poa account opening application
TRANSCRIPT
SINGAPORE
© 2005 Citibank
Citibank and Arc Design is a service mark of Citigroup Inc or Citibank, N.A.Citibank is a registered service mark of Citigroup Inc or Citibank, N.A.
Citibank Singapore LtdCo. Reg. No. 200309485K
www.ipb.citibank.com.sg
Telemarketing Hotline(65) 6426-336824-Hour CitiPhone Banking(65) 6224-5757
Fax(65) 6328-8008
23 Church StreetCapital Square #07-01Singapore 049481
40A Orchard RoadMezzanine LevelSingapore 238838(Opposite Dhoby Ghaut MRT)
Banking Hours:Mondays to Fridays: 9.30am – 3.30pmSaturdays (Orchard Road branch only): 9.30am – 12.00pm
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Citibank International Personal Bank Centers
Asia Australia Europe USA
Hong Kong Brisbane London Guam
Singapore Melbourne Jersey Miami
Perth New York
Sydney San Francisco
Account Opening Application
English
ACCOUNT TITLE (Names of all Account Holders): ACCOUNT NO.:
NAME NAME
SIGNATURE X SIGNATURE X
NAME NAME ❐ POA
SIGNATURE X SIGNATURE X
SIGNHERE
13) SIGNATURECARD(All applicants to sign.If Power of Attorney,
please indicate.)❐ Single (any one to sign)
❐ All to sign
❐ Citibank International Junior Account(Any Parent to sign)
❐ Others
SignatureRequirements:
Account Type: ❐ Single ❐ Joint
❐ Joint Junior
No. of Parent(s)
❐ USD Checking Facility via Citibank GuamRequest For:
Please also sign on the “Application For Citibank USD CheckingFacilities” form.
FOR BANK USE ONLY
APPROVED BY: DATE:
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Citibank Singapore LtdInternational Personal Bank
Robinson Road P.O. Box 0361
Singapore 900711
Tel: 24-Hour CitiPhone Banking
(65) 6224-5757
Fax:
(65) 6323-1288
Website:
www.ipb.citibank.com.sg
Co. Reg. No. 200309485K
To enable us to provide faster service, please remember to indicateyour Account Number in all your correspondence with us.
Dear Investor
Thank you for your interest in opening a bankingrelationship with Citibank Singapore Ltd. Attached isthe Account Opening Application. To allow us toopen your account as quickly as possible, please takea moment to review the checklist below. Incompleteapplications and missing documentation cause mostdelays in account opening:
✔ Write clearly, in BLOCK LETTERS.
✔ Complete all sections of the Application, particularlySection 6 (Additional Information About Myself) andSection 11 (US Tax Declaration & Acceptance).
✔ Provide at least one bank reference, which could bea Citibank account or a Citibank credit card in yourhome country.
✔ Sign the Account Opening Application as well as theSignature Card.
✔ Attach photocopies of the first four pages ofpassport for each account holder, ensuring correctexpiry date is shown.
To start an account, all you need is just US$5,000 for aSavings Account or US$50,000 for a Time Deposit. If youmaintain an average minimum balance of US$20,000 afterthree months, the monthly service fee of US$30 will bewaived. However, accounts closed within six months ofopening are subject to a US$300 fee per account.
Please mail this Account Opening Application to:
Citibank Singapore Ltd
Robinson Road P.O. Box 0361
Singapore 900711
Or visit us at our branches.
Should you have any questions regarding your AccountApplication, please call (65) 6426-3368. You should alsoensure that you keep your bank documents securelyand advise us immediately if you do not receiveimportant items such as your monthly bank statements,bank advices, ATM card and checkbooks.
We look forward to serving your financial needs.
