents Eq];ts-{rc-er{ |

)\b. cofrE+f6c",@fssqf s t{rolftqb$l-{ \e sl6i-{{ s ()) qfiT (t) qru.drGo

Information regarding Credit Card: Issuing Organi zation & Card No Local International

In case of dual citizenship (\) llcrffitTi$].fr r-v.olr lpassport issuing authoritl,)

)b. k-{tfu'q{t ltr+ 121611 ffiF eturks v€-rqto$d

Marital stanrs Nlarried Unmamed Divorcee
)b. crtxrc-nffxLtro ("/)frdl s vG aa-ff
Residence status (please tick) Resrdenr \on-resrdent
lo. qpft efc-<"fq6d{ cTlrftzTlrrii qnl nZTftE TIfuFftT s-.,t6 nzalnE fr-$F T<-+.-ai T.filoT (Nominared person substirure go\.r, olficial nominated by
respective offlce, in case of em ergencr, correspondence ) :

rlr (Name) fron lAddress)

ftcmqil/RqT{ 'rffi<;,nq :-rf (Relation 1ith Accounr Holder/ Operatorl
F-otq (e-mail): cff{E{(Mobile) Ntft
r) EI4E6{frHfss'qfifr T<"rF-{6{{ (The following information to be filled up, if the customer is student):
qi\,sRrsr TI{ (<t<ql-{):
I tir<-qtu (B1ock Letter):
CLrardian's Name (In Bangla) In English

I Fm qfrd-rr+<qm e ftolqr,
\ame & address of Instrtution

It. +*-Gfr6st +camft SrE fit3;o.r-ffi tr"l'F<lT{ (The following information to be filled in, if the customer is a Non-Resident Bangladeshi):
Passporl No. ........,..,.,... , Date of Issue..

(lf available)
Date of Visa
Issuing authot'ity of
Foreign address
Msa........
Validity date of Visa.....
Occupation.. f{ tft
lo' Introduced by Bangladesh Embassy/Bonafide Account Holder of any Branch/IBBL Representative
working abroad (In case of those only who
'"vish to open account from abroad):

Seal & Signature (Ba ngladesh Embassy/Account Holder/IBBL Representative)

Seal & Signature ofA/C Opener
i8. $t s FATCA qf ilErd-{E-ar 64rs,Tftor? qr n{U*qrq6{, FATCA q6qlfiq-flrtnt"€.p<<,
WhetherthecustomcriseligibletbrcomplyingwithFAfCA? L yes l. No. ,tr"orTlry"ncemustbeensuretl.
I 6r"l t
qr(<c-ffifu/ RiR {Rumrt$tfti rfTir, qRfiq
(Applicant's /Operator's Signature with Date)

Md. urul Haquc

aFri€s{fi,{) q-*TEffitft Tf$sl (.ll!rl eHFr) (TlrTE' qsifq {sr e vtR.{)
Signature & Date) Authorized ofiicer (Head of Branch) (Seal with Name, Signature & Date)

e$lEq{fr-{fl{T{T"lqqkT{TfsRiT{ (?flql< ct.rqq{fi"{fic.Tnlr4-{qGfr-sSt{s/fu<

In case of opening of account by only Birth Registration Cerlificate, the customer must submit,
tffirrcfuqrcfiq,|q
m csl{ rR6t'9iq qq|{q{c'9-cr<
in addition, any photo paste ID.
,{RF/ ft{R ffilfA{lFIAT Proof of Address qd {"lCT'U{W+{ q\rR
Sif6s {f,{ I Documents to be collected in favor of proof of address of customer/account operator.

