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The form should be signed after all details are completely filled.All information in the "Entity Details" section is Mandatory. Please complete all sections in BLOCK LETTERS and tick boxes where applicable. Do not hand over the cash at the time of Account opening. Kindly enclose only an accountpayee cheque drawn in favour of the Entity/Firm at the time of Account opening.Doing Business As (Name) :DDDate of Commencement of Business:M MDYYYM MDYYForm 60:PAN:YYY(if PAN number not mentioned)Place of Incorporation/Registration:Unique ID No./CIN:Registration No.:Registered Address :City:State :Country :PINTelephone 1 (Mandatory):Fax :City:Country :State :VER 4.0/BAN/CB-AOF PDF/WPC/03-21Correspondence Address : c Please tick, if Correspondence address should be maintained same as the Registered addressPINTelephone 1 (Mandatory):Fax :Mobile 1:Mobile 2:Email 1:Email 2:Proof of Identity:Type of DocumentNumberProof of Address:Type of DocumentNumberAre your Primary locations/trade areas, customer/supplier domiciled in any of the below mentioned list of U.S. Sanctioned Countries ?Comprehensive U.S. Sanctions countries:SyriaIranCuba(Please tick as applicable)DDMMYYYY1North KoreaCrimea RegionYesNo
I/We, hereby declare that the stated above is true to the best of my/our knowledge and belief.First SignatorySecond SignatoryThird SignatoryAccount Operation InstructionsAs per Board ResolutionForm 60:c Yesc No(If yes, please fill & attach the Form 60 separately) Mandatory if PAN Number not mentionedNomination:c Yesc No(If yes, please fill & attach the Nomination form separately)c Yesc No(If yes, physical copy of the account statement will be sent only annually)c Yesc No(If yes, please fill the below section for debit card application. Debit application form attached)Signature :(Applicable only for sole proprietor)Channel FacilitiesStatement on email:CitiBusiness Debit Card Request FormName: (as to be embossed on card)Do you want foreign currency transactions to be enabled on your card?c YESc NOPlease note: The limit for foreign currency transactions will be USD 25,000 per financial year. Foreign currency transactions are enabled acrossmerchants from Travel and Entertainment category only.Existing Banking Relationshipc Yesc NoAccounts with other Banks :c Yesc NoBranch & AddressBankcIf Yes, Account No. & type :Account TypeAvailing Credit Facility (Yes/No)Credit Facility AmountI/We declare that we do not enjoy credit facilities with any bank/banksInternet Banking Channel Access FormOnline Bulk Paymentc Yesc No(If Yes, Hardware Token will be issued to signatory for online bulk payment facility)If Yes, mention per day transfer limit: For Issuance of Net Banking access card to authorized signatories:Signatory NameDOBEmail IdMobile noSignature rule to be maintained for online banking:Signature Rule NoSignatory NamePer txn approving limitRule 1Rule 2Rule 32No of Signatures RequiredVER 4.0/BAN/CB-AOF PDF/WPC/03-21:Account with Citibank
Details of Signatories(1) Mr./Ms./Mrs./Mx.Father/Spouse NameAddress:Paste Color PhotographCountry:State:Date of Birth : DDM MYYYYNationality (Mandatory):Gender (Mandatory): c Male c Female c Third GenderOccupation:Designation:Mobile Number:Telephone:Fax:Email ID:KYC ID Document Issuing Authority:KYC Number:KYC ID Document Place of Issue(2) Mr./Ms./Mrs./Mx.Father/Spouse NamePaste Color PhotographCountry:State:Date of Birth : DDM MYYYYNationality (Mandatory):Gender (Mandatory): c Male c Female c Third GenderOccupation:Designation:Mobile Number:Telephone:Fax:Email ID:KYC ID Document Issuing Authority:KYC Number:KYC ID Document Place of Issue(3) Mr./Ms./Mrs./Mx.Father/Spouse NameAddress:Paste Color PhotographState:Date of Birth : DCountry:DM MYNa applicable, in consonance with the applicable process of the Bank.
6Signatory with StampVER 4.0/BAN/CB-AOF PDF/WPC/03-21
Declarations (as applicable for your type of entity)Sole ProprietorName :Place:Signature:Date:Firm Seal:VER 4.0/BAN/CB-AOF PDF/WPC/03-21PartnershipName of the Partner:Name of the Partner:Name of the Partner:First SignatorySecond SignatoryThird Signatory:::(Note: each partner has to sign in his/her individual capacity without affixing any seal/rubber stamp)Place:Firm erscoparcenercoparcenerscoparcenerscoparceners1st Coparcener Name :2nd Coparcener Name:3rd Coparcener Name:Signature:Signature:SignatureKarta Seal & Sign:Place::Date : 2021 Citigroup Inc. Citi, Citibank and Arc Design are registered service marks of Citigroup Inc. or its affiliates used and registered throughout the world.7
CitiBusiness Debit Card Request Form VER 4 /B 21 I/We, hereby declare that the stated above is true to the best of my/our knowledge and belief. First Signatory Second Signatory Third Signatory. 3 VER 4 /B 21 Details of Signatories Paste Color Photograph Nationality ( andatory)M: ( )Mr./Ms./Mrs./Mx.1
