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APPLICATION FORM FOR OPENING INDIVIDUAL / JOINT ACCOUNT


FOR BANK USE ONLY

BRANCH
DATE: ................................................................................... :
Note: Kindly fill the form in BLOCK letters and sign in the appropriate space
only after reading the terms and conditions. The terms and conditions which
apply to operating this account form an integral part of this application form.
PLEASE COMPLETE IN FULL AND TICK WHEREVER APPLICABLE.

CUSTOMER NUMBER

:
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( ) )@(

(All fields marked with (*) are mandatory)

Customer Details (Primary Applicant)


*Name :...........................................................................................................
(As per ID/PP) (HH/SKH/Mr./Mrs./Miss/Others)

*Postal Address: PO Box:..............................PC:.............................................

................................................................... : . ........................................................ : . : @
.......................... : ............................... : ..................:
..................................................................................................................................................... :

Wilayat:.............................................Sultanate of Oman

................................................................................. : /

Tel (R):................................*GSM:..................................

........................................................................................................................................................... :
...............................................................................................................................................................................................

......................................................... : @ ................................................ :

Tel (O):.................................Fax:.....................................

......................................................................... : ...............................................................:

E-mail: ............................................................................

....................................................................................................................................................... :


@
() .....................................................................................
: @

Male

*Nationality:

( / / / / / / ) /

Location:........................Locality:....................................

.........................................................................................................................

*Sex:

.......................................................................................................................................................................... : @

H. No.:................ Apt. No.:................Way No.:...............

Permanent Address:.........................................................................................
Contact Details:

( )

Omani

Female
Others..................................(please specify)

*Place & Date of Birth:...................................................................................


*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

*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

call center 24 79 5555

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www.bankmuscat.com

Account Details

Individual

Joint

Minor

(Guardian name if minor)................................................................................


Current

Saving

Fixed

Currency of Account:

.................................................................................................... ( )

Call

Other...........................................................................................................

............................................................................................................................................................. :

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)

( )

Account Statement to be sent:

byE-mail by Post

( ) :@@

**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..........................


For Current Account: Cheque book facility required: Yes

No

Number of Cheque leaves required:

50

10

25

For Fixed Deposit: Fixed deposit for...........................months (specify period)

Credit Account No........................................................and roll over principal


Cash

Transfer to Account

Joint Account Holder Details


*Name:...............................................................................................
(As per ID/PP) (HH/SKH/Mr./Mrs./Miss/Others)
Postal Address:

............................ :

Auto roll over with interest on maturity OR Interest accruels to

Cheque

.( ) / ................................................... : :

Maturity Date:............................

Source of funds:


. ................................................... :

:
@

...................................................................................................................................................... :

( / / / / / ) / )

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:............

call center 24 79 5555

........................... : ............................... : ( @ )
............................................................................................................ : (@ )
................................ : ....................................... : ( ) @

www.bankmuscat.com

*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
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.

*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

Source of Income/Fund:...................................................................

. .

. .

. .

. .

............................................................................................................ : /

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 of
maturity.
Name of the guardian:......................................................................

.......................................................................................................................................................... :

Signature:..........................................................................................

.................................................................................................................................................................... :

........................................................................................................................................................
..../......./........ ........ /......../..........
...../....../....... /

Other Bank Account Details


Bank Name/Location:.......................................................................

.......................................................................................................................... : /

Account No.:......................................................................................

.................................................................................................................................... :

Bank Name/Location:........................................................................

.......................................................................................................................... : /

Account No.:......................................................................................

..................................................................................................................................... :
/

Declaration/Operating Instructions
I/We confirm that the information given is true and complete.
I/We have read the terms and conditions (F3B V1 09/08) governing 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)

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( / ) /
/

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. / .


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( )

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Relationship with customer:...............................................................

........................................................................................... :

Signing instructions:

Self

call center 24 79 5555

Jointly

Either or Survivor

www.bankmuscat.com

For Account Holder

Specimen Signature

Name:............................................................. :

Second Account Holder


(Applicable for Joint Account only)


()

Specimen Signature

Name:............................................................... :

For Bank Use Only


KYC Check List

Details of Introducer :
Customer referred by:................................ (Staff No.....................)
*Confirm having met the Customer in person

Yes

No

*Confirm if the Customer is US Indicia

Yes

No

(................. ) ...............................................( )

Interest Rate (For Fixed Deposit only) .............................


Original Seen

Copy Optained

.........................................( )

National ID (for Omanis)

( )

Passport

Resident Card

Driving License

Account Numbers

Specimen signatures for all authorized received with limits


applicable to each Account set up in system and all identification
copies stamped Certified True Copy and Banks KYC Policy
complied with latest CBO caution list checked for current
account.


/

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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 Indicia
only)

(968) 24780308 ( 968) 24795555 - - 112 : - 134 :.


P.O. Box 134, Ruwi, Postal Code 112, Sultanate of Oman
Tel.: (968) 24768603 Fax: (968) 24795555, e-mail: customerservice@bankmuscat.com www.bankmuscat.com