H
 ffi<rtq-s
@ <t(qtfin frfr6s
rudil'cif, iiltiifr iidilnbiNmc
,\,'.. 5=:..a. i. i.- r. r.... .i , r1...- r ..r,lr I
A/C No:
I

1
*@Too L9
I Title of Account: E6
aTllFfiq+f f-aa FuIt -vame of the Sigoatory) q{il TtFn (Specimen Signsture)

1 ear\8 6\a I
/6h I 1
-
l
,ot I
larE I
) L

.-1

qalq fut'qif
tqE qffl Speciar tnstmoion (if nny):
\5
6-r-{ J

srl;;i#^[o#$iltffi11 H uq uu o 11 16I&.q 45+ Authorized Officer i Manager

lslamr Banl Archt Brnhnt
MH cI,b:I TGCh
Ku4rrft iral [tur& hrflrt|rrrl Date:

Tt{t atrpl efiqq(qT EFI WT 'rfft{ fiEtfu ecf (In case of specimen signature ls thumb impression, detailed information of the witness
is required)

q€-<"IN Qr{ame of the witness) :..,..

i

I
si+$ flRD-T"rsr( (NID No) r........
N/ft
6Grol-+/mRt{ (Te I ephone/Mob it e )
 csrrcqrffiErlfu qfdil 0ransaction Profi le)

Rcf-r{{il{ (Name of theAccount):

*^tzfiww
* Etf-q,
ft;t (Dav) {]I (i!{oilrh) <9( (YeaO

qffr-s qfT (Monthly Income): {o;

{fr-{wl<l DI"feW (Monthly Possible tumover):.. Account No

r'.rr qLre ('L sonrer ID Code)

WKf E,qt (Probable Deposit)

qffierfs {fi-+qrlscRrt ,4F€qTI{Cr E-"tRTI"t 61b{tft-{qrrtr'tRrtEl
(Total montbly deposit)
(Natue of deposit) (No. of monthly deposit) (Maximm amouni ola single deposit)

Trfnq{f Cash deposit (By self) \9 Troa,6W V, aroq7ft

flEq{I (qr{l{E1fl) Cash deposit (by Others) 8 Vo,66Tf b ,6-D,aaTp
cEr+TrI{mEErFt{ (Transfer by Cheque ) :. Go, attb Ooro atp
q;rirqf @ .s< TltrrrTolqrF'K (Transfer by Orherst

Elecffonic q{( ,!<{I$mq$

(Deposit through electronic & i-Banking)
?ffiFiT mfirlt ult loeposit as Foreign Reminance) 6b
I qEflft Fgift <o qm (Income from Import'Export)
"lfuilqBAq'K {cuq{f (Deposit from B.oA/C)
I (ftfft ofl{) Othe$ (Please Specify)
q-{if-{r
mE rot<T q{I lqlfrOfotal probable depo sit (Monthly)

wf<l E?reIdI+ (P rohablc \\'i thd ra 11 x l)

ft-sldrtT{erffu {frsfuqrrK{$lx qqs Er€t{r+-{ {rfm "rRnr-r F-;+a arerecr{ 'lfin]ct
(Nature of withdrawal) No. of monthly withdrawal) (Maximum amount of a single withdra* a1l (Tlrlal monlhl\ u ithdrau'al)

flqErct+-{ (fi'cw) Cash Withdrawal (By self) fc 6a lg,6o,6Ttb

q{q&sfffi (Hr{I{EkI) Cash Withdrawal (by others) \9 Ao, caTF b,6v 6Tnb
6Erf,{ I,t<IGTElq-s]T (Transfer by cheque ) ) Eo, tTdF d,66TT
qqfl-n'tqtITE ,4R ${ffi,ilqrFK (Transfer by others)

Electronic e<( qiRftq q{ TFI-jTT BrgFH

tffi
(Withdrawal through electronic & i-Banking)

|ffir+ ffi5a a1-aqBr<lfi (Wrthdrawal for Foreign Remittance) ), 60,a-66F >.,6V,626F

qjlqfr ReIft <t<q "tkc-rK lrayment for Import/Export)
ffifiqr<<<qErst+r (witnarawal for B.o A/c)
qi6r 1ffia-e-a) Others (Please speciff)
6rD-wFTETgm{Gilfr o)Totalprobablewithdrawal(monthly)
qtfr/ffifiBrffi (?t"f) ,4 {c(fi,5TEt eW{$<E c{, wFt c{1fir{{q{frs{liqtqNK/q$rq-<-{]qfr-s/ef.$sr{-d6ftr ErtlsT!--<Tql.fifffi
etr]-{+.{E R, qlql-qrr<lc{ffifqr:r<tw'r<l 6{i1I1-fiq{fis{re=l q-(r"ffflAlffiHmT<K r LTVe, the undersigned, conhrm that the above transaction
profile is my/our normaVreal transactions. I/We, fuilher assure that I/we will update the same from time to time, if required.

