:----r

Midland Bank Ltd. <l"t(TFrfirotu)BranchTIRII

dld f1:

'l Name of the Account / Account Title (<RdrI)

€nr<<aw

ln English (Block Letter)

lndividual Account f <rG-+ e q-<fi+ fur<)Speci al Scheme) ( cv.G.or<. e frc,tl frN,9< N-G erc{Mr)

account with your branch. My / Our, organization's and account information is fumished below:

€xr< enar< qs oir<ra o<E t qlwr< / qulrs<, sBbrc+<.x<s Enrc<< ffis orfi frcN sqrd €<8,

Currency:NqI

PUYlEd

Maturitv Date:(EEtn 6<orfr{r

(lndividualand Non(Application for FDR &

Date:5,-?{

N4anager lffr+sr<)ll C:anC Bank Ltd.(frsanu<rqofrfrds)

Dear Sir, 1fi16pma)

I We hereby apply to open a

qfi/ ow<rwor*r<,ruq eo6

2. FDR Related lnformation :

ev .G.qr< . rqerg oPIt

Tenor:(NluliFt"t _

BranchqRIT

{Produci i'{ame l Q 3+Ier iJdi$ EIil si< 4B}

Amount:qfrsrq

Year<tr<

MonthEflN

Rate of lnterest{aq-<eRI

Renewal Renew Principal & lnterest Renew Principal only;l-<lI]Gl<l ffiGi --_ . qp6 €<q5qd<Il;lo<trd ___ el6gq17affi-{rao<p4,{h

2. Special Scheme Related lnformation :

ft=ersGnrssrds2r

Name of Scheme

ac<€nK<q'{r€odNot ApplicableelGIrSl crQl

ftas<ars

Account No:

fui<ac-<

Unique Customer lD Code:QGF-++rfwrcoEG ers

{For !3anlt Use 0illy} lqrl3F<<r<erc<:ml)

Scheme Tenor lnitial DeoosiUlnstalment Amounttr-fldfdqEr/ tol5<'tk[6llct _

No of lnstalment (Yearly)frfr67qry(qrft{)€ra-<oqrq

Amount Payable at end of Tenor Amount Payable Montllyarfi-+ ercqt(8IITqIGIETSTI

4. Account Operation lnstruction (please tick) : Single Jointly Any One or Survivor^ Others

€xr< qRsr+ar rqlTd ({E];rr (Bo fi-*ls €o€st(< raJrrerc< ({ CoI;I €oq;l qel<,I 6Ro-oa o"nl;IJ

5. Purpose ofAccount Opening:fui< en-arcGm,u

6. Does Customer Have Ofrer Bank Accounts (Please Tick)?.2,lQro<r q"I' <rlqo €nr< slq ft (fio fia) z

(lf Yes, please provide details below) (Gs<urzafi5+ctfrpooa)

Name of the Bank and Branch<flqa€ rRIEl dl-31

a)

b)

c)

d)

e)

YesQIr

Loan AccountsarqQnr<

Loan AccountsqqExr<

Loan AccountsqqEar<

nNoI ldr

Nature of Accounts (please tick)qRErFofor+<soF (fiofid)

' Deposit Accounts Loan Accounts_. oxrExr< <rq€x<

Deposit Accountsq'6tTlE fl?[

Deposit AccountsoarErr<

r r Deposit Accounts ''-

l92p Accounts

;_- uar Exr< i_ <rq €xr<

Deposit AccountsoarExr<

Page - 01

,/

7. Customer lnformation: ( Customer information form has to be filled in as per Annexure-1(A))<rG aqo, e o-rnr<Ac ( qRfrS- o ( o) e args' <iG aqer6 ornr<fr o<e "pt c<o er<)

8. lf account holder is minor / fur<q? 6fl?n-trF'Q-Gs

l/ We, being the guardian of the below mentioned account holder, do hereby declare that the account holder is minor. His/ her required informationis provided in the attached form. Until the account holder attain majority (Adulthood) or any further declaration !s given by mei us, the account will beoperated by me being the guardian. ( Guardian refers to Father or Mother or any other legal guardian)oTfi fiE<fio fu<{ra< qGci-<-o frat< .9e vd rsnql T-<Q €, fur<<rfr ar<ra-o t or< er-arofu oer nq{s rF<rF emn a-<r a6r I Enrc<ra a<rfrr i{r -as{r qd-6 ftq<r uwr<ors<3 rsrrdr dr fi{r qfe qG<T-<o frnr< Ear<G qwr< zrsr< "rffio ar< t (oG-<<o <ao <r<r opt<rr Nr orercr cFrr con qrQa:rs o&sr<oto E<n<)Account Holder's (minor) Name:fuT<<Ta (dr<rtrr) g<drs

