/CIF no. of Account Owner 1:... /CIF no. of Account Owner 2:...
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1 Application cum Card, Account Contract /For individual Customer /No.:..... /Date:... /CIF no. of Account Owner 1:... /CIF no. of Account Owner 2:... HONG LEONG BANK VIETNAM LIMITED (HLBVN) Address: Ground and First Floor, Centec Tower, No Nguyen Thi Minh Khai Street, Ward 6, District 3, Ho Chi Minh City /Tel: CUSTOMER ACCOUNT OWNER 1 1 ACCOUNT OWNER 2 1 Salution Mr Mrs Ms Mr Mrs Ms Fullname in BLOCK letters) Date of birth Place of birth ID/Passport no. Date of issue Place of issue VISA number Expiration date Nationality Residential status Permanent address Current residential address Resident Non-resident Resident Non-resident Note: If you are HLBVN existing customer and your following information is unchanged, please fill up information from Section 3 1 Account owner 2 can be joint account holder, or for Junior saving account, information of account owner 2 is of legal representative of the account owner 1.
2 Mailing address Contact no. Current residential address Office Mobile: Register this mobile no. for SMS Banking and Hong Leong Connect services Current residential address Office Mobile: Register this mobile no. for SMS Banking and Hong Leong Connect services address (Maximum 30 characters) Education Preferred language Home: Other: Register this address for Hong Leong Connect services High school Graduate Post graduate Other: Vietnamese English Other: Home: Other: Register this address for Hong Leong Connect services High school Graduate Post graduate Other: Vietnamese English Other: Marital Status Emergency contact info Company name Company address Occupation Job title Office number Income (Million VND/year) Single Married Other: Name: Mobile: Relationship: Single Married Other: Name: Mobile: Relationship:
3 I/We hereby request the Bank to open account/issue card to me/us with information below: TYPES OF ACCOUNT/ PURPOSE OF ACCOUNT USAGE Individual Account Account ownership type Account Savings Account Hi-saver Account Current Account Fixed Deposit Time Savings Salary Account Junior Savings Account Currency USD EUR SGD USD EUR SGD USD EUR SGD USD EUR SGD USD Joint Account Fixed Deposit / Time Savings account must be opened prior to placing deposit online Signing conditions Source of fund For individual account For joint account Salary Savings ATM CARD ISSUANCE (applied for Account Owner 1) One to sign All to sign Anyone to sign Other: Business Other: ATM card for normal Customer ATM card for Priority Banking Customer Current resident ATM Card mailing address Office HLBVN s branch Name to appear on card (In BLOCK letters, including spaces) SERVICE TYPES SMS Banking service Hong Leong Connect service Request for Activation Code of Hong Leong Connect service (Online / Mobile Banking) Via address Security words: Via hard copy at HLBVN s branch
4 Other: Specimen signature Account Owner 1 Account Owner 2 1 st time signing 2 nd time signing 1 st time signing 2 nd time signing Name: ID /Passport no.: Name: ID /Passport no.: CUSTOMER S CONFIRMATION apply to open the above account(s) with HLBVN. For Junior Savings Account, I am the legal representative of the Account Owner 1 who is an individual (1) under 15 years old, or (2) who is a person with limited legal capacity or a legally incapacitated person, a person with limited cognition or behavior control who ; and I confirm that the Junior Savings Account is opened and operated by me as the Legal Representative; declare that all information and documents provided to HLBVN are true and correct and will immediately inform HLBVN of any changes to the same and authorise HLBVN to verify and obtain any other information required relating to opening and using Account(s); confirm that I /we have received a copy of, read understood and agreed to be bound by the Terms & Conditions of Accounts and Terms & Conditions of Card (if applicable) and any subsequent revisions and/or variations as may be made by HLBVN from time to time. If I/we disagree with such revisions and/or variations, I/we have the right to terminate this Application cum Card, Account Contract. Any termination by the Customer under this clause shall be submitted in writing as HLBVN s form during working hours and subject to the discharge of all our obligations, if any. I/We hereby agree to sign the contract for opening and use of the account subject to the terms & conditions provided herein upon acceptance by HLBVN and be bound the General Terms & Conditions of Accounts and / or Terms & Conditions of Card provided by HLBVN from time to time.
5 Based on confirmations as stated below, parties agree to enter into this contract for opening and use of the account which is made in two (2) original documents in bilingual English and Vietnamese. If there is any conflict between the English and the Vietnamese, the Vietnamese version shall prevail. Each Party will keep one (1) original. i n 1 Signature Account Owner 1 i n Signature Account Owner 2 Name: ID /Passport no.: Name: ID /Passport no.: HLBVN S CONFIRMATION Date: Remark: Authorisation Account Officer Attended by Authorised by Name: Staff code: Branch / TO Hong Leong Bank Vietnam Limited Branch / TO Code Name: Job title: Account no.: Date of account opening:
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