) .{r{+/f$KqfiElr+qft* .c.
\ t ,q]-<:f,{fu]-{ffi}I{-{Trfr{

$Hl'fifly,":::::: :
tlF{ (Singature) .......
ffit mwr Customer's /Operator's
4N(Name)
{qF<t (Signaturc): ........,.......

ufr+patel
" ffi+ patey
rUEf€l8{qnnTEffi (for Bank use onll')

<l(El-fi-i efffim iEfrCF{ frcAFT ffifslr<?F EI<FT Wl-<l cflrqrlT sXfre {trT {.I1ffi}-fl T-{f CrEt (Transaction profile of the
t(iGIqE
client is changed in accordance with the instruction given by Bangladesh Financial Inteligence Unit).
Ef{-f,{ WK .{irqr{{ w{fis {|EI "tR<-6 4-{I/ 4l S<K +t{t (Causes for changing/not changing transaction profi ofthe client)

ereTdlrfa svtk.l
{nrili lilt*gs,,u,rr. & Date)
MH
Kut3aon Bazar

H
 r}
.{Es ffiGe
)
Name of the Account (In Bangla) Accoonl No

tsI(Qzv (Block Letter): MD. CHRN MIA (Unique Customer ID Code)

In English
r. ftqlr{{eTG(ffirc) M3A
Nature of the Account (detailed)
s. RqFI;t't<,
Account No.
e. iBfr-+eI{s$tfu c+rg,

a.
Unique Customer ID Code
Qp55-s ("1.[ (fr€-fro):
Oca4afion of C\stomer lDetailed)
ffi ) ffiIIE) l

s- .rlt<€T|fi'{6ffigffi:.. i.o 2 {.{ -tr}:

t.
Probable monthly income of the customer
wtr* trs7trlsrqq (ffis)'........
Source.iS ources of Fund (Detailed)
-ffi ) )..
I

b w:d< Esc'fifue ffilfr csr€ c(tlQe Iffi (Documents collected to assertain the source of fund):
)).. a.) ......... o)
* x1Qsq6flfrqEts-<t<rcsft'It IF-s (,/) fr{ r.I
Whether documents collected are verified Yes No
b. tuR<Tft-{6$r-dr (q{q) fr-srm{rtrt+<rqcrcs 1frua-'; ..
How the addresses of the Firm have been verified (Detailed)
.. .8) VI9ITINQ.. N:.ID-.. ..........

>o. frqrF{ qTv rF,rr6rlft (Beneficial owner) frfi{ c*r^qrrce f., ()fuqL- ,4-
tfr-+ + i E-e-{ qT <8, e1-1s nRnz-,tfr (Beneficial
owner)q{qIcTt'TI clFc(T6 TCnE-{fr? (r{(/)fr':T) TI 6t
Hasactualbeneficialowneroftheaccountbeendetected? Yes No.Ifyes:HasseparateClFofthebeneficialownerbeenattached? yes No
)). "GGG"6qaq1frft, "flqrffi q{fr{s:T{dq,fE i-fi-+{+n"fq qfttv<qlEcc-dT I q{i6i(Eq.{e*-q),
"^ffi"rfrm"fE
Photocopy of identity: Passport National ID Birth Registration Certificate E-TIN Certificate Driving License Others

x 1RGG,rE{m4-<tcrr.aft.+ t$-+ 1Z)ffi ,6 "ll

Whether identity has been verified yes No
)\. qfr<Ift e<\.fr6"ftcq-{fu< c{FrK 6TrGr:
Applicable for opening ofNon-resident and foreigner's Account:
F) B[a{r @urpose):