Name of the Guardian:

Date of Birth:o-{oTR?r

qGsr<cq<ara

Signature of the Guardian:qlggr<rGF<,:II{F<I

Relationship with minor:ar<raro< xrcq a*r6

(For Both Minor and Guardian, Customer lnformation form as per Annexure-1 (A) has to be completed and for Minor Applicant, in both forms Guardian has fo slgnin place of Applicant's Signature)1a7a7aa;a<qdGsrao-@qQfrA-s@) axga "o6xqors s2n<A"F<NZ<"roaoq@a4<dRndoqrcqaor?<cwa€oqo<@iq@qao64zwanpaGor<o€dozTffqo<oq@t)

9. Introducer Information /qffi<orr: (<re.ro.:rtQrq<walcowlGq6nr<qn+raercgrqdadQ)

A) Name:dl'31

B) Account Name:fon<<ara

D) Branch Name:XIRIEI dTEI

E) Relationship with Account Holder:{Rr+<fletnaq6

C) AccountErr<aq

aFfr<rqrir:

F) Way of Communication:GIIflIGII'f ET{r8I3

Phone No(silol dl

Mobile Nor$<Ea dR

G) Signature and Date:

srs<s ffi{r

Attesting Bank Officer's name and signature (with seal and date)qlffi< orr erorErcr-sTA nqfiS <fiqo rrpfl<r o.forixr drsr c rs< (fi-a e orRlne)

10. lnformation of Nominee: Nominee related information form has to be filled in as per Annexure-2affi rqors oa.Br<A s 'rRFiS-r .! nqTsaffi nsord oqir<fi +<* T<q o<?o {(<Number of Nominee:

11. Source of fund/funds (Mention specifically and in detail) :

wei< Gsal€sr a-q: ($ff8 e €srfrs G6r +-<ro zc<)

12. Net Asset : (for Non lndividual Account)fiB r*rq (q'<G-o fur<-< cwa)

13. Declaration & Signature / €wff€ YIE<B

lAtVe hereby ensure that, l/VVe have read the account rules/terms and conditions and abide by the account rules/terms and conditions. lAtVe declare that,the information furnished above are true. lf further information is required, l/we will provide the required information/documents as per your requirementorfilErr<r eQ Ed fugvst qETd o-<Q cs, qrfi/urs<r for< xqe're {r<&{ lM/,l-offi qr-sQ €<q Os fiENr<A/*rof<A cfl-Gr EE|-(o. <Irrr qFtr< | qfiErs<r n-gBrc{

envo<Q ra, GfrFrooemfirrsr lqfirora-<rsqssen<q6ft-s'xsfiS € crrdst*rsa{o{r/qfrdrfisrqr$-<uEq rxorc<oa-<<<rE o<<t

-tName of the 1st Applicant, Signature & Date

in qrGmr€rA< {t$<r, ars e srR{Name of the 2nd Applicant, Signature & Date

rg qK<Edsra< Trs<, ara e orR{

Comments / a-s<l

Account Opening Officer's Seal, Signature & DateExr< crnar< xrer alffi offor<amgsfi-aFrnlF<e orfr{r

Approving Officeds Seal, Signature & Datecgalrdrra Tffir< (*rur <rc{pro)amgofi-aa-rxm<e orfr<

Page - 02

Annexure-l (A) / cfrfi6-!(G)PLEASE FILL lN THE FORM lN CAPITAL LETTER lN ENGLISH i s{nefisu-<xBQsrilfiTsero-{snFr<Tfff s<Ff,Please fill in all fields carefully and strike-out the ones which are not apptiiaolJ/o*qaT<+nodomil#*-*o*"".1qqq€rclrqlq-<s"nt (s6fiil1

