Personal Account
Opening Form
Date: _________________________________ Account No: _________________________________ Customer ID No: _______________________ Existing customer (put ü mark): o Yes o No
The Manager HSBC
____________________ Branch,
Dear Sir/Madam,
I/We, the undersigned, hereby request and authorise the Bank to open an account in your Branch of HSBC. My/our detailed information are given below:
1. Name of Account/Name of First Applicant as in NID/Passport (in block letters): o Mr o Mrs o Ms
_____________________________________________________________________________________________ First Name Middle Name Last Name
2. Type of Account (put ü mark):
o Savings o Current oSND o FC
o RFCD o NFCD o Others ______________________________
3. Currency (put ü mark): o Taka (BDT) o US Dollar (USD) o Euro o Pound (GBP) o Others _______
4. Signing Mandate (put ü mark):
o Singly o Jointly o Any or Survivor(s) o Other Instructions ______________________
5. Joint Applicant:
Name of Second Applicant/Parent/Guardian of Minor as in NID/Passport (in block letters) o Mr o Mrs o Ms
____________________________________________________________________________________________
First Name Middle Name Last name
6. Correspondence Address: ________________________________________________________________________ ________________________________________________ Postal Code: ____________________________ Time at this correspondence address ________________________ (years) ________________ (months)
Previous correspondence address (required if account holder is at current address for less than 3 years)
_________________________________________________________________________________________________ _________________________________________________________________________________________________ 7. Other Bank Account(s) (if any):
Bank’s Name Branch Name Type of Accounts (put ü mark)
A _____________________ A ________________ o Deposit A/C o Loan/Credit A/C o Others ___________ B _____________________ B ________________ o Deposit A/C o Loan/Credit A/C o Others ___________ C _____________________ C ________________ o Deposit A/C o Loan/Credit A/C o Others ___________
8. Introducer’s Information:
A. Name: _________________________________________ B. Account Number: ___________________________ C. Name of the Branch: _________________ D. Tel No(s): __________________ E. Staff ID No: _________________
F. Signature: _____________________ G. Sales ID: ____________ H. RM Code:_________ Date: ______________ I. HSBC Group’s identification form (if any) o J. Other bank’s verification letter (if any) o
9. Initial Deposit:
Cash Deposit : Amount BDT/USD/GBP/EUR: ___________________________
Cheque/CO Deposit : Cheque/CO No._____________________________ Dated:___________________ Drawn on (bank name) _____________________ BDT/FC ___________________ Debit my HSBC account No. : _________________________________________ for BDT/FC ______________
10. Information of Nominee:
Name of the Nominee : _____________________________________
Father’s Name : ___________________________________________________________________________ Mother’s Name : ___________________________________________________________________________ Husband’s/ Wife’s Name: ___________________________________________________________________________ Permanent Address of the Nominee: __________________________________________________________________ ________________________________________________________________________________________________ Country of Residence : _____________________________ Date of Birth: _________________________________ Nationality : _____________________________ National ID No.: ________________________________ Passport No. (if any): ________________________________ Driving License No. (if any): ______________________ Occupation: ________________________________ Relationship with Accountholder: ________________________
(If a Non-Resident Bangladeshi is nominated, payment/repatriation to such nominee will be subject to compliance with the existing Foreign Exchange Control Regulations. )
However, if the nominee remains a minor at the time of my/our death, the following individual, as the guardian of the minor, shall be authorized to receive/draw on behalf of the nominee:
Name of Guardian of Nominee: ______________________________________________________________________ National ID/Passport No. of Guardian: _____________________ Relationship with Minor: ________________________ (Note: The photograph of such Guardian must be attested and submitted by the Customer)
I/We do hereunder appoint the following individual as my/our nominee, who shall, in the event of my/our death, receive/draw the amount of deposits held by the Bank in my/our account. I/We reserve the right to cancel or change this nomination at any time. I/We also acknowledge that the payment made by the Bank to him/her shall constitute a full discharge by the Bank of its liability in respect of such deposits. I/We declare that everything done by the Bank in pursuance of this authority shall be binding upon me/us until the Bank receives any notice from me/us in writing to the contrary.
Photograph of
Nominee
(attested by the
11. If the Accountholder(s) is/are Minor:
I, the legal guardian of the undersigned Accountholder hereby declare that the Accountholder is a minor. His/her necessary information is provided in the attached form. The account will be operated under my signature as the legal guardian until the Accountholder becomes mature or until the Bank receives any notice from me/us in writing to the contrary.
A. Name of the Accountholder (Minor): _________________________________________________________________ B. Date of Birth of the Minor: ____________________ The Minor attains majority on (date): ______________________ C. Name of the Guardian: ____________________________________________________________________________ Relationship with the Minor: __________________________________________________________________________
__________________________________
Signature of the Guardian of the Minor S.V
(Both the Minor and the Guardian will have to fill up the “Personal Information Forms” and both the forms must be signed by the legal Guardian)
12. Source of Fund/Income (put ü mark):
o Salary/earning from service o Earning from business o Personal Savings o Inheritance o Earning given by spouse o Sale of an asset (e.g. car) o Winning Lottery/prize Money
o Return on Investment/Investment matured o Others (please specify) _____________________________________
13. Purpose of Opening Account (put ü mark):
o Receipt of Salary o Savings/Fixed Deposit o Investment o Loan repayment
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
14. Phonebanking
Account Name ____________________________________________ A/C No ________________________________
______________________________ _______________________________
Signature of 1st Applicant S.V. Signature of 2nd Applicant S.V.
