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Customer Informaton

Date
Clien No
Account No
Name
S/O
Supporting
Fund Provided Souce
Name Fund Provided
Mother Name
Address
Occupation
Nature
No. of Acres
CNIC

Customer Informaton
15-Dec-15
5555
226193599
MUHAMMAD YASIN
MUHAMMAD ABDULLAH
Son Support
Son Support(Private Job)
Yaseen Ali
Near Masjid Ahl-Hadees Main Bazaar Mustafabad Kasur
Mobile Shop owner
Business income
4 Acre
35102-0619943-9

Proved By
MUHAMMAD SALEEM
BM
489647

roved By
MUHAMMAD SALEEM

Foreign Account Tax Compliance Act (FATCA) Form


- This form must be filled by an individual and submitted with Account Opening Form
- Separate form must be filled for each individual i.e. each holder of an account in case of joint account.
Mandate holder or Beneficial Owner if ultimate beneficiary is other than the customer

Name(as mentioned on the Account Opening Form)

MUHAMMAD YASIN

Country of Birth

PAKISTAN

(If country of birth United States, please provide documents as mentioned overleaf.)

Yes

1. Are you a U.S National / Citizen ?


2. Are you a U.S Resident ?

3. Do you hold a U.S Permanent Resident Card (Green Card) ?

4. Do you hold a U.S Contact Number ?

(if yes, please provide on CIF)

5. Do you hold a U.S Address ?

(if yes, please provide on CIF)

I hereby confirm the information provided above is true, accurate and complete.

I hereby expressly and unconditionally allow United Bank Limited ("Bank") to give the necessary
information as deemed fit to any regulatory authority allowed assess to such information under Pakistan
statutes,rules,regulations or any other applicable law or to the US Treasury Internal Revenue Service of
the United States of America (or its representatives or agents), and do hereby consent, agree and confirm
that the Bank shall have the right to the disclose my personal information with respect to any of my accoun
with the Bank directly or Indirectly to the U.S Treasury Internal Revenue Service of the United States of
America (or its representatives or agents ) when requested and as deemed necessary by the Bank, of
whatsoever nature.
I acknowledge and accept that the Bank reserves the right to close or suspend without notice, any
account for which required document/information is not submitted within stipulated time
I undertake to notify the Bank within 30 days if there is a change in any information which I have provided
to the Bank

Signature

Date
Account No.

ct (FATCA) Form

unt in case of joint account.


e customer

MUHAMMAD YASIN
PAKISTAN

ned overleaf.)

No

("Bank") to give the necessary


h information under Pakistan
Internal Revenue Service of
by consent, agree and confirm
with respect to any of my accounts
vice of the United States of
necessary by the Bank, of

e or suspend without notice, any


ipulated time

ormation which I have provided

15-Dec-15
226193599

Declaration Form
(Where Occupation or Source of fund is marked as Agriculture)
Date
This is refers to my request to United Bank Limited
Lulliani Branch Kasur
Branch Code
0422 for opening of following account
UBL Business Partner (Current A/C)
UBL BBA (Current A/C)
Asaan Account ( Current )

UBL Business Partner Plus(Current A/C)


E-Transaction (Current)

Unisaver (PLS A/C)


Unisaver Plus (PLS A/C)
UBL Rupee Transactional Account (PLS A/C)
UBL Uniflex (PLS A/C)
UBL First Minor (PLS A/C)
Asaan Account(Savings)
Other
(USD,GBP,EURO,UAE DARHAM,SAUDI RIYAL UBL FCY)
I here disclose & Confirm that I engaged in the profession of agriculture under the following Category
Crop Cultivation
Livestock & Dairy

Horticulture & Orchards Fisheries


Other (PLZ Specially)
Fertilizer & Pesticides

4 Acre

being used for the above mentioned agribusiness is

The land measuring


Self-Owned
and is situated at

Family Owned

Po

Rented

Near Masjid Ahl-Hadees Main Bazaar Mustafabad Kasur

I undertake to abide all the rules & regulations for maintenance of account at the bank and
to provide any /all information thereof in respect of my profession if required by the bank now or at
any later stage.
Also I wish to certify that information/undertaking provided above is all respects and I shall
be full responsible for any/all consequences is case any information provided by me the bank prove
to false at any later stage in which case the bank shall be fully entitled to close the account without
any prior intimation to me

________________________
Signature of Applicant
Name
CNIC #

MUHAMMAD YASIN
35102-0619943-9

________________________
Signature verified By CSOM/B

Name
MUHAMMAD SALE
Employee NO :-

ulture)
15-Dec-15

er Plus(Current A/C)

UDI RIYAL UBL FCY)

he following Category
Fisheries

Poultry

Other (PLZ Specially)

ed agribusiness is

ustafabad Kasur

ccount at the bank and


y the bank now or at

all respects and I shall


y me the bank prove
the account without

_____________________
ure verified By CSOM/BM
MUHAMMAD SALEEM
489647

The Manager
United Bank Ltd
Lullyani 0422

Annexure B
Date:

CUSTOMER INFORMATION AMENDMENT REQUEST


I here request you update / amend my detail for the following:
Account Number(s)
226193599

Account Title:
Fields to be amended / update (tick mark

Mailing

Land Line / Mobile / Fax No.

