ÜÉ°ùM ∞°ûc QGó°UEG ≈∏Y 𫪩dG á≤aGƒe êPƒ‰

Customer Consent Form for Release of

Statement of Account

CONSENT (Permission upon signing this consent form)
By signing this form, you consent (permission) to Commercial
Bank of Dubai to request for your statement of account through
the Central Bank of the United Arab Emirates, from your bank (as
can be identified by the account number IBAN) and also for your
bank to provide this information through the Central Bank of the
United Arab Emirates, without taking additional consent.
(á≤aGƒŸG êPƒ‰ ™«bƒJ óæY ¿PEG) á≤aGƒe
∞``°ûc Ö``∏£H ΩÉ``«≤∏d …QÉ``éàdG »``HO ∂``æÑd á``ëjô°U á``≤aGƒe ,Gò``g êPƒ``ªædG ≈``∏Y ∂``©«bƒJ ó``©jo
ø``eh Ió``ëàŸG á``«Hô©dG äGQÉ``eE’G á``dhód …õ``côŸG ∂``æÑdG ∫Ó``N ø``e ∂``H ¢``UÉÿG ÜÉ``°ù◊G
≈∏Y á≤aƒŸG ¤G áaÉ°VE’ÉH (IBAN ÜÉ°ù◊G ºbQ øe í°Vƒe ɪc) ¬©e πeÉ©àJ …òdG ∂æÑdG
á``«Hô©dG äGQÉ``eE’G á``dhód …õ``côŸG ∂``æÑdG ∫Ó``N ø``e äÉ``eƒ∏©ŸG √ò``g Ëó``≤àH ∂``aô°üe ΩÉ``«b
.á«aÉ°VEG á≤aGƒe ≈∏Y ∫ƒ°ü◊G ¿hO IóëàŸG

Identity document used áeóîà°ùŸG ájƒ¡dG

Name as per document ájƒ¡dG ‘ Qƒcòe ƒg Ée Ö°ùM º°S’G
Bank name ∂æÑdG º°SG
Account number ÜÉ°ù◊G ºbQ
Statement period ∞°ûµdG IÎa
Emirates ID number á«JGQÉeE’G ájƒ¡dG ºbQ
IBAN number IBAN ºbQ

For official use »ª°SôdG ΩGóîà°SÓd

Product ID èàæŸG õeQ
Product description èàæŸG ∞°Uh
Reference number ™LôŸG ºbQ
FTS ID as obtained É¡«∏Y ∫ƒ°ü◊G ” ɪc FTS õeQ

.Gòg á≤aGƒŸG êPƒ‰ ‘ ¬«∏Y ¢Uƒ°üæŸG ¢Vô¨∏d Ék jô°üM »HÉ°ùM ∞°ûc øY (IóMGh IôŸ) ìÉ°üa’G ≈∏Y ≥aGhCG ,√ÉfOCG ™«bƒàdG ∫ÓN øe
By signing the below, I consent to the (one time) release of my account statement exclusively for the purpose stipulated in this Consent Form.

WHY CONSENT IS NEEDED AND HOW THE INFORMATION WILL BE USED

Your consent (permission) for us to obtain and share your account information, including the transaction details for the identified
period, is needed for the purpose listed and explained below. The information provided will be shared and retained in accordance
with applicable law concerning data security and privacy protections. The information you authorize us to obtain and share will be
used to determine your eligibility for the product. You understand that some services may not be available to you unless you
consent share/release information as stated in this Authorization..