Retial

            

Account Opening Application

:        

:
 ‫أﺳﺗﻣــــــﺎرة طﻠـــب ﻓﺗـــــﺢ ﺣـﺳــــــﺎب أﻓراد‬
‫‪Account Opening Application‬‬

‫‪Account‬‬ ‫رﻗم ﺣﺳﺎب‬ ‫اﻟﺗﺎرﯾﺦ‬

‫‪i,the undersigned, hereby request to open an account in your books‬‬ ‫أﻧﺎ اﻟﻣوﻗﻊ أدﻧﺎه أطﻠب ﻓﺗﺢ ﺣﺳﺎب ﺑﺳﺟﻼﺗﻛم طﺑﻘﺎ ً ﻟﻠﺑﯾﺎﻧﺎت أدﻧﺎه ووﻓﻘﺎ ً ﻟﻠﺷروط اﻟﻌﺎﻣﺔ اﻟﻣﻧظﻣﺔ‬
‫‪under the title shown below subject to the general conditions attached‬‬ ‫ﻟﻠﺣﺳﺎﺑﺎت اﻟﻣرﻓﻘﺔ ﻣﻊ ھذا اﻟطﻠب واﻟﺗﻲ ﻗرأﺗﮭﺎ وﻓﮭﻣﺗﮭﺎ‬
‫‪herewith governing accounts which have read and understood‬‬

‫‪Please complete all sections in block capitals and tick( )where applicable.‬‬ ‫ﯾرﺟﻲ ﻣلء اﻟﻔراﻏﺎت ﻟﺟﻣﯾﻊ اﻷﻗﺳﺎم وﺑوﺿوح و اﻟﺗﺄﺷﯾر ﻋﻠﻰ اﻟﺑﻧد ﺑﻌﻼﻣﺔ) (‪:‬‬

‫‪Reason for opening a/c:‬‬ ‫‪personal‬‬ ‫‪Salary transfer‬‬ ‫ﺗﺣوﯾل راﺗب‬ ‫أﻏراض ﺷﺧﺻﯾﺔ‬ ‫اﻟﻐرض ﻣن ﻓﺗﺢ اﻟﺣﺳﺎب ‪:‬‬

‫)‪Other (please Specify‬‬ ‫أﺧرى )اﻟرﺟﺎء اﻟﺗوﺿﯾﺢ (‬

‫‪Type of A/c:‬‬ ‫‪Savings‬‬ ‫‪Current‬‬ ‫‪Non-checking Current‬‬ ‫‪Time Deposit‬‬ ‫ودﯾﻌﺔ ﻷﺟل‬ ‫ﺟﺎري )ﺑدون ﺷﯾﻛﺎت (‬ ‫ﺟﺎري‬ ‫ﺗوﻓﯾر‬ ‫ﻧوع اﻟﺣﺳﺎب‬

