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Application Information Application Date: Currency: Operating Authority:

Singly

Jointly

Account Type: Business Name: Nature of Business/Occupation: Number of Employees: Number of Branches: Countries of Operations: Business Address/Location: Permanent Address: Business Registration Number/Date of Issue: Office Telephone Number: Work Email: Primary Contact Person: Annual Income:

Personal Information Full Name: Designation:
Nationality: Date of Birth: Place of Birth: Passport No.: Date of Issue: Expiry Date: Home Address: Postcode: Personal Email: Telephone Number:

Applicant's Declaration

I/we hereby apply for the opening of account(s) with Mashreq Bank PSC, New York. I/we understand that the information given herein and the documents supplied are the basis for opening such account(s) and I/we therefore warrant that such information is correct.

I/we further undertake to indemnify the bank of any loss suffered as a result of any false information or error in the information provided to the bank.