Photo oftheCustomer

<iG-<oramfu

Midland Bank Ltd. (fumMs't\<Ffrfr#gBranchIII{II

1. Name of the Account / Emr<<aw'

(eQ m-<xB 'g.rad-o <Ga e o-<jGo Eff< c{aT< qrcr, Cd<r qa qqcnr wu rygs o<o {r< t)

* ;ii'-'

Account No:

€nl<ac-<

Unique Customer lD Code:QGR-oorSxi<orQG rors

(For Bank Use Only)(<lrer€< <r<Qtrs< q-dr)

2. Name of the Customer / Beneficial Owner / Account Operator (ln English) :

srarl r<66fi$n sil<l fur<,lm< ilE

Please write full name /TKIdtEI(<tedm)

3. Relationship with the account (please tick where applicable) :

fuR-T< Nt?r n*rd (fio qarsr ffi(a Bo fr*) s

T--r DirectorL-l qAna-o

T---t PartnerL--]oqQqr<

;--1 Proprietort l.rcoaErffi[-r MinorAccount Horder i-_l Guardian T_l Attorney Horder f-l Account operator ;-_l Trustee r--l Beneficiar owner f--r others| | tui<<rfrm'<mo L-J oc-sr+ L--l dffar*'u Lr EnrKffi#i' i liii#'"" L--L -aen*.u*u r I qcr*r

3rd applicant.rqqrc<q-{m

n 1st applicant i__] 2nd aoDlicanti luaqn<q-++rfi | ilqo6+d<Era

4. FatheCs Name:frsmaw

5. Mothe/s Name:SfSkI cllEl

6. Spouse's Name:niS/S<ilx

7. Nationality/urOgoc

(fttqQ apr6-o e6 Gnrl'€ clniql6< ofi ol<fuos-R< erqq o-<o er<)

\ 8. Resident Status (Please tick) / c<fir66n6r:n (ErFd) r l--l Resident [--l Non-Resident

(where applicable, inbrmation b be .lltected complying with the rn"traio* in m"Haffo,",nn rr*nr"1*Lf,"r*H;fl@(g€rsA{rw@<fi qrr€r,fl ffi cE{qa-osqoqErarq@c-dl.ll<frdrorordmre<orr<)

9. Date of Birth / wqofiv a

10. Place of Birth (lncluding Country Name) / s-{!rd (G,Ea) s

11.Gen9,er (pleesetick): T-.1 Malefdrd(ErF€frd) I I g+aI I remateI I NEdr

Third Genderp6{fift

12. Occupation: (Details with Designation):arne (cqaneffio)

13. Mo_nthly lncome (For lndividual account holder):mfro qtg (<rG-s €rrr<< mra) g

( u.r ai ofico< mo ffis Gg{T{o s@'* rsF@ <nno-< Efi ar ce*r-s qffi shra o-{o Er<)

14. ldentification:qEGG,rs :

a) National lD Number'qr6t qfrr'q,rsa{<

b) Passport No. (tmcm6 at) Expiry (rxrm) :

c) Birth Certificate No.uq fr<ra n*ot'rs ar<

d)E-Tl\Noi@<,Et{+-6ng on?ls f,{<

e) Driving License No. -

Expiry (ra'llt) ;gl{rsRcrl€orff iltr<

f) Others (Please sPecifY) -'

o-airal t Rffisrc< 36u o-<e a<)

la {rs c {!-r-ofr(+ <ffg cfr.irli {rs qqFfiTstr{ rq .{F-q$6-{fun sq]a arra <r< uc< q* fi-Eln 1i i sTtf{ frir< r{q]-{ oFc 6{ 1i{fi ,lo.q{ca? qfG-e qI{{&{< * fX

,.. rfie {Rtrfs ,rd sq,o ,=rs {.u ;;-ffin-;.i fr.sft *'ra"cqa rril ert'ii;;''#r# "a orffir<-eq, .qr" <c< r qrql+fa:r< qkftts qq { {lo(q

'8 f{q'{ {fir* qr

15. PresentAddress (Place of Residence):

TSE.ra6'{IaI (w<naa)

16. Permanent Address:

$er7E r<"rffi<lProofofaddresss< |z'f6F 5gffin sna o?rcs I

{r< ( o-fl "rcs ) E 6-rr-dT<-J

n*6)ErSeotdl

1 7 Drofessi?n'!/Business Addre'qs

ef"fltls 6€r.il

18. Contact Deiails:€I'IIGIT'I

a) Address .- Present

ffTT-dr ' <-68ril

Permanent Professional/Business

- lr8 cc5IT o

b) TelephoneNumber: 1.

