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7/25/2019 Application Form Opening Account RevisedV1 210814
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DATE:
Note: Kindly fill the form in BLOCK letters and sign in the
appropriate spaceonly after reading the terms and conditions. The
terms and conditions whichapply to operating this account form an
integral part of this application form.PLEASE COMPLETE IN FULL AND
TICK WHEREVER APPLICABLE.(All fields marked with (*) are
mandatory)
BRANCH
CUSTOMER NUMBER
FOR BANK USE ONLY
:
Customer Details (Primary Applicant) ()
*Name
:...........................................................................................................
(As per ID/PP) (HH/SKH/Mr./Mrs./Miss/Others)
:
.
.
( (@) )
...................................................................................
Barcode
*Employment Details
Employed Unemployed
Name of Employer
:...........................................................................
Employers Address: PO
Box:..............PC:...........Location..................
Employee No:.................Date of
Employment..................................
Present
Position:.................................................................................
Expected Monthly Income/Activity:
No Income
Upto OMR 250
Above OMR 251 upto OMR 1000
Above OMR 1001 upto 2500 Above OMR2501 upto OMR 3500
Above OMR 3501 upto 9000 Above OMR 9001
@
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.
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.
..
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APPLICATION FORM FOR OPENING INDIVIDUAL / JOINT ACCOUNT
/
*Postal Address: PO
Box:..............................PC:.............................................
H. No.:................ Apt. No.:................Way
No.:...............
Location:........................Locality:....................................
Wilayat:.............................................Sultanate
of Oman
Permanent
Address:.........................................................................................
.........................................................................................................................
Contact Details: Tel
(R):................................*GSM:..................................
Tel
(O):.................................Fax:.....................................
E-mail:
............................................................................*Sex:
Male Female
*Nationality: Omani
Others..................................(please specify)
*Place & Date of Bir
th:...................................................................................
*Civil ID No.
(Nationals):..................................Expiry
Date:...........................
*Passport No. (for
Expatriates):......................................................................
*Resident Card No. (for
Expatriates):.........................Expiry
Date:.................
*Are you Holder any of the Followings?(please specify) Yes
No
US Nationality Green Card
Address / Telephone No. in USA
Make ongoing payments to USA
US Tax Resident
:
..........................................................................................................................................................................@
(
/
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/
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call center 24 79 5555 www.bankmuscat.com
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7/25/2019 Application Form Opening Account RevisedV1 210814
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Account Details
Individual Joint Minor
(Guardian name if
minor)................................................................................
Current Saving Fixed Call
Other...........................................................................................................
Currency of Account: OMR AED USD
Other..............................
For Savings Account: With Al Mazyona (no interest) With Interest
(no Al Mazyona)
Bulk Salary Account - Private Company
Name as desired on the card (Maximum 21 characters)
......................................................................................................................................................
:
@
@
:
:
.:...............................................:
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...................................... :
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. : ...................................................
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**Type of business: (mandatory for Current Accounts)
Wholesale/Retail Trade Estate Agents Government Companies
Listed Companies Financial Institutions Charity/NGO/Clubs
Money Exchanges
Offshore Companies
Commodity/Metal
Trading Professionals Hospitals/Educationals Export &
Import
Building Materials/Construction Travel & Tourism
Investments
Other Business (please specify)
................................................................
Self Employed*............................(*specify CR number if
self employed)
Individual for Cheque Book facility Business (Please
specify).............
Others, please specify..........................
(
)
(
) :
@@
/
/ /
/ /
/
()
......................................................................................................................
@
(
)....................................................... @:
....................................................... :
...................................................................:
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@(): ...............................:
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Account Statement to be sent:
byE-mail by Post
*Name:...............................................................................................
(As per ID/PP) (HH/SKH/Mr./Mrs./Miss/Others)
Postal Address:
P.O.Box:.................................PC............................
H.No............Apt No.................Way No.................
Location:...........................Locality:........................
Wilayat:..................................Sultanate of Oman
Permanent
Address:............................................................................
Contact Details: Tel
(R):...............................GSM.............................
Tel
(O):..................................Fax:...........................
E-mail:...................................................................
Relationship with primary
applicant:..................................................
*Sex: Male Female
*Nationality: Omani Others........................(please
specify)
*Place:.......................................... Date of
Birth:..............................
*Civil ID No. (Nationals):.............................Expiry
Date:...................
*Passport No. (for
Expatriates):............................................................
*Resident Card No.(for Expatriates):....................Expiry
Date:............
Joint Account Holder Details
For Current Account: Cheque book facility required: Yes No
Number of Cheque leaves required: 10 25 50
For Fixed Deposit: Fixed deposit
for...........................months (specify period)
Maturity Date:............................