Country Residence

Father / Husband Name

CINC / Passort No.

Directors Information

CIF Creation

Customer Category

Economic

Other

Client Number(s)

MUHAMMAD YASIN
the appropriate box(es):
Permanent Address

Zakat Exemption
E-Mail

Nationality
Date of Brith

Martital Status
Occupation

NTN Number
CINC/Passport Expiry

Contract Person
Gender

Business Registration No
Tax Details

Portfolio Sector
Mother Maiden Name

Place of Birth
Suspend Mail Code

Global ID Resident

Updated Details

S. NO
1
2
3

Authorized Signatory

Contact Numb

All Authorized Signatories Signatures are required


Mandatory Field Should be Check Uploading the request at CIF Amendment Portal
Customer Name / Father Name & Gender will be changed error occurred due to Migration
FOR BRANCH USE ONLY

Signature verified by (CSR) Name

Authorized By (BM/CSOM) Name

Processed by Name
Authorized by Name

ZUNAIR HUSSAIN HASHMI Signature

SHAHID MANZOOR

Signature

FOR CPU USE ONLY


Signature
Signature

.
.

Annexure B
15-Dec-15

ENT REQUEST
5555

kat Exemption

artital Status
N Number
ntract Person

siness Registration No

rtfolio Sector
ace of Birth
obal ID Resident

Contact Number

to Migration

.
.

Declaration Form House Wife Account


Date:

15-Dec-15

The Barnch Manager


UBL 0422
Lulliani Branch Kasur
In terms of directives issued by State Bank of Pakistan. I
MUHAMMAD YASIN
S/O
MUHAMMAD ABDULLAH
the accountholder of UBL at 0422 Lulliani Kasur
Account No #

226193599

holding CNIC #

35102-0619943-9

1.
The sources of funds / proceed deposited or to be deposited in my above mentioned
account alongwith name of the funds provider/relationship with me are follows:

Source of Funds
a.
b.
c.
d.

Funds Provided by (Name & Relationship)

House Wife
Yaseen Ali

Son Support(Private Job)


Yaseen Ali

2.
If the funds/amounts are recevied / deposited in my above mentioned account from
a source other than the sources mentioned above. I undertake to inform / declare in writing
to you forthwith to update the Bank`s record.

3.
The ultimate beneficiary of my above said account is
Relationship with Customer
having CINC NO.

___________________
Customer`s Signature

CSR/CSM/BM Signature

AMMAD YASIN
422 Lulliani Kasur

02-0619943-9

e mentioned

me & Relationship)

(Private Job)
en Ali

account from
re in writing

M Signature

Physical Verification

15-Dec-15

Date

226193599 titled as
MUHAMMAD Y
This refers to account no
and categorized under the category code" _____" (Please refer to the list below)

In order to comply to AML guidelines conveyed vide Compliance No.Date March 27,
2013, I confirm having verified the physical existence of business situated at:
Near Masjid Ahl-Hadees Main Bazaar Mustafabad Kasur
and bring run by the customer as
Individual/ Professional.

Name:

Sole Proprietor

MUHAMMAD SALEEM

Designation:

Branch Manager

Employee No:

489647

Signature:____________________________

Code

Description
2
19

IND-SELF EMPLOYED PROFESSIONAL


INDIVIDUAL-STOCK BOKER

IND-SELF EMPLOYED BUSINESS

20

INDIVIDUAL-PROPERTY DEALED

MUHAMMAD YASIN

e refer to the list below)

liance No.Date March 27,


usiness situated at:

Self Employed

Proprietor

Type

Code

Description

Sole
Proprietor

Business
31

Sole
Proprietor

Enhanced Due Diligence (EDD) for High Risk Customers


Please see the trigger that categorized refer Compliance Circular No.295 Dated 30-Oct-2014 the Customer as High risk and recorded to and those which are arable

Branch Name
Account Number
Customer Category
Source of Fund
Tigger
AOF/CIF Field

Lullyani Branch Kasur


226193599

Branch Code
Account Title
Occupation
Mode of Transactions

Information Provided
by the Customer
Name of the mandate holder
Is Mandate holder a customer of UBL?
Re

o422

Cash,Clearing,Collection,Remittance

To
Branch Manager
United Bank Ltd.
Mustafabad Kasur 0422
Subject :- Request For New Bank Account
Respected Sir,
It is State That I am
Resident of
I am a

MUHAMMAD YASIN

Near Masjid Ahl-Hadees Main Bazaar Mustafabad Kasur


Mobile Shop owner

I want to save my Income for

personal use, so please open my new bank account in your bank.