Gfraora ar<

c) Mobile No. 1

(Er<rtd il{<

d) E-mail:a-GQ-d

19. Person to contact in case of emergency:

s-+a sLETsG c{rrrclllm q.lr l+Glrfto <G, s

Residence: 2. Office'.o6I

<IJIT

Mobile No. 2

rwr<Q-a ag<

e) Fax:5,'rg

Name:arsl

Address:Afldr

Relation with the account holder/operator:fur<qramffr< qffit<nrer)rsq{ --

Mobile No.rgr<rQiq il{<

E-mail Address:A-cNA-d Srr-dI

20. lnformation regarding Credit Cards (if any):

c;GB Frg nqsr6 o2tt ({fi rtn@)

lssuing Company/Bank (if more than one, name of all banks):

tryo? s6tmr<lr'+ (os,lQ-+ {G n-sa <nla5<r aw)

(b) lnternational:qrEf$fsr

-

Name and Signature oi Applicant (with date)

wr<h-frsla-< {ls< o ots 1 5ffitra'r)

Approving Officer's Seal & Signature

o-*nm*ora a'{.f6rc (qnn <r<Er"r+)

aragsfi-amam<

ur*rmal<rfr<arsnqnq.nfir,fi6*Cft*.rr6o< .6{<, cqG ca'g<e rrGfi-tr<fi, orsar<rrdc+'6< 66s otl*dnclcfltffisffil.qr<FFRxfrqna#ilfire'ffiIqfrqm-< rr,$<sn-ds =,tn

c$T{nd,acfiTdcR,{rqa r-"*;,;;; **" "n"

ierGfi-r<2q,,"-**aa:4"'tmmq{'ITa, GrTsIaiF66d*nF' <<r-++r30r'

.:Qs rc m sx.q riqt6 tvrga u{€${Tf€ flf< I

Account Opening Officer's Seal & Signature

Gxr< crnar<x$Sr&t6t<arafo-fi-amqnrd

Annexure-2 / qRfiE-iMidland Bank Lrd. (fuErM<rl\o'frftFu)

BranchIIT{I

(Applicableforonlylndividual/JointAccountandifnumberofnomineei'(egm <Ga furm< (scr scq* eou e<q ec+< oko -ffi qc-;ffi

"1E6 "=;i"r;ffi'il ,iAccount No:frt<as-<

Unique Customer lD Code:eOfr-oor6rfl<o€Gcsrc

(For Bank Use Only) (<nS@-<<rqart<<q-dr)

l/we nominate the following person to receive/ draw the balance held in my/ our account after my/ our death. I/ we retain the right to cancel or changethis nomination at any time' l/ we hereby accord my/ our consent that the-Bank shall not be liable in any ,annet. *hatsoever to make payment as permy/ our instruction.oriimm<r € efl6< q2l qr6lkil(Ir.IrGil

{^qr< T fiqrc-^sre fig <rF <rel<ro{crcF sqrct<r s-d, mmfrs o-aar* r ffimra-<i ffiFro ar*ravr <r ."ra rys{ <r6a <r"rR<66< sfrrK aq<wq oR I qftrqer<r ie' xr* sr6i ,T{6 **}r<e a, im<mrmml nrt * ,fl-ra. <nqo s.i ffi -<u ,us ,.,-sic' u,rq?F ci'R.rrsr*r qr{<h qr< orr r

1. Name of the Account (frrcr<am)

2. Account No (6nr<ar<)

3. Nominees Name (a8fi-<aw)

4. Fatheds Name (frsmare)

5. Mothe/s Name (xtomma)

6. Spouse Name (zr$r$<arw)

7. Birth Date 1uqglfu)8. Present Address

(@ta&rdr)

9. Permanent Address(ErSAolar)

10. Occupation (em)

D I D lrvt lrvi I v lv lv I v

11. ldentification of Nominee (aR#<a€uvna):