tD F{'-{!e (SzlTqr 6FrdI) Work permit (if applicable) :

s)<iRs'fut{c{FTErq{]{?t[$f +-v."tm<1q$qf[{<r{rqfr{|lfrf ('/)ft{le t q]- , t4I

Whether has he/she permission from the competent authority for opening Bank account (please tick) Yes No
)e. qt<s' "ifrffi qqc"Il ls
'fl<+.{q eEPyeF,-IT.irfr vG/9tg6eT cq{K E{-{iBm. fl{ta-{ Fffif q<\ El6q3r close Associates fr q[r 1fr,lvwrIlB
{frR e <fu l(E.fficT) Is the customer PEP/Influential Person/Head./High Officials of International Organization & their Close Associate
(As per definition of BFIU Circular) Ot 1V"9 i {l OIo), Us-{q|qrq (if yes) :
o) frfil-*vxnsnr+<sq{cqlr{cdtrrqcvqfrdlF+(/)n-q s
Whether has he/she permission from the senior management (please tick)
- qf
yes
.ll

"DqRrf-{W3"l{ft{-sFFl{ G$Ernrsfrqlz tfio (/)691 ,

No
! q.r TI
Nln
Whether has face to face interview been taken from the customer ? (please tick) yes No
)8. fl q(eB qlt+, frRrHI e qf{alrd{ q16a16$ AR-o< ilq qTB{\(sT fr-<r"rq flkmr{ fre{ ffiEqq-tfi{ qfsEl-{ xqlT, r-qTfr $I( \3 <il"ts lK(qrqs
qaft-st-*qdm'cqq&sqrq-rqvlfuffW csFt'<iG q<(<t(El6q".lT{sl{F-qsEIfrsr-W 641-44fu-446sErfr-fl<qtr.l ittrtTffi c+F frE "ifu
rs$fifficsft'qlr tft-+ (/) ft-{r s {ir iT
At the time of verification, has the name of the customer been found similar with the sanction list as suspected by tN Security council in each
different resolutions with regard to terrorism, terrorist activities and proliferation of any weapons of mass destruction and also black listed by
Bangladesh Gort. as per concerned acts, rules and circular [please (/)tick] : yes No.
E-e-< tn <e 1Qs or{< fr<-{"f:.............
Ifyes, please mention the steps taken in detailed

"I)
,fl{rf,{ TIT 6sFl' Sanction (t Adverse Media Report EtcS fr' tfi-s' frT]
Is there any Sanction orAdverse Media Report against the customer (please tick)
(r') gl
Yes
4I
No.
/n
* Us-{ fu E6T oIQ v vaqm fra<"t:.................................
Ifyes, please mention the steps taken in detailed:
^r
 :C. AfqS frTLTVft f<rq{<j<q1mffi<T{fCq (What the customer does/In what type of business he/she is involved)

rB (sc

{J?l{l Business of Jewellery/Gold/ Precious Metal) c (s)

fl.4il.ir,3'\LrcrtL'utlIt I1:rrrl'::Ii t
31-s.)
c (s)
frrsq erSE 6grq'tB/qrq't (Real Estate Develooer/Acent)
8
r (5)
a (5)
c Gqrl Paintins/Antic dcder)
g a (5)
SrR^{r<lfi-s 6(tdFr/efm{ airrtt (Resrauran/BarNisht E]qb/Tt9$d$tlgl HotelParl-og Bt$Ecs.O
a (!)
I lmfiftf{slfr \s qFiqlft/itffi qrqb [mporuExport & tmport Gxpo{tAeent)
c (5)
E. qrd+{ qr{ry!fir{tC qE$qfr{f{ql_{Ei5r (Gametrls business/G_grment B9t&$9ngs,tsqylqg House} - c(s)
b m
a (5)
)o. <l"l-ffi frfrrfltf{qi Onvestor of Share/Stock Business)
Stft <rrfi 0vtanpo*'er Export Business)
AE
)4.. 915)
o (s)
)9
a (5)
)8
a (s)
lc, {+B,gqrfd1r.{A'[Eq] dIftBqr{qt (Softwme BusinessBusiness of hfomntion TechnoloE')
8 (4)
q66 (TravelSqen0
8 (4)
)q. qfird
8 (4)
)v.
8 (4)
)b. q6r fr-drl< (frirfgt{ flfr) Auto Dealer (Reconditioned Vehiclel
8 (4)
lo <r{Ct
8 (4)
<K{t
8 (4)
t\. 8 (4)
Q.e. ffi{(erffi/ {RG-rGfrtts ciFrqf{) t Private, Public Limited
\8 s{furs$q6r of Multinational C i 14)
s (4)
)11 I lqlfq.ll!:i
ts.
t

