Branch Less Form Mandatory

Branchless Banking Agent Account Opening Form Level-2
Date Mobile # SIM Opening Biometric Verified Yes No
Franchise ID Shared / Exclusive Region:

Personal Information
Title of Account Name CNIC No.
Father / Husband Name: CNIC Expiry Date
Date of Birth Qualification: Gender: Male Female
Current Address Country
Permanent Address Country

Next of KIN (incase of need, please contact the following person)
Name CNIC No. Relationship
Permanent Address City / Teshil: District Contact No.

Beneficial Owner Details
In beneficial owner for account different from account holder? ? Yes No

if yes, please provide below mentioned details
Name of beneficial owner CNIC No. CNIC Expiry Date
Nationalize of beneficial owner Contact No. Relationship

FATCA Consent
Country of Residence Country Birth Telephone No.
Country code Area Code Phone Number
1-Passport No. Address Expiry Date
2-Passport No. Address Expiry Date
3. Do you have granted a Power of Attorney Yes No
Yes No
1. Are you USA Resident hold a US permanent to a person who has a US access.
resident card / a US citizen / a US national 4. Do you have authorized a person who has a US address
to operate the banking account (either physically or electronically
5. Do you have set up Payment Standing instruction(s) the banking
2. Are you register in the US as a tax resident account and the beneficiary account(s) in the US
Common Reporting Standards (CRS)

Do you hold tax residency of any other / jurisdiction other than Pakistan and/or United States? Yes (Fill below) No (Ignore below)
Identification of Account Holder Individual Entity Controlling Person City / Country of Birth
Legal Name of Individual/Entity/Controlling Person: Country of Incorporation
Entity Type Financial Institution Other Investment Entity Financial Institution Other(s)
Global Intermediary Identification Number (GIIN)
Non-Financial Entity Active NFE Passive NFE Name of NFE AC Controlling Person
Taxpayer Identification No TIN TIN Country
Reason for not Having TIN:
(a) Country does not issue TIN to its residents. (b) A/C holder does not obtain TIN (Reason) (c) No TIN is required ( if country is not issuing)
Business Information
Title of Account / Business Name NTN No.
Directors / Partner Details;

1) Name CNIC No. Contact
Business Address
Village / Town City / Tehsil District Business Contact No. Latitude Longitude:
Know Your Customer (KYC)

Business Legal status Core Business Purpose of Account
Political Exposed Person (PEP) Details
Sole Proprietorship Mobile shop Business Payment
& Receipts Source of wealth of
Partnership Name (PEP) PEP
(Register / Un Register) Retail Outlet Others
Private Ltd Others Beneficial ownership
Relationship of funds
Non Cash
Expected No of Deposit/Month Amount Expected No of Deposit/Month Amount

Cash
Expected No of Withdrawal/Month Amount Expected No of Withdrawal/Month Amount
Total Assets Total Liabilities Total Worth

Annual Business Turnover Business Status: Satisfactory Un-Satisfactory
Length of Business Years Months Relationship with other Banks:

Length of Relationship with JAZZ Years Months Avg Sale Volume per month (Rs.)
Mailing Address Business Address Current Address Expected type of Parties:

Chanel of Transaction Cash Online Banking ATM/POS
Declaration and Signature Mandate
I requested you to open an account as specified above. I hereby declare and confirm that the content of information
provided here is true correct and complete. I further confirm that in case of any change in the above information, I shall
notify the same to the Bank, further and not in any case later than 30 days. I authorized handlers to use my account and
take all the responsibility of transactions executed by them. I hereby accept Terms & Conditions.
Specimen Signature as
Specimen Signature as
Per Account Opening
Per CNIC
Form
Thumb Impression Business Stamp
For Bank Use Only
Risk Category High Medium Low (Risk Category as per Evaluation Criteria)
CBC Status Done Failed No Power off ECIB Status: Satisfactory Un-Satisfactory
A/C # Agent ID: Account Opened by Supervised by Approved by

Terms & Conditions for Opening and Operation of Branchless Banking Level - 2 Accounts
Declaration by the Customer
have been signed by me/us in acceptance thereof.

at any time in terms thereof.
Copy of AOF and T&Cs Received and Accepted

Customer Signature
Check List
INDIVIDUAL SOLE PROPRIETOR PARTNERSHIP PVT LIMITED COMPANY

CNIC, NICOP, Passport etc. Copy CNIC, NICOP, Passport etc. Copy Account Opening Request ECIB Report Account Opening Request Board Resolution
AOF (Sign and Stamp) AOF (Sign and Stamp) Registration Certificate NADRA Verisys Registration Certificate Form-29, Form-A, Form-B
OFAC/UNSC/PEP/4th Schedule PMCL Certificate Account Opening Form NTN / STN OFAC/UNSC/PEP/4th Schedule
Copy of Utility Bill Shop Picture NTN / STN Memorandum of Association ECIB Report
NADRA Verisys OFAC/UNSC/PEP/4th Schedule Partnership Deed Articles of Association NADRA Verisys
ECIB Report Authority Letter to operate AC Certificate of Incorporation
NADRA Verisys OFAC/UNSC/PEP/4th Schedule List of Directors
Sole Proprietor Indemnity

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Branch Less Form Mandatory

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Branchless Banking Agent Account Opening Form Level-2

Date Mobile # SIM Opening Biometric Verified Yes No

Franchise ID Shared / Exclusive Region:

Title of Account Name CNIC No.

Father / Husband Name: CNIC Expiry Date

Date of Birth Qualification: Gender: Male Female

Current Address Country

Permanent Address Country

Name CNIC No. Relationship

Permanent Address City / Teshil: District Contact No.

In beneficial owner for account different from account holder? ? Yes No

Name of beneficial owner CNIC No. CNIC Expiry Date

Nationalize of beneficial owner Contact No. Relationship

Common Reporting Standards (CRS)

Directors / Partner Details;

Know Your Customer (KYC)

Expected No of Deposit/Month Amount Expected No of Deposit/Month Amount

Expected No of Withdrawal/Month Amount Expected No of Withdrawal/Month Amount

Total Assets Total Liabilities Total Worth

Length of Business Years Months Relationship with other Banks:

Mailing Address Business Address Current Address Expected type of Parties:

Thumb Impression Business Stamp

For Bank Use Only

A/C # Agent ID: Account Opened by Supervised by Approved by

Declaration by the Customer

have been signed by me/us in acceptance thereof.

Copy of AOF and T&Cs Received and Accepted

INDIVIDUAL SOLE PROPRIETOR PARTNERSHIP PVT LIMITED COMPANY

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