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New Customer Information Form

This document contains a new customer application form requesting personal information such as name, identification details, date and place of birth, address, contact information, employment details, income, expenses, references, and a signature agreeing to terms and authorizing verification of the information provided. The applicant provides information about themselves and any spouse or dependents. They specify the purpose of the account as either savings or expenses payments.

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Jake
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132 views2 pages

New Customer Information Form

This document contains a new customer application form requesting personal information such as name, identification details, date and place of birth, address, contact information, employment details, income, expenses, references, and a signature agreeing to terms and authorizing verification of the information provided. The applicant provides information about themselves and any spouse or dependents. They specify the purpose of the account as either savings or expenses payments.

Uploaded by

Jake
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

NEW CUSTOMER

Personal information

Name: ______________________________ ___________________________


______________________________ ___________________________

ID: Passport: __________________________________


2nd ID: __________________________________

Day of Birth : _______/____________/__________

Country of Birth: ______________________________

Nationality: ______________________________

Marital status: Married Single* Divorced Joined Other:______________

Address: _________________________________________________________
Country: __________________________________________________
State: _____________________________________________________
District: ___________________________________Street: #_________
Address since: _______/ ____________/ _________
Own Rent with parents / other Mortgage $___________

Zip code: __________________________

Phone number: Home: ( ) _________________ Cell phone: ( ) _______________

Email: __________________________________________________________

Previous address (if current less than two years):___________________________________________


Country:___________________________________________________
State: _____________________________________________________
District:___________________________________ Street #:__________
Address since: _______/ ____________/ _________

N° of dependents: _______

Employer: Name:_____________________________________________________
Country: ___________________________________________________
Address: ___________________________________________________
Employed Since: _______/ ____________/ _________
Occupation: _______________________________________
Income: $_______________
Monthly expenses (aprox): ____________________________________

Work Number Office: ( ) _________________ Fax: ( ) _______________

1
Previous employment (if current less than two years):
Name: ____________________________________________________
Employed Since: _______/ ____________/ _________

*Spouse information: Name: __________________________ ________________________


Passport number: ______________________
Birth Date: _____/_______/______
Nationality: _________________

Account Purpose: Savings Expenses payments

Personal Reference can be family, friends or co-worker (Address or work phone number):

Name Address Occupation Relationship Phone Number

I certify that the above information is true and correct. I acknowledge receipt of the copy of the
service fees and interest rates of the bank and agree to pay the charges imposed on products /
services.

I hereby authorize the Bank, its subsidiaries / or affiliates to obtain independent verification of
any information supplied on these application.

Signature ____________________________ Date: ___________ Witness: ___________________

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