Note: Your Phonebanking PIN will be delivered to your mentioned correspondence address.To avail services of fund transfer to other pre-designated HSBC accounts and bill payment using Phonebanking please contact any of our branches.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
15. ATM Card:
Account No.______________________________________________________________________________________ Second A/C No. ______________________________________ Third A/C No. ________________________________ Name of the first applicant _________________________________________
Name of the second applicant _________________________________________ Card to be collected at _________________ branch
ATM PIN to be collected at _____________ branch
¨ Linked Account ¨ Separate Account
_________________________________ _______________________________
Signature of 1st Applicant S.V. Signature of 2nd Applicant S.V
[Note: ATM cannot be issued (a) against Non-Resident Taka account (b) NITA (c) where the mode of operation is jointly. Your ATM Card will be delivered to your mentioned correspondence address unless you have instructed otherwise in the above form. Please be informed that if we are unable to deliver your card at your correspondence address, the card may be forwarded to the branch where your account is held. Your ATM PIN will be at your preferred branch for collection. On receipt of your ATM Card, please collect your ATM PIN from the branch. You must show the original of your passport/National ID Card/Valid Photo ID at the time of ATM PIN collection.]
To be filled by the bank
Card Type (put ü mark) o A – Local Card o I – International o S – Select Card Product Code ________________
Special waiver (if any, put ü mark ) o waiver on ATM Card annual fee
Signature of BM with seal (if special waiver is applicable) ___________________________________________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
16. Chequebook :
Please issue a chequebook for my/our account. I/We confirm that I/we have read or will read prior to drawing any cheque(s), the conditions subject to which chequebooks are currently issued as printed on the inside of the front cover of the chequebook and agree to be bound by such conditions or such other conditions relating thereto from time to time in force
(Note: Cheque book cannot be issued against, RFCD, SND, TMD, etc.)
Account Name ___________________________________________________ A/C No _________________________ o Savings o Current o Others _____________________________ Currency: _______________________
______________________________ ____________________________
17. Declaration & Signature:
I/We declare that I/we have read and understood the Bank’s Account Terms & Conditions and hereby agree to be bound by the Terms and Conditions mentioned and any changes that may occur from time to time. I confirm that I/we have received the ‘Account Terms and Conditions’ and ‘Retail Banking and Wealth Management Fees and Charges’ and am/are aware that the latest copies of these are and will be available at www.hsbc.com.bd
Where I/we have applied for HSBC Select Proposition, I/we agree to be bound by the terms and conditions applicable for HSBC Select that are mentioned in the ‘Account Terms and Conditions’ a copy of which has been received, read and understood by me/us. I/We understand the requirement to fulfill the stipulated prevailing eligibility criteria for HSBC Select and will cease to be a HSBC Select customer if I/we are unable to comply, subject always to HSBC’s right to amend these terms at its discretion.
Where I have applied for an account under HSBC CEPS, I understand that I shall be eligible for a CEPS account and its privileges as long as my employer has a valid CEPS agreement with HSBC and on formal introduction from my employer stating that my payroll from the company shall be transferred in this account as long as I am employed with the company. I understand and accept that I will cease to be a HSBC CEPS customer on discontinuation of my employment with my present employer or if my monthly salary is not credited in my account for two consecutive months from my employer or on discontinuation of my employer's CEPS status with the Bank. Additionally, I also accept that the Bank reserves the right in its sole discretion without assigning any reason to discontinue CEPS status on my account with immediate effect. I accept responsibility of notifying the Bank immediately on change of my employment
I/We, consciously, hereby declare that, all information provided in this application form is true, complete and accurate. I/We have not willfully withheld any material fact. I/We will provide any further information/documents as per the Bank’s requirement. I/We agree to inform you of any changes in my/our status that could affect the operation of the Account(s), including change of nationality, residency, contact details and employment. I/We hereby authorize HSBC to verify any information pertaining to this Form, from whatever sources it may consider appropriate. I/We accept that HSBC is entitled in its absolute discretion to accept or reject the account opening without assigning any reason whatsoever and that this Account Opening Form and its supporting documents shall become part of the Bank’s records and shall not be returned to me/us.
I/We assume full responsibility for complying with the provision of the Foreign Exchange Regulation Act 1947, and rules, orders and directives issued there under.
I/We hereby declare that I am fully aware and accept that HSBC does not give any tax advice to customers. I/We hereby assume the full responsibility to fulfill my/our worldwide tax reporting and filing obligations in relation to the account and I/we acknowledge that HSBC expects me/us to fully comply with all of my/our tax obligations. I/We also declare that I/we will provide any information requested by HSBC that is required by law to enable HSBC to meet its own compliance and tax reporting obligations. Additionally I/we acknowledge that where a referral is made to an external organisation for specific tax advice, the contract for such tax advice is between me/us and the third party, and any advice provided is the responsibility of the third party and not the responsibility of HSBC.
I/We also authorise and request the Bank to honor and to comply with all cheques, promissory notes and other orders drawn, and all bills accepted on behalf of me/us, whether the account be in credit or overdrawn, to comply with all directions given for or in connection with any account or accounts of any kind whatsoever on behalf of me/us and to accept and act upon all recipients for monies deposited with or owing by the Bank on any account or accounts in my/our name, provided that such cheques, promissory notes, orders, bills, directions or receipts are signed by myself/ourselves.
Any securities or other property of or deposited in my/our name may be withdrawn and any monies may be borrowed from the Bank in the name or on behalf of me/us and may be secured in any manner upon any securities, monies or property of or deposited in my/our name by myself/ourselves.
_________________________ _________________________
Signature of 1st Applicant S.V. Signature of 2nd Applicant S.V.
Date Date
For Bank’s Use
_____________________________________________ _____________________________________________
Signature of branch staff Signature of approval staff (branch)
Name Name with seal
Designation
Date Date
_____________________________________________ _____________________________________________ Signature of account opening staff (SD) Signature of account opening approval staff (SD)
Name Name with seal
Designation