‫ﻏﯾره‬

‫ﻋﻣﻠﺔ اﻟﺣﺳﺎب‬

‫اﻷﺳم اﻟﻛﺎﻣل ‪) :‬اﻷخ ‪ /‬اﻷﺧت ‪ /‬اﻷﺧوة (‬

‫ﻏﯾر ﻣﻘﯾم‬ ‫ﻣﻘﯾم‬ ‫ﻣواطن‬

‫ﻣﺣل اﻹﺻدر ‪:‬‬ ‫رﻗم اﻟﺟواز اﻟﺳﻔر ‪:‬‬

‫‪Ddate of Expiry:‬‬ ‫ﺗﺎرﯾﺦ إﻧﺗﮭﺎء ﺟواز‪:‬‬ ‫ﺗﺎرﯾﺦ إﺻدار ﺟواز اﻟﺳﻔر ‪:‬‬

‫ﺗﺎرﯾﺦ إﻧﺗﮭﺎء اﻟﺑطﺎﻗﺔ‪:‬‬ ‫رﻗم اﻟﺑطﺎﻗﺔ اﻟﺷﺧﺻﯾﺔ‪:‬‬

‫إﺳـم اﻟــــزوﺟﺔ ‪ /‬اﻟــــزوج‬

‫) ﻣﺑﻧﻲ (‪:‬‬ ‫) ﺷﺎرع (‪:‬‬ ‫ﻋﻧوان اﻟﺳﻛن )اﻟﻣﻧزل ‪ /‬اﻟﺷﻘﺔ (‪:‬‬

‫)ﻣدﯾﻧﺔ (‪:‬‬ ‫)اﻟرﻗم اﻟوطﻧﻲ (‪:‬‬

‫اﻟﻌﻧوان اﻟﺑرﯾدي )إذا ﻛﺎن ﻣﺧﺗﻠﻔﺎ ً ﻋن اﻟﻌﻧوان أﻋﻼه(‬

‫اﻟﻌﻧوان اﻟداﺋم و رﻗم اﻟﺗﻠﯾﻔون ﻓﻲ اﻟﻣوطن اﻷﺻﻠﻲ ) ﻟﻼﺟﺎﻧب ﻓﻘط (‬

‫‪Telephone (work) :‬‬ ‫)اﻟﻌﻣل(‪:‬‬ ‫)‪(Home‬‬ ‫رﻗم اﻟﮭﺎﺗف )اﻟﻣﻧزل (‪:‬‬

‫‪Mobil:‬‬ ‫) اﻟﻔﺎﻛس(‬ ‫‪Facsimile:‬‬ ‫)اﻟﺟوال(‪:‬‬

‫‪E- mail Address‬‬ ‫ﻋﻧوان اﻟﺑرﯾد اﻹﻛﺗروﻧﻲ‬

‫‪Nationality:‬‬ ‫‪Date of Birth:‬‬ ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد ‪:‬‬ ‫اﻟﺟﻧﺳﯾﺔ ‪:‬‬

‫‪Minor:‬‬ ‫‪yes‬‬ ‫‪No‬‬ ‫ﻓﻲ ﺣﺎﻟﺔ ﻛون ﻓﺎﺗﺢ اﻟﺣﺳﺎب ﻗﺎﺻر ﯾوﻗﻊ ﻋﻧﮫ وﻟﯾﮫ‪.‬‬

‫‪Place of Birth:‬‬ ‫‪Gender:‬‬ ‫‪Male‬‬ ‫‪Female‬‬ ‫أﻧﺛﻰ‬ ‫ذﻛر‪:‬‬ ‫اﻟﺟﻧس‪:‬‬ ‫ﻣﻛﺎن اﻟوﻻدة‪:‬‬

‫‪Mother`s name‬‬ ‫‪(this is security feature for your protection):‬‬ ‫)ھذا اﺣﺗﯾﺎط أﻣﻧﻲ ﻟﺣﻣﺎﯾﺗك(‪:‬‬ ‫إﺳم اﻷم‬

‫‪Employment Status:‬‬ ‫‪Employed‬‬ ‫‪self- employed‬‬ ‫‪Student‬‬ ‫‪Retired‬‬ ‫ﻣﺗﻘﺎﻋد‬ ‫طﺎﻟب‬ ‫ﺻﺎﺣب اﻟﻌﻣل‬ ‫ﻣوظف‬ ‫ﺣﺎﻟﺔ ﻣﻘدم اﻟطﻠب‬

‫‪Unemployed‬‬ ‫‪Housewife‬‬ ‫‪Others‬‬ ‫أﺧرى‬ ‫رﺑﺔ ﻣﻧزل‬ ‫ﻻﯾﻌﻣل‬

‫‪Date of Joining‬‬ ‫ﺗﺎرﯾﺦ اﻹﻟﺗﺣﺎق‬

‫‪Occupation or Public Position held:‬‬ ‫اﻟوظﯾﻔﺔ‬

‫‪Employer`s Name:‬‬ ‫إﺳم اﻟﻣوظف‬

‫‪work Address:‬‬ ‫ﻋﻧوان اﻟﻌﻣل‬

‫‪lf self-employed state nature of self employment:‬‬ ‫ﻓﻲ ﺣﺎﻟﺔ أن ﯾﻛون ﺻﺎﺣب اﻟﻌﻣل ﯾذﻛر طﺑﯾﻌﺔ اﻟﻌﻣل‪.‬‬

‫‪1‬‬
 ‫ﻓرع ‪.........................:‬‬

‫‪Date‬‬ ‫اﻟﺗﺎرﯾﺦ‬

‫‪:‬‬
‫أﺳـــــم ‪Name ........................................................................................................................................................‬‬

‫رﻗم اﻟﺣﺳﺎب ‪Account No :..........................................................................................................................................:‬‬