EelT-?t{fu 6Frq Elit;ff (Job in the Information-'lechnology Secror)

I (4)
5q c"Irqrrg/frfu$ (IFIGE/ qfrB{IT /&1<3( Media Celebraty/ Producer/ Director) !11)
8 (4)
tb &qTrq qTi\efi( cscsqelEt (l'reelencc Software
a.b. ai<-fi-qrqt Bu!r!g! 1S!41
(
I (.1)

9o e (3)
T{fiaf (Governmeot Employee)
e (3)
Ownerl
e\. <r<qlft (qqlg!:Jlqe Businessman)
s (3)
s (-j)
tk.+c{saE<i{ Cr
e (3)
98. Ef{lfsfrrfic{&{ffiCl Business)
e (3)
9C House / Park
s (3)
<r{{t Parts/
91 Sewice
e (3)
Educational r. (2)
9b
r (l)
\9b rr1ft Service (Prirate)
8o ffi ffi@-'ffiElra"srffi Small businessman (Yearly tum over less than 50 lac Talq)
I (2)

8)
8\.
Proffessional) -
-\Er-(21---
--
/ c{lqlt{ mtfq< fuqf< ( Dcaicr of Computer / mobile I'honc )

8e. Produ er \ (2)

EIF a.il)
8C

q{iFr
(Retired persoo)
(Farmer/ Labourer/ Fisherman)
Others (please mention specifically)
;tr ) (1t

)-a(1J)
81.
,., KyC cfodr gr{asa <i-{4;ril-{ <r (4{1-g e-.+fu, <r-Earr'.ir< srnrt. qF-qrailit qfof<, kqn<-< erfs d<urrslii q-'?ts fo{;Fi{q F{z<Eal-?r
sffiiGf{s qiffi
firq grc<rgtn )g-a q g.frm E.1&; c,f.f6 ('rm <FYs 66K q(qw e-s.
ETa
csilr ERrn <t{IEi {Kr< I wa{qa-{Tft Ers Erq. E-q;

qcet<e< fi-* ft +-{cs qr< "

tfr r

In case of scoring as mentioned in the serial Nos. 16-47, the KYC executing official may mark the score high, considering
customer's

nature of business or profession, area of business, size of business and beneficial owner of the account. If the applicant is a sfudent, the
guardian's risk scoring to be made following the table.

)g. {l-q(q{ {Ifr-€ q1-69{ {k{t"l' (Amount of Monthly Income of Customer)

c+l{ (Score)
"lfuT"i Offi) Amount (in Taka)
) 4s lfs (1lac) v6
)(1)
> ) E[s e 45F'l{g (above llac to 3 lac)
e qTfa{s (more than 3 lac) e(3)

H
I
,{},
)c, ftqfd ("tf4fd {?I"f (Way ofAccor.rnt C-)peril.ng)

C*-RI (Scorc)

6;
e (3)

r: . tffir*rtffiffihibe.l.,+fi?]ffi8.).iij-, I (t)
o (l)