Expiry (evm) s

a) National lD Number(ur6a ffiuvla ae-<)

b) Passport No. (rmmr6a$

c) Birth Certificate No.' (wqR'<s-aa-mroaw)

d) E-TIN No.(ta@Ro-66oECae<)

e) Driving License No.(gEGqaEu-qaq-{)

f) Others (Please specifu)(q'drdr fiffSqr< ti6er sii.o er<)

12. Relationship with A/C Holde(s)(frl<ro*<fiBrnq6)

't 3. Percentage ("roo<r em)

14. ln the event that.the \g1nin9e remains as a minor at the time of account holderamount oi d'e'iJdiiJ ireid ov ihe oi;i['ii; #haiiiffi'tg::o:,. ,ause r oali) ciiif;"tfi3llli,,l[t"i|]fiX3lr%:li 6d{i"rized person to receive/draw the

afioar<moerhs*r",ri-<*fooafloru<Er{hiri:#ffi*a'o*vq<mo<noffiwr{d, Dbb).r<uoo (i) <r<rwEa6qnp466Brorure.rsr+<o.E:

a) Name (am)

b) Father'siHusband's Name(fi-.e-yElfi,s< arf,)

c) Birth Date (s-{oIR{)

d) Present Address(T6ilaAordr)

For Non-Resident and Foreisners copv,or passport arons with ;;rdliisa ;;i;;':,iiiriJo.'ripilij'iriffi:i#tffi"ffH:[fi:':,;l*,fl:society to the bank, satisrying the bank's requirements. fhe mentioned iJentinetion oaDer hes ln hav6

^h^r^^?anh ^, rL^ ^,.^.^---,-----.r- .,,atons with varid visa must be submifted, lr photo ro'is noiavaitb6 6;; ;;!niffffii"J,Ei;Hlfi:1i#lffS:[::H';Hi l*:.Hll::1""r,,:iTlf5:i:i3:f^": 13^1j:3y-".t!tqq ;r u,"

",.to,",rop"ori,, "r m. l..o,,iiourill-esteo in lre

Expiry (mm) s

olo M ti,tlvlv Y Y

IH]#H]#ffi'*'ffiil,jffi"E$m**jgg#::;j.1"#sJpiffi,'l'ryil:i"}J"#llff.Ti'iit'J:fii,il".',i"T,",Xit?ilta tro c ar< frro <lilu qFrarG qo' or<firwn< cl coracB qrn €al6 qftrd 6Erd r-<o q3 I or< q.{ E-{E-d r-d

ilad.1;il;;"H;ffi,ffi'.ffi tr

of the

6fi q6#rii-s{affi 'Eiilrfi'iffi qffi'U"ilitlft"#lo'[.#i,i

addition

e) Permanent Address(E€lerdr)

f) ldentity infomation of legal gurdian accordinosrsro JJ wqxr<w< orGsrceo-< qffiB,rs lqrg oqi

to SL no. 11

g) Relation with nomineeaFfr<xnsr""rd -_-

{ r{]a offiqir+ aRF +-<r ra 's<l -} ofr<nft x$8 ftry+o u{ erg tc $g w{ €reec (${cla ero €qisn 0<rqfi'o ryr fivq.r !!,tr< 6re frvn gr0rsr m r l

Nominee's Signature & Date (Optional)aRR< srs-<e infr{r ("+&-{)

Na;.;e .:f i,,e 1st A-piic,,rt, -ignarure & Di:.etx on<r++r?< n1,r-<, aw o sr6<

Cheque Book: Yes Noo-o<rQ fi ar

e-statement: -ryes lNoQ-ffi r- r {n -_ tar

f

C- : :,. - _4. "_. .| ,_i ,r_ _. r::

linportant persuns of the society rnclude Membcrs of the Parliament, Mayors of city corporations, Deputy Mayors and counsellors, 9th Grade and aboveGazzetted officersunder National Pay scale' Teachers of Public univers'ties, chairmen and vice chrirrnun of Upaziila bouncits, chairmen of union council, Mayors and counseilors ofMunicipal corporations' Teachers of Private universilies, Principals of Private colleges, Head Masters o, private High schools, Editors of National Dailies, Notar public,