‫اﻟﻣوﻗﻌون أدﻧﺎه )ﺗوﻗﯾﻊ ﻣﻧﻔرد( )ﺗوﻗﯾﻊ ﻣﺷﺗرك ( ) ﺗوﻗﯾﻊ أول أﺳﺎﺳﻲ ﻣﻊ ﺗوﻗﯾﻊ ﺛﺎﻧﻲ (‬
‫)‪Single Signature/Joont Signature/Signature A basic/Signature &(B‬‬

‫اﻷﺳـم ‪Name :....................... :‬‬

‫اﻟ ‪ot‬‬
‫ﺻــو ‪Ph‬‬
‫‪o‬‬
‫رة‬

‫‪Signature :......................:‬‬ ‫اﻟﺗوﻗﯾﻊ‬ ‫اﻟﺻﻔﺔ‪Occupation :...................:‬‬

‫اﻟ ‪ot‬‬

‫اﻷﺳـم ‪Name :....................... :‬‬

‫ﺻــو ‪Ph‬‬
‫‪o‬‬
‫رة‬

‫‪Signature :......................:‬‬ ‫اﻟﺗوﻗﯾﻊ‬ ‫اﻟﺻﻔﺔ‪Occupation :...................:‬‬

‫اﻟ ‪ot‬‬

‫اﻷﺳـم ‪Name :....................... :‬‬

‫ﺻــو ‪Ph‬‬
‫‪o‬‬
‫رة‬

‫‪Signature :......................:‬‬ ‫اﻟﺗوﻗﯾﻊ‬ ‫اﻟﺻﻔﺔ‪Occupation :...................:‬‬

‫اﻟ ‪ot‬‬

‫اﻷﺳـم ‪Name :....................... :‬‬

‫ﺻــو ‪Ph‬‬
‫‪o‬‬
‫رة‬

‫‪Signature :......................:‬‬ ‫اﻟﺗوﻗﯾﻊ‬ ‫اﻟﺻﻔﺔ‪Occupation :...................:‬‬

‫‪For bank use only‬‬ ‫ﻻﺳﺗﻌﻣﺎل اﻟﻣﺻرف‬

‫رﺋﯾس ﻗﺳم اﻟﺣﺳﺎﺑﺎت اﻟﺟﺎرﯾﺔ‬ ‫اﻟﻣوظف اﻟﻣﺧﺗص‬

‫‪............................................................................‬‬ ‫‪..............................................................‬‬

‫اﻟﻌﻧوان ﺑﺎﻟﻛﺎﻣل‪ ...............................................................................................................................‬ص ‪ .‬ب ‪............................................................................................‬‬

‫أرﻗﺎم اﻟﮭﺎﺗف‪...............................................................................................................................................................................................................................................‬‬

‫ﺗوﻗﯾﻊ ﻣدﯾر اﻟﻔرع‬

‫‪............................................................................‬‬
‫‪2‬‬
 ‫(‬ ‫)‬
‫(‬ ‫)‬

‫اﻟﻌﻣﻠﯾﺎت‬

‫‪3‬‬
( )