)1r. '{l?[FT o:.:= r+= '-;'-;';.? "?r*"i 1,\rrount olp'.bable rronLhlv tra,s:rctio, of custo,tcr)

cf,ilIEz;'<'<afd :
ffi (0-5i
ffi
0W
#ffiffi
4.4- o (01
-7-: . .a:-; r* ,3:1{t
=-
i -,r.,rr Lr tr Ftr rn lacl ffifire
sFF:FFr=i-
>:o {>J.0)' e ll)
H4Effi ffiE
{fl4
(
af,;t(E1;t{ {(?.Tl
Nurlber of Tr ansaction

(q;r(qri-?I 4[-!qf"r (qsDffi{)

)

rc o-.ro ( f)-20'i

err lG.tt
"r41;
*ffiE==i
EE.:]5
E:.XI:EI:f,
o (01

Arrourtt ol Cr.lr 'l'riLlsuiion

H @
rc
tFig, in lae r
>€*(>ii) i1r-. s l-lj

;IrTF Ffd(Era3l
l rrber of L'ash
,Ti?rTr

rrn slct ion ==HET .e-)q i6-I.,fr ,ir,I,'l e;

ffiI
(N T )

ffibffi
)b.4frO1,f+tefvo)C(?f(s)b-'l':(T-fr'sC<Es.!<fn'rrr-{Fq) Conrprchc-nsireRisk(SLrnrrnarionolRisliRatingfl.ornS[-No ]5roI8):
f+t r<Dr {fu{ o..sTo
( Ri\k Ilating) ( Nature o1 Risk t
:l.S{J ( RenriLrks )

4
)=)8 >- Em(lrgn
l.1r
Low
r

<)8 (<t.l) fix( Lu'u,

(*fr-tf'.)8s<iF:r{.F€Benetlcial owner-q{GFqfkco.rmf+r.lor<qErF-.rTisSuhjectirefir<Er-rr,q.olrEm<fq*rn,?.qmfo',"tT<rczreef(< )

tftrroon : i!rcrfrciai: nfil{5K q''frcf.F-rl nf?ff <l<Al?loAil.{f etifFr

drtufrl eiimrr qfr"rrnoiotir lamno f,t-++q xw< s ofrer;
t,,rr.
lamao flrela.str< € qfr?ri
ra6re fi?F? t'xz e ofrr)
Ioroaoa Betar. Xatiadi. r'i.t1t
), i Marr{er ()perations Branch lnuumbent Head ol Branch
- ()llj(ir
Prcpilmrp Verl\ rng I llllr!r Seal rvrth Nanre. Sigrrattrre & Darcl Scal wrth Nrmc- Srunature & Dalcl
Srll rlrth Nalrr. !ignaturc ,lr Seal u rLh Nanrc. Sigrature & Drrcl

(PEP,'IP/ qErinir qq< G{Ed Gffir ({TBg; ii{T{ .itsir € Erfu{)

Evfqd o:fflit s< cwr-q- q{6:ilq{sli}
Authorized Senior Ofllcer. in case of PllP/lP/Senior otlicial of any InlernationalAgency (Seal rvith Name, Signatr-rre & Date.y

lo. ftTa € qlao {(-+-t'5 o-afifu xi.-m anirc-t-roar q<< qFFTflTn $;il< olkl' (Larest clate ol rcvie*, & update of infbrnratron *,ith regard to
AccotLnl & custonte r): ..

Srilr{tErf ,!<q Et-{dt'tTn s,€l Tfu[ (ilT'{E fieqq qr+<,,s otfr'qi)