Thanks
Your's Truly,
MUHAMMAD YASIN
Account #

Date :

226193599
15-Dec-15

ranch Manager

nited Bank Ltd.

ustafabad Kasur 0422

UHAMMAD YASIN

aar Mustafabad Kasur

t to save my Income for

UHAMMAD YASIN

To
Branch Manager
United Bank Ltd.
Mustafabad Kasur 0422
Subject :- Request For New Cheque Book
Respected Sir,
It is State That I am
I have finished my cheque book and my cheque book requestion has lost and I am
unable to find it.
So, kindly issue me a new cheque book, I will be very thankful to you.
Thanks
Name
Account #
Date :

Singature

Enhanced Due Dili

Please see the trigger that categorized (refer Compliance Circular No. 295 Dated 30-Oct-2014) the customer as High risk and respond to only those which are applicable.

Branch Code

O422

Account Number
Customer Category
Source of Fund

Trigger
AOF/CIFField

Information provided by the customer

Signing Authority

Mandate

Source of Fund

Stock Investment

Family Business

Agriculture Rented/Property

PEP

Yes

Customer Category

NGO/NPO/Club /Societies

Trigger
AOF/CIF Field

Information provided by the customer

Stock Broker

Customer Category

Self Employed

Non-Resident

House Wife

Nationality

Other than Pakistan

Hold Mail

Yes

Mode of Transaction

Cash Only

Confirms that the Conduct of transaction and expected aggregate credit is in line with customer profile? In case of No, refer the account to Compliance

Confirm that CDD questionnaire is filled after direct interaction with customer:
Branch Declaration

Other observations (if any)?


Pl attach additional sheets, if required

EDD Reviewed By
BM/PB/RM
Name
Designation

Enhanced Due Diligence (EDD) for High Risk Customers

spond to only those which are applicable.

Branch Name

Lallyani Branch

Account Title
Occupation
Mode of Transactions

Question to ask

Name of the mandate holder


Is Mandate holder a customer of UBL?
Relationship of the customer with mandate holder
Expiry date of Mandate, if any
No of Changes (if any) in Mandates since inception along with reason

The customer is a Principal or agent or investor

Does customer hold a CDC investor / CDC sub account with a stock broker :

Specific nature of Family Business


Does the customer hold a significant position in Family Business
Confirm that the branch hold a valid (i.e. less than one year old) declaration of the customer?

Name & Designation of the organization to which the PEP belongs to:

Reputation of PEP in general:


Confirm that the branch hold a valid (i.e. less than one year old) declaration of the customer?
The funds received by the NGO are utilized for:
Name of the major Foreign/Local donors
Geographical Area of Operation of the NGO
Reputation of the NGO/ NPO

Question to ask

Is the customer a Principal or an agent?


Name of Principal/Agent

Does customer hold a CDC / CDC sub account

Customer confirm that physical verification of the business place of the customer is still valid
Exact nature of Business of the customer
Counterparties of the customer
Geographical Area of Operation of the Customer
International Contact Number & International address
Customer's Foreign Bank account No
Confirm that the branch hold a valid (i.e. less than one year old) declaration of the customer?
Purpose of Customer's stay in Pakistan
Validity of Visa
Specific reason for selection of Hold mail option

Justification for selection of cash as only mode of transaction

credit is in line with customer profile? In case of No, refer the account to Compliance through line management
Via
Personal visit of the customer to the branch
Visit of branch officials to the customers place
Phone(#_____________________)
Date & Time of Contact: _________________

Signature with Date (It is hereby confirmed that the above EDD form has been filled out as per the best of my knowledge and is

based on the updated inform

Response

YES

NO

If Yes, please give below mentioned information


In his own name
In the name of other individual: _____________________

YES

Positive

Satisfactory

NO

Negative

Unsatisfactory

Response

In his own name


In the name of other individual: _____________________
Date of Physical verification

NO (EDD form filled based on already available information)

rmation as per record and interaction with the customer)