Information Form: Maldives Islamic Bank
Information Form: Maldives Islamic Bank
Information Form: Maldives Islamic Bank
If you are submitting for an information update, please complete section A and relevant sections to be changed
Full Name
(as in ID card/PP for foreigners)
Other, specify
City/Island/Atoll City/Island/Atoll
Preferred mailing
Permanent Present
address
Name Relationship
EMPLOYMENT DETAILS:
Employer Name
Occupation/
Joined Date:
Designation
Address of Employer
Street Name
Less than 10,000 10,000 to 35,000 35,000 to 50,000 More than 50,000
Since
Is your property
No Yes, list all the mortgaged property(s)
mortgaged?
Is your property
No Yes, list all insured property(s)
Insured?
Is your vehicle/
No Yes, list all insured vehicle(s)
vessel insured?
200,000 to 500,000 500,000 to 1,000,000 More than 1,000,000, please specify a minimun amount
0 - 10 10 - 20 20 - 30 More than 30
ADDITIONAL INFORMATION
1.Please tick the appropriate box if you are in any of the following positions:
Members & Senior Most Officials of a State Agency or Institution [like board members of central banks]
Senior Officials appointed as per the provisions of a specific law (example: Head of FIU)
Senior Political Party Members [including members of the governing bodies of political parties]
OR
I have been retired for less than 12 months from the above mentioned positions;
My Close Family Members [Parents, Spouses, Children, sibling etc.] – are holding, OR actively seeking OR being considered OR retired for less than
12 months from the above stated positions. (Please Complete below)
Any individual holding any of the above stated position is associated party with my Business and holds more than 25% voting rights/share in your
Business/Company; (Please Complete below)
Any individual holding any of the above stated position has significant influence over the policy, business and strategy of my Business/Company
implying that the individual takes part in day to day management and the position is not an isolated consultative role or a non—executive role.
(Please Complete below)
I have a joint beneficial ownership of a legal entity or a legal arrangement (for example company or trust etc.) or any other close business
relationship with an individual holding any of the above stated positions;
I have a sole beneficial ownership of a legal entity or a legal arrangement (for example company or trust etc.) which is set up by a person holding
any of the above stated positions;
Full Name
Occupation / Designation
FATCA DECLARATION
Home Address
I declare that I possess USA nationality/Lawful Permanent Residency/Passport and authorize Maldives Islamic Bank to disclose required
information to Inland Revenue Services of USA under FATCA.
I declare that I do not possess USA nationality/ Lawful Permanent Residency /passport as on date. I further undertake to inform the Bank
of obtaining USA Citizenship/Green card/Passport in future within material time and authorize Maldives Islamic Bank to disclose required
information to Inland Revenue Services in USA.
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Date: D D M M Y Y Y Y
(Please complete Annexure 1 - Customer Risk Rating sheet and attach with this form)
Received by
Checked by
Authorized by