4
 ‫(‬ ‫)‬

‫ة‬ ‫اﻹﺳﺗﻣﺎرة‬

‫‪kyc‬‬ ‫ﻧﻣوذج إﻋرف زﺑوﻧك‬

‫‪5‬‬
Undertaking
By signing the account application from, I declare that said personal
account at the Bank shall be used for personal purposes only and not for
any commercial purposes in accordance with the directives of Tripoli Bank
In case the account was used for any purposes other than personal
purposes the Bank shall have the right to take all necessary actions to
implement the regulations of Tripoli Bank, including closing the account
with out prior notice
I, the undersigned, declare that all the information given on the account
application from are correct and complete : that I shall be Legally
responsible if it proved to be other wise : that I shall abide by every action
to be taken by the Bank in such case : that I authorize the Bank t close the
account and accept the liability for an Iosses and compensations that may
result from such case .
‫إﻗــرار وﺗﻌــــﮭد‬
‫أﺗﻌــــــﮭد ﺑﻣـــــوﺟب ﺗوﻗﯾــــﻌﻲ اﻟوارد ﻋﻠﻲ أﺳــــﺗﻣﺎرة ﻓﺗﺢ اﻟﺣﺳــﺎب ﺑﺎﺳـﺗﺧدام ﺣﺳﺎﺑﻲ اﻟﺷﺧﺻﻲ ﻟدى‬
‫اﻟﻣﺻرف ﻓﻲ اﻷﻏراض اﻟﺷﺧﺻﯾﺔ ﻓﻘط دون أﺳﺗﺧدام ﻷي ﻏرض ﺗﺟﺎري وذﻟك وﻓﻘﺎ ً ﻟﺗﻌﻠﯾﻣﺎت ﻣﺻرف‬
‫ﻟﯾﺑﯾﺎ اﻟﻣرﻛزي وﯾﺣﻖ ﻟﻠﻣﺻرف إذا ﻣﺎ ﺗﺑﯾن ﻟﮫ اﺳﺗﺧدام اﻟﺣﺳﺎب ﻋﻠﻰ ﺧﻼف ذﻟك إﺗﺧﺎد ﻛﺎﻓﺔ اﻹﺟـراءات‬
‫اﻟﻼزﻣﺔ ﻟﺗﻧﻔﯾد ﺗﻌﻠﯾﻣﺎت ﻣﺻرف ﻟﯾﺑﯾﺎ اﻟﻣرﻛزي ﻣﻊ أﺣﻘﯾﺗﮫ ﻛذﻟك ﺑﺈﻏﻼق اﻟﺣﺳﺎب دون إﻧدار أو إﺧطـﺎر‬
‫أﻗر أﻧﺎ اﻟﻣوﻗﻊ أدﻧﺎه ﺑﺻﺣﺔ ﺟﻣﯾﻊ اﻟﺑﯾﺎﻧﺎت اﻟواردة ﺑﻧﻣوذج ﻓﺗﺢ اﻟﺣﺳﺎب وﻣﺳــؤﻟﯾﺗﻲ اﻟﻘﺎﻧوﻧﯾـﺔ ﻋن ﻣـــدى‬
‫ﺻﺣﺗﮫ وﺗطﺎﺑﻘﮭﺎ ﻣﻊ اﻟواردة ﺑﻧﻣوذج ﻓﺗﺢ اﻟﺣﺳﺎب واﻟـــﺗزم ﺑﺄى إﺟـراء ﯾﺗـﺧد ﻣن ﻗﺑل اﻟﻣﺻــرف إذا ﻣﺎ‬
‫ﺗﺑﯾن ﻋدم ﺻﺣﺔ ﻣﺎ ورد ﺑﺗﻠك اﻟﺑﯾﺎﻧﺎت ﻣﻊ أﺣﻘﯾﺔ اﻟﻣﺻــــرف وﺗﺧوﯾﻠﮫ ﻓﻲ إﻏﻼق اﻟﺣﺳـﺎب وأﺗﺣﻣل ﻛﺎﻓﺔ‬
‫اﻷﺿرار واﻟﺗﻌوﯾﺿﺎت إذا ﻣﺎ ﺗﺑﯾن ﺧﻼف ذﻟك‬

I/ we the undersigned below agree with Bank`s terms and ‫ﻧواﻓﻖ ﻋﻠﻲ ﺟﻣﯾﻊ اﻟﺷروط‬/ ‫ ﻧﺣن اﻟﻣوﻗﻊ أ دﻧﺎه أواﻓﻖ‬/ ‫أﻧﺎ‬
conditions above. : ‫واﻷﺣﻛﺎم اﻟﻣذﻛوره أﻋﻼه‬

Name ‫اﻷﺳـم‬
Signature ‫اﻟﺗوﻗﯾﻊ‬

Date ‫اﻟﺗﺎرﯾﺦ‬

Name ‫اﻷﺳـم‬
Signature ‫اﻟﺗوﻗﯾﻊ‬
Date ‫اﻟﺗﺎرﯾﺦ‬

The above terms and conditions are an integral part of the account ( ‫)ﺗﻌﺗﺑر ھذه اﻟﺑﻧود ﺟزءا ً ﻻ ﯾﺗﺟزأ ﻣن طﻠب ﻓﺗﺢ اﻟﺣﺳﺎب وﻣﺗﻣﻣﺔ ﻟﮫ‬

openingform.

For Bank Use Only : :‫ﻻﺳﺗﻌﻣﺎل اﻟﻣﺻرف ﻓﻘط‬

Refrence No
Branch :
Customer No :
Customer Account No :
css Name
Account Opening Staff: Name

Supervisor/Manager: Name
Head of Business Unit: Name

Kyc Review:

ID Yes No
Passport Yes No
Birth certificate/passport for minors Yes No
Guardianship decision for minors Yes No
Guardianship judgement for legally incompetent Yes No