Auto roll over with interest on maturity OR Interest accruels
to
Credit Account
No........................................................and roll
over principal
Source of funds: Cheque Cash Transfer to Account
................................................................................
) @( ........................................
@
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( (
:
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:
:
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( ) ( ) :
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:
call center 24 79 5555 www.bankmuscat.com
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7/25/2019 Application Form Opening Account RevisedV1 210814
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Bank
Name/Location:.......................................................................
Account
No.:......................................................................................
Bank
Name/Location:........................................................................
Account
No.:......................................................................................
I/We confirm that the information given is true and
complete.I/We have read the terms and conditions (F3B V1 09/08)
govern-
ing this application including delivery channels and agree to
be
bound by the same and any amendment thereto as may be made
by the bank from time to time. Of the account remains
without
operation over a reasonable period of time, the bank has the
right
to close the account without reference to me/us.
I hereby accept that my name and details as a winner of Al
Mazyona draw shall be advertised in all leading newspapers and
on
the banks website without prior consent from me.
Ultimate beneficiary of the account (if different from the
customer)
Relationship with
customer:...............................................................
Signing instructions: Self Jointly Either or Survivor
..........................................................................................................................
:
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:
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.
Declaration/Operating Instructions
Other Bank Account Details
:
...................................................................................................................@
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:
/
For Non-Resident and Customer on visit visa
*Reason for opening
Account:............................................................
Declaration for Minor Account
I hereby certify that
.....................................................was born
on
....../...... /......and attains majority on.......
/...../....... I am the natural
/ legal guardian appointed by the court order
dated...../....../..........
I will confirm to operate the account only till minor attains
the age ofmaturity.
Name of the
guardian:......................................................................
Signature:..........................................................................................
........................................................................................................................................................
........../......../ ................/......./....
/ ......./....../.....
..........................................................................................................................................................
:
....................................................................................................................................................................
:
*Employment Details
Employed Unemployed
Name of Employer
:...........................................................................
Employers Address: PO
Box:..............PC:...........Location..................
Employee No:.................Date of
Employment..................................
Present
Position:.................................................................................
Expected Monthly Income/Activity:
No Income Upto OMR 250 Above OMR 251 upto OMR 1000
Above OMR 1001 upto 2500 Above OMR2501 upto OMR 3500
Above OMR 3501 upto 9000 Above OMR 9001
@
.
.
.
. . ..
.
.
.
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:
.: ...............................:
.............................:
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:
: /
For electronic channels like ATM, Call Center, Internet Banking
which operate with individual
PINs, please attach a separate letter requesting for the
services and the mode of operation.
/
*Are you Holder any of the Followings?(please specify) Yes
No
US Nationality Green Card
Address / Tel No. in USA
Make ongoing payments to USA
US Tax Resident
() @
call center 24 79 5555 www.bankmuscat.com
Source of
Income/Fund:...................................................................
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7/25/2019 Application Form Opening Account RevisedV1 210814
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(
)
Name:.............................................................
:
Name:...............................................................
:
:
*
*
( )
/
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.
.
....................................................................
:
..............................................................
:
................................................................................................................
:
.....................................................................
:
..............................................................
:
...............................................................................................................................
:
For Account Holder Second Account Holder(Applicable for Joint
Account only)
For Bank Use Only
*Confirm having met the Customer in person Yes No
*Confirm if the Customer is US Indicia Yes No
Original Seen Copy Optained
National ID (for Omanis)
Passport
Resident Card
Driving License
Account Numbers
Specimen signatures for all authorized received with
limitsapplicable to each Account set up in system and all
identificationcopies stamped Certified True Copy and Banks KYC
Policycomplied with latest CBO caution list checked for
currentaccount.
Checked
by:....................................................................................
Signature:...........................................Date:....................................
Approved
by:..................................................................................
Signature:...........................................Date:....................................
Photograph to be attached in case of illiterate or blind
customers
using thumb impression/with shaky signatures/signing in
Language other than Arabic/English.
W8 / W9 Original forms to be filled completely (for US
Indiciaonly)
P.O. Box 134, Ruwi, Postal Code 112, Sultanate of OmanTel.:
(968) 24768603 Fax: (968) 24795555, e-mail:
[email protected] www.bankmuscat.com
(968) 24780308
(968) 24795555
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112 :
- 134 :
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Specimen Signature : Specimen Signature
Details of Introducer :
Customer referred by:................................ (Staff
No.....................)
()............................................... (
.................)
Interest Rate (For Fixed Deposit only)
............................. (
).........................................
KYC Check List
:
