Southeast Bank Limited

A Bank with visionAccount Opening Form:

Personal Banking

Date:Account Number:

DayMonthYearCustomer ID:

Customer Group ID:

The ManagerSoutheast Bank Limited

.. Branch

Dear Sir,

I/We request you to open an account in my/our name with your Branch. The detailed information is given below:

1.Name of the Account Holder:

( Individual ( Joint1) ..

2) ..

3) ..

2.Type of Account ():

( Conventional Banking:( SB( CD( STD( FDR

( Special Scheme( FC( RFCD( NFCD

( Others (Please Specify): .

( Islamic Banking:( Mudaraba SB( Al-Wadiah CD( Mudaraba STD( MTDR

( FC( RFCD( NFCD( Mudaraba Special Scheme

( Others (Please Specify): .

3.Currency ():( Taka( Dollar( Euro( Pound

( Others (Please Specify): ...

4.Mode of Operations ():( Singly( Jointly( Any one

( Others (Please Specify): .

5.Other Bank A/C(s) of the client (if any):

Name of the BankBranchType of Account ()

A. A. ( Deposit( Loan ( Others.....

B. B. ( Deposit( Loan ( Others..

C. C.( Deposit( Loan ( Others..

6.Introducers Information:

A. Name:

B. Account No.:

C. Name of the Branch:

I declare that, I know the applicant(s) and confirm the occupation and address of the applicant(s)

Introducers Signature Verified by:

Name: .

Signature:

Introducers Signature: Date:

7.Initial Deposit ():Amount:

( Cash( Cheque

Bank: Branch: ..Cheque No.: .

8.Information about FDR/MTDR : Amount:

Currency:( Taka( Dollar( Euro( Pound

( Others (Please Specify): ..

Period:.. Month .... Year. DayMaturity Date: /. /...

For Renewal (): ( Principal with Interest/Profit( Principal only and pay interest / profit in cash

( Principal only and credit Interest / Profit to A/c No: ....

( Not Applicable

9.Information about Special Scheme Deposit Account:

Name of the Scheme: ()

( Conventional Banking:( MSS( PSS( MIS( DBS( WEPSS

( Islamic Banking:( Mudaraba MSS( Mudaraba PSS( Mudaraba MIS

( Mudaraba WEPSS( Mudaraba DBS( Mudaraba Hajj Scheme

( Others (Please Specify): ..

Period of the Scheme:Deposit at a time/Installment Amount:Tk.No. of Installment (Yearly):

( Payable at maturity:Tk.( Monthly Payable:Tk.

Please credit Interest / Profit amount to A/c No: ....

10.Nominees Information:Photograph of the Nominee

duly attested by the A/C Holder

I/We have nominated the following person in the event of my/our death to receive/draw the amount of deposits held by you in my/our account. I/We reserve the right to cancel or amend the mentioned nomination at any time. I/We also agree that, the bank will not be liable for any transaction made as per my/our instruction.

Name of the Nominee:...Date of Birth/Age:

Fathers Name:...Mothers Name:

Spouse Name:...

Permanent Address of the Nominee:....

....

Occupation:Relation with the A/C Holder:

National I.D. Card Number:....

Signature of the Nominee

(In case, a non-resident nominee is eligible to receive deposits, all the rules and regulations of existing Foreign Exchange Regulation Act shall be applicable for remitting the said deposits abroad.)

11.If one or more Account Holder(s) is/are Minor:

I declare as a legal guardian of the following Account holder(s) that the account holder(s) is/are minor. His/her/their detailed information is furnished in the attached form. Until the account holder(s) become(s) adult or any further declaration comes from me, the account will be operated under my signature as legal guardian.

A. Name of the (Minor) Account holder(s):.

B. Name of the Guardian:C. Relationship with the Minor: ....

(Personal Information Form in the names of the Minor and Legal Guardian must be filled in and both the forms must be signed by the legal guardian.)

12.Source of Fund:

.

13.Statement Frequency ():( Monthly( Quarterly( Half Yearly( Yearly

14.Statement Delivery (): (Please choose only one option only)

( Collection from Branch( By Mail( By E-mail

15.ATM Transaction:( Yes( No

16.Declaration & Signature:

I / We have read, understood and hereby agree to abide by all the terms and conditions related to the account. I / We do hereby consciously declare that all the information provided herein above is correct. I/We also confirm that we will provide further information/documents in addition to the supplied information/documents as per your requirements.

Yours faithfully,

Name of the Account holder:1) 2) 3) .

Signature:1) .2) 3) .

Date:1) .2) ...3) .

For Banks use only

SBS CodesCIB Codes

Sector Code:Borrower Code:

Economic Purpose Code:Borrower Type:

Deposit Advance Code:Sector Type:

Security Code:Sector Code:

Privilege Code:Type of Institution:

Remarks:

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

A/C opened by:Approved by:Data captured by:

Name:Name:Name:

Designation:Designation:Designation:

Signature with Seal:Signature with Seal:Signature with Seal:

Date:Date:Date:

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