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CUSTOMERS ACCOUNT OPENING & IDENTIFICATION FORM
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Form A-1 Account for Natural Perso
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qjtutm ¢`r(: / Account Number /

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tpilryw,?,<,: / Account Branch /

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1 ) ?chiAfl q&t+ / Account Class Or Account Type / '.;

£.ti+cr,A^,'Jfr7-'Doyou needapassbook?/ #sH I No
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Date of Birth DD/MM/yy Place of Birth
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!:'xwloE i.^r,`+ cnm. ngn/ Mother's full name /
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Nationality Marital status Single E2' Marr;:jE "'viia;.;I Divor:`e-dE
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Permanent
Address
)\t'..i apt,'il I,I. `::ft%%.#`,.rd Rng%:,tri ifJi#, i # c#`a,iwor%.,!ffMre iiy*A RIS§?_2£TS@q%:£§%hM
Current Cou ntry Reg ion City Sub city Woreda/ Kebele H, No Residence Tele Mobile
Address
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4,ll/I i€1'(-JFAX/ _ A -?JL`AVEm<iil/ |^uz-?AAVebsite/

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ID

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Government Sector Employee II
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.r„^wlar,unemployed,I

h7m^£c/Diplomat/I
nternat,ona,o,gqa^nTz,;.tT:htt{£*,,:;g.I
un,+^quL+/Housewlfe/I

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Private Sector Employee

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t['J^/"/,/Self-employed/ c7n`r)tn4qz j'AUTI` f:i:.e``fli.. #i4`l.F
Rellglousorgan,tzha9tii::,:!£¥:U:g;y:e# G0 Employee
+o%/.Student/ A.V0ther/
q+:`r:F1.fi>giwame of Employer/ aeac? owp/ profession / t'/' '4` £&P,./Position Hel d/
tD(:yq! '/i| /Monthly Income
0-650Birr I 25,001 -50,000Birr] 200,001 -250,000 Birr] 150,001 -200,000 BirrE
651 -25,000Birr I 50,001 ~ 100,000BirrE 100,001 -150,000 Birr I
lf >250,000, ^tllixp'} f,.)^x /please Specify hJryli`.i^¢n+q!'z(l,i'AverageAnnual Income/

3) ^nhp ?otdAT+? prLg*.A rl?h hf}t+ f,gpf rfu (A?rl¥ hf t+i4.P* +&&qt+ ^^7:a+)
Please choose Digital Banking channel services you would like to have (all terms and conditions apply)

AmexGold card I Dashen card I lntemet & Mobile Banking (Amole) I

Amex Green card I SMS Banking I A.-nrlutfllr}..i`/a-statement facility/ I
4) hr|hp ^orAhnr+ patmipoo.rl.in g}* $g°/.fm /Please choose language for SMS Service/

EA,:,:,i;rjc I ;%j:<oromo I,#g<r,;Fnga ESo:,#:„gna H^„^E,:Fg„sh

5) ?onrflod.P 4:n`q nnitial Deposit

Et:`d::I:'hfl I n;?hcheque
r7'}it(`, gn'riJ,b /Source of proceeds/
Ettr`:'.#`.,
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E] Other I qn}Hrf l ot.ml
Amount EEal±
 6) nA.ffi in?tr ac:?.6Bti* q+hd.4 drnrl} /Account maintained in other Branches of the Bank/
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Acct No. Branch Active Inactive
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Acct No. Branch Active Inactive

7) ifh onmrej./Cheque Requisition / for Cheque account only

t'.Eh ^f,*. ,i'Cheque Category/

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8) Ithc^ ?fl4 i?7il+ JL` qu¥£m 90D?TF H£-?+FIFTal. /Which Media of communication is suitable for youi ong

I+hat;!phone H€^Li{;Cpr'^dn.} HEhma¥;`;i^ E3'8'aox E8`t^;trFPEEffFr~

9) fd,£a? font /Specimen signature/
I authorize the Bank to recognize and honour the specimen signature appearing below as a valid`
discharger for all transactions of the account opened as per this application in my name. It is agreed
that all transactions between the Bank and the undersignecl shall be governed by the rule and
regulations of the Bank,
ttlih.A. nyD(ntimA itoi'rji47iti hiri)
Agent Name (if the account ls opened by an agent)

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Specimen signature

10) h+.i¢rtym `Luim +an gr&p¥ Current Account Holders

1.If your account does not show any movement for six months, the amount win be cctnsidered as clormant and be transferrecl to
Inactive Accounts. If the A/C shows zero balance for consecutive 3 months, the A/C will be closed.
2 lf the balance in each Inactive account is less than birr ZOO, a charge of birr 20 will be deducted at the end of every six
months, and if the balance is birr 20 or less, the whole balance thereof wHl be chargecl ancl the account will be closecl ln this
case the cu5{omer should returri the remaining cheque leaves to the Bank,
3.The bank will dispatch statement of account monthly and for inactive accounts every six months.
4`A cheque drawn aga!nst insufficient funds shall entail penalties as per the prevailing (current) NBE's directives.
5 The Bank may send SMS alert to provi`de information on transactions The service is provicled "As available" without making
any further investigation and doesn't warrant its fitness for another purpose. The Bank doesn't warrant that this service wiH
always be uninterrupted or-the information provided js accurate and current at the time it is received.
6.The Bank reserves itself the right to alter or adcl to these rules at any time.

IELAp roval of Accoup_i opening

Designation Signature |`iJIICITI( / .\1`,\,i
i D6`'`.I) /V \t /y \ y y
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Maker I

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Ei_piii`Lgi!eiit list checked 8 'Cheekei _|feifi±r[!:rtl:A£:s,£±±±!2±. s)I:1!!() i

Sa r`ctioi` list checked By `.:'M:.

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8ustne`s terminalpd customer List checked hy
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Pflli`icaw exnoted nersan lLst chcekpd hv I_:

HILT
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Checker (Approved 8y) i

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I Branct` operation Auditor I- I I I

11) Imponant Remarks (If any) of Customer Service Manager or Branch Manager

IIIfhicb`ir;i Segmentation Catei.

Based on {lio ln(om`atlori provlded, trie customeHs segmented as DasheriJ]rimeE Dasr)ei`-Stcir [T

Dashen.C,ass[c I

Dashen-BaslcE Dashen Emenglng I