;:lrl*:Jit::lff,iilffiffii[:i 33f" or Semi Government, Autonomous, ,nd Go,e.n,"nt bodiesunder ruaiionar pay scare and gth Grade and above orricers or

a-*rarai <G ?r"r'5 nq'q nE*' fiE otqrrgra< ffir<. cset' rxv< s. o*B-a<"rq. sTs{ Gr."r GfF. ;N 3 5?<d cr(s<, (,(5-6s +-ffi;r. qr<fi-s ffinrara< fis-f , Go.sdTqRxq-< ov-<arm e .,Q, oq*etr6, ?cfi{d 'fr="u ffi"'^ei-<n-€T<

^au. ;ru Hfr-**, .un-*,'aftTRqra6< qryrq-o, cor+or<r oo*rq. qvrs, er+oi* suffi**$T.#*#.H;mm;mfl-;'ffi*;;";;"H;€* xsE< srs{'cd;'&*.F <r or<6 *rsu o$.o-6,,n €<( <Tq-r.q.r

Name of the 2nd Applicant, Signature & Datetl sKq-a-orfi-< S|TF-<, arN c orB{

Name, Seal & Signa'ure of customer,s signature verifying Bank otficial

E-mail:A-raea

2nd Applicant Signaturewwr<q-++r?-< zrs<

Debit Card: r'--t Yes - - lNocgfrBors ttr - dT

midland online (lnlernel Banking): - yes tNofr'sdrrreoa-dTQ-d(fu<rsfrq) fu _, ar

For Debit card & midland online l/we hereby declare that l/we will complete the related forms & abide by the relevant terms & conditions<nfrrqnr<r erongaq<E re oR6or-$ s<Rfrsdlruw.rfrri{ c,r<tr$Q-f, <'<rRr q-mr aq$s+.as iFq <5<K r<q fru,.,uas -rffira-ca rsr< ryx6 fi&r

II

I vrs' Please enroll me in the sMS service offered by Midland Bank, where I shali recerve Transaction Notifcations and other bank related information to my mobile number.{n' qv oca qwr+ frs-dus <nq+ -,,lJI€}l <ttlfti o<r< o-*r ofrorqs c-+-d ornra <n& c"rarqc{< n33 s <tr"q ,q6s o;nrdr o.rrG .,'o,. cm<rta rura qn<r r

','.e lh ,!,r,s;ltn,l J?.t?,\r I g ni i.:,,1 ^7a1 d-r rf ..,-i-rt' ri we srrall irrforrn you oI a,,y changes there ro. Ar y overdraft wt,rch ma|'from time ti time oe "*"ri* "" *;;;io";orrriilu,, ;;;i;ij#hi'::#J:l'#ffi;ff3:i-",:.X,X,i "'to

declare that l/ we nave not siven Jrvi*n or cash/ o""r"i.n"!r" to any Bank represenrative to open theqrfi <r wnrcr, fu zrra+r? rvm'n o<E rs, Gqr< <tts orirfi ror, x*1,f s x&+ e<q qfi <r onr6r arqr-f-s-gr< a6-rr <g,ro sef (rn,ra offi r qrfr <r 11ra-<r cs cora "{frq6qnqrd qror;{re-< w<Fo q<r< I sfi q,o'<l t[i{RT< e@G;6 rsr{ {arcs vo Br:or u'sr wrE o*r <r-Gr t<fi ch$q crrT r- ; * (o-mBfr-o) srqo. uorfr <r qwfl ralrr e<Rqramrsn< qra f< t qrfr <r qrs<r qrI<Ire cqxqr +-{Q rn, otfi Er qrsrcr c{t;r <rqrc-< s6fta@ €nr< or-"* -* **a.l .fi" q,s, cord drrq/ ap6 6a qffi

1

Mobile Number:rfir<ttd;Tf<

A,/C Opening Ofiicer:eorg$cndfl<sffiI

1 st Applicant Signaturelx qrcaq-d{r+< ?ts<

Checked & Authorized by:sr< Erfl TAfus s q-ddrfo,

Manager/ Branch Operation Manager (Full Signature with Seai)i$rcrsir</ 3rrrr siqrGrrd E T6MRT (a.t nrffina fia)

Dateorfr{I(Full Signature with Seat)

(t.tznr-qqfi"a)

l/VVe appiy for the following service(s):urfirom-<r fiqrs rn-<r< q-+r qraq-d o-<e,