Customer profiling form Fill in BLOCK letters and check þ where appropriate Habib Bank AG Zurich
Date day month year
______Branch, United Arab Emirates.
CUSTOMER REFERENCE
Customer account number 0 2 - - - - - 22 digits Account title ______
GENERAL INFORMATION Trade license number Trade license expiry date day month year Emirates of incorporation ______Nature of Business / Product & Services Offered: Wholesale / Retail, details of shop/warehouse. (please describe below)
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MAJOR CUSTOMERS & SUPPLIERS List of Customers: ______NAME LOCATION ______/ COUNTRY
1) ______
2) ______
3) ______
4) ______
5) ______List of Suppliers: ______NAME LOCATION ______/ COUNTRY
1) ______
2) ______
3) ______
4) ______
5) ______
TOTAL ANNUAL REVENUE / SALES TURNOVER (UAE only) ______YEAR REVENUE ______/ SALES AMOUNT ______YEAR ______REVENUE / SALES AMOUNT
Last financial year ______AED Previous year 2 ______AED
Previous year 1 ______AED Previous year 3 ______AED
RELATIONSHIP MANAGEMENT
Do you Trade with any of the below Countries (Tick þ as appropriate) � No � Yes, please specify; � Switzerland � United Kingdom � United States of America � Canada � Pakistan � Hong Kong � Kenya � South Africa
authorized signatory’s initial
NOTE: In the case of multiple signatories, authorized signatories must initial as per the account mandate. AM19AUG20/UAE | Page 1/3 OTHER BANK’S DETAILS ______# NAME OF BANK & BRANCH BANKING SINCE DEPOSIT BALANCE APPROVED FACILITIES TYPES OF APPROVED ______(all accounts) AED LIMIT______(all types) AED ______FACILITIES
1)______
2)______
3)______
4)______
5)______
PURPOSE OF ACCOUNT
Specify purpose for opening the account (Tick þ as appropriate) � Savings � Loan Repayments � Investment � Transactional / Business � Others , please specify ______
TYPE OF OPERATIONAL ACTIVITIES
Countries where you and your group companies are located (Tick þ as appropriate) � Only Locally (UAE) � Regionally (GCC) � Globally
1) ______6) ______
2) ______7) ______
3) ______8) ______
4) ______9) ______
5) ______10) ______
Number of persons employed (Tick þ as appropriate) � <10 � 10 to 25 � 25 to 50 � 50 to 100 � >100
SANCTION COUNTRIES
Do you Trade with any of the below Countries (Tick þ as appropriate) � No � Yes, please specify; � Iran � Syria � Sudan � Cuba � Yemen � Myanmar � North Korea
MONTHLY TRANSACTION INFORMATION (with all banks) ______
PARTICULARS DEPOSITS / INCOMING FUNDS WITHDRAWALS / OUTGOING FUNDS EXPECTED ______NUMBERS ______AMOUNT (AED) ______NUMBERS ______AMOUNT (AED) HBZ______SHARE (%)
Monthly transactions (Cash) ______
(Cheque / PO / DD) ______
Monthly transfers TXN (Currency 1) ______AED ______
(FTS, SWIFT) (Currency 2) ______USD ______
(Currency 3) ______
(Currency 4) ______
Turnover as per the Bank Statement(s):
Type of transactions as per the Bank Statement(s): ______
authorized signatory’s initial
NOTE: In the case of multiple signatories, authorized signatories must initial as per the account mandate. AM19AUG20/UAE | Page 2/3 DEPOSIT & PROFIT INFORMATION
1) Expected initial deposit � AED 0 – 50,000 � AED 50,001 – 100,000 � AED 100,001 – 500,000 � AED 500,001 – 2,000,000 � AED 2,000,001 & more
2) Expected average deposits/assets/funds balances with HBZ UAE � AED 0 – 100,000 � AED 100,001 – 500,000 � AED 500,001 – 1,000,000 � AED 1,000,001 – 5,000,000 � AED 5,000,001 & more
3) Estimate of current monthly business Net Profit � AED 0 – 50,000 � AED 50,001 – 250,000 � AED 250,001 – 1,000,000 � AED 1,000,001 – 5,000,000 � AED 5,000,001 & more
OTHER INFORMATION
1) Company and group entity website(s): (a) ______(b) ______(c) ______(d) ______
2) Any Existing Relationship (Personal / Business) with HBZ-UAE or HBZ Group? � Yes � No If Yes, provide Account Numbers
a) 0 2 - - - - - 22 digits
b) 0 2 - - - - - 22 digits 3) Source of funds � Job & Personal Savings � Investments � Family Inheritance / support � Business income � Other, please specify: ______
4) Background information on shareholders, partners, beneficial owners / controllers: (i.e. Sources of personal wealth, Sources of funding for business, Personal net worth, last year’s personal income, etc.)
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5) Additional information (optional):
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FOR OFFICE USE SV ______signature Verified by ______authorized signatory(s)
NOTE: In the case of multiple signatories, authorized signatories must sign as per the account mandate. AM19AUG20/UAE | Page 3/3