PRINTING DATE: 04/07/2023

Name : Md. Zahid Hasan

Customer Account Number : 1301000179802
Unique Customer ID Code(UCIC) : 100317229
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Date : 26-06-2023 Account Number : 1301000179802

Customer ID Code : 100317229
The Manager/In-charge
Mutual Trust Bank Limited
------------------------- Branch/Sub-branch
Dear Sir,

I/We, the undersigned, request and authorize you to open an account in your branch/sub-branch. My/Our account related detailed personal information
is furnished below :

ACCOUNT RELATED INFORMATION

Account Title Md. Zahid Hasan
Full Name Md. Zahid Hasan
Type of Account MTB Personal Current Account(PRA)
Currency BDT
Purpose of Opening Account Saving
Source(s) of Fund Business
Initial Deposit 00.00
SMS Banking Yes
Internet Banking
Mobile 01761379527
Email
Debit Card Yes
Name to be Printed on the Card(s) Md.Zahid Hasan
Preferred Communication Address Present
FOREIGN ACCOUNT TAX COMPLIANCE ACT
US Citizen No
Green Card Holder/Lawful US Resident No
Granted Power of Attorney to US Person No
Is Staying in U.S. for 183 days ? No
Receiving Payments Sourced from U.S.A. ? No
DECLARATION AND SIGNATURE
Account No. 1301000179802
Declaration for Operation of NC Singly
Special Instruction (If any) No
Mobile No. 01761379527 Email

I/We, hereby confirm that I/we have read and agreed to all the terms and conditions related to the account (as attached with the account opening form)
and shall be bound to abide by the said terms and conditions. I/We hereby declare consciously that the information mentioned in this form is true. In
addition to the information furnished,
I/we shall provide additional necessary information/document(s) as and when required by the bank

Signature

Name Md. Zahid Hasan

Date 26-06-2023

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INDIVIDUAL INFORMATION
Account Number 1301000179802
Unique Customer ID Code 100317229
Account Title Md. Zahid Hasan
Customer Name Md. Zahid Hasan
Relationship with the account 1st Applicant
Father Name Md. Abdul Razzak Orfe Rezaul
Mother Name Jharna Aktar
Spouse Name Arin
Resident Status Resident Bangladeshi
Country of Birth BD
Country of Residence BD
Gender Male
Occupation Business
Name of the Organization Business
National ID No. 4188126249
Passport No.
Present Address
Address House :porpo boirager chor Pos:boirager chor dolothpur kushtia
Upazilla/Thana 039
District 050
Post Code 7051
Country Bangladesh
Permanent Address
Address House :porpo boirager chor Pos:boirager chor dolothpur kushtia
Upazilla/Thana 039
District 050
Post Code 7051
Profession Address
Address
Upazilla/Thana
District
Post Code

NOMINEE RELATED INFORMATION

Name of the Nominee

Relationship with Account Holder
Account no. of Nominee
National ID No.
Date of Birth
Address ,
Upazilla/Thana
District
Post Code
Post Code

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SIGNATURE OF ACCOUNT OPENING OFFICIAL

Name
N/A
Emp_ID
N/A
Date
N/A

SIGNATURE OF AUTHORIZED OFFICIAL

Name
N/A
Emp_ID
N/A
Date
N/A

Bank Official Remarks

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