Rer"ieu,ing & Updating Offlcer (SeaI rvith narre. signaturc & daLe)
 <.)
() -
ctGR R4ffi qrrys q{ BrsraFlT
,ril s.ctP Er{t qrtFr{ EqInFrft cratfu^€[s ,flirtrFr r fursqT-{rdr {g'IT '|"
frc|qqtft qq{, lrri wa qo* Er{ r q[Ttrl efrft T-'6{t mE
qq-s
qqi afirw?r qir \xrrriq q@{irc{ {fi'r*riit .** s{"# fi'}efi" <tFM"fi[ttFtqfi
flr*e
q-<QE q\crrirt ['t'flc f'6<t
Erc{tfq-fl< r-rq nFrq Ellllr
qHrcF rrt r (c) R{r{'{tfu l9lqfu qfi'to | *t* +q;
c"""lo ry@
cqrq
,lfrsq
R* ;qfi" Etq-{ offi err<r {fu I$Fs.
sfiffir6fu li6 E5qr ({) afrfi-< ,fiGfrm .*"
ono Hq.{r <Ir$sr
ffi *ry
(q) qfrfr s-'"{' fir
oq*o,ryft6<c{mn o, ffi;1p,il srrd rN#
";.# cQ. rrrc q?m,Etr #ra{ t'D
TsIIfrs
u no*in., ro withdraw the rcmaining balmce
of those Accounts after the death of
rrgEpffi {s.eF,- r (The Account holder can nominate nominee at the tirue of
the constituent(s). The following documents u,
*.rr u. uppii.ation as per nomination -uri b. submitted by the
is not required to produce successioo certificate
account. In such case. tlre nominee
withdrawar of the remaining balance of the concemed land, Death cErtificate signed by the
of the Account holder. In casc of death in the foreign
issued by the court (a) DJath certificate of nominee issued by two valued customers.or
must be produced) (b) cerlit-rcate in favour
Bangladesh Embassy of the cor,cerncd country (c) Attested passpott stze
two officials of the Bank or Chairman of union
roristJcity corporation or ward councilor of Municipality)
the nominee)'
Ofr"aS*nU of nominee) (d) Indemnity Bond to be signed by

lo. TIFES'IR(qM(qltllo){:to5c'lsacgtt'{ft'R)'{qfcfrr{tftqtqloob-(\ol\-\o5e-q{:T(wftqq)sfrfr{IEft'o!e€rEft-ffi
qiT; *.* *"" *.- er*1" lr6'm7amm q-Wft drno <xRrrr EIfrET c{ls|cFr m
vrf$rprfiq 1rnfrFq ?Fffi G.*opng, 4\tnrq'r
q.,lts c{ c+n cooffi qhfr{ dfrql q-$ft'6{'' qqr{ sifts
rllEtrit (Customer is obtiged to submit any
r6Fr Eqr 4fi{E <tlrrg <I$ elFFGn I Anti renorism Act-2009 (amended 2012-
prevention 2015),
Act-20^12{amended
information as per demand of the Money Laundering Bangladesh Bank) t The
Finaocial lntelligenie unit (FIU) and CirculanlRules issued tim€ to time by
2013),Rules -2013, Local/Foreign
BankcanprovidetheaccountinfomrationtotheRegularyAuthority,ondemarrd.
{(r{t({<I<fteTl{rs'ms 'a<(Rqr+rt*q cTr{b?t[g<FnqFFTq
<ltRn m m|{ir{<it$'Rrl-<c(tr"ls R m-r+ffi ",fi-<\t'{, {k<'fu,
is obliged to abide by the iustruction
(The Bank can change, add, ame,d or nullify any rures related to accounr and the account holder

made by the Bank in this regard at any time)'

-.Tq {@fiqd 1;-fi1T (We, the undersigned, are agreed
q<" qgq'q'(@ls e5frE Tf,a otE-d crF Uqfo 4df q41- fr11 Sfa;{ a-43.
q{fi Bsr"iq' Ee frilrKfr !fu;11n1
conditions & prevaihng Lau s reuarding the matter)'
to accornplish this contract standing for all aforemcntioned

r<nsv'4fry.<dEqErE'Tlggy-G?riNameoftheAccountholder(s)'signatue&date):

r.)
I
I
I

W lvld Huquu

rr rlh Natur't
o)

efEIqTq EFfqIfr'Sqfr'fi (List of documents proYided)

ET

qilB ftsF'EI lAcknorrledgement Receipt)

qlT{qr..{{ etk"t (Date of Appiicati on)....'........, "' EIqfts qrT (Initial Deposit).........

Stqfroqfl{ it<-{ (Nature of Initial Deposit) ""'