Very truly yours
Amy Tan (Mrs)Vice President
✔
✔
✔
✔
✔
55 3
2 30
6300
Citibank Singapore LtdRobinson Road P.O. Box 0361
Singapore 900711
(65) 6426-3368
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SIGNHERESIGNHERE
SIGNHERESIGNHERE
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X
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ACCOUNT TITLE :
ACCOUNT NO. : R/S NO:
1) MY PERSONAL PARTICULARS (please provide a photocopy of passport) :
Mr/Mrs/Mdm/Ms (Underline surname) : C/NO:
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
2) JOINT ACCOUNT HOLDER(S) / POWER OF ATTORNEY (please provide a photocopy of your valid passport):
:
❐ Joint Account ❐ Power of Attorney Relationship to Account Holder : C/NO:
Mr/Mrs/Mdm/Ms (Underline surname) :
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
12) SIGNATURE(S) : Date :
SIGNATURE REQUIREMENTS :
❐ Single (any one to sign) ❐ All to sign ❐ Others
❐ Citibank International Junior Account (Any Parent to sign)
LAWS OF OWN COUNTRY :
I shall be aware of the laws in my country with regards to my banking with you in Singapore or in any other jurisdictions and you shall not be liable for any loss or liability
imposed by my country on me as a result of my non-compliance with any regulations, laws or legal process of my country.
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1 ❐ WI ❐ CS
❐ OR ❐ Remote
❐ Others
2 Introduced by:
Bank Staff/Cust
❐ Savings ccy ❐ MaxiSave/Checking (Checkbook Y/N)
❐ TD ❐ US$ Interest Checking (Checkbook Y/N)
Cost Centre: PC Code:
Referral Code: Broker Base:
Branch Code:
PPlus Updated: ❐ Yes ❐ No
Within SDN/PF List ❐ Yes ❐ No
Signature verified by:
Approved by: Date:
Input Authorized
MA
FOR BANK USE
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11) US TAX DECLARATION & ACCEPTANCE :
By checking the appropriate box and signing below, I accept the terms and conditions of this agreement and declare my tax status under US tax law. I understand that
a false statement or misrepresentation of tax status by a US person could lead to penalties under US law.
(A) NON-US PERSON I represent and warrant that I am not a US person (i.e. a citizen or lawful resident (green card holder) of the United States) for purposes of US
federal income tax and that I am not acting on behalf of a US person. If my tax status changes and I become a US citizen or resident of the United States I must
notify Citibank Singapore Ltd within 30 days. In the event that I shall become (a) United States person(s), I agree that you shall be entitled to do all acts and things
you deem necessary to comply with applicable US law, including but not limited to a liquidation of the affected assets and/or a transfer of my account to an
alternate vehicle. I agree to bear all costs and expenses incurred by the Bank as a result thereof.
(B) US PERSON In respect to Section 12, I declare under penalties or perjury that:
1) The number shown in Section 12 is my correct US taxpayer identification number, and
2) I am not subject to backup withholding as a result of failure to report all interest and dividends or the IRS has notified me that I am no longer subject to
backup withholding.
3) For purposes of complying with applicable US tax laws, I waive any bank secrecy privacy or data protection rights related to my account.
(C) I understand that the Bank assumes no liability for any tax withheld on any reportable payments made to a customer under the US Tax Rules.
(A)
30
(B) 12
1) 12
2)
3)
(C)
❐ Joint Account ❐ Power of Attorney Relationship to Account Holder : C/NO:
Mr/Mrs/Mdm/Ms (Underline surname) :
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
❐ Joint Account ❐ Power of Attorney Relationship to Account Holder : C/NO:
Mr/Mrs/Mdm/Ms (Underline surname) :
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
10) MAKING GLOBAL INVESTMENT OPPORTUNITIES AVAILABLE TO YOU :
Please provide me with global market information and research, and from time to time, information on specific banking and investment opportunities which
you consider may be of interest to me. I understand that the provision of the said information and services (if any) to me arise out of your advisory relationship
with me.
(
“MAS”) Banking Act (Chapter 19)
(a) (b) MAS
Base No:
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(a)
(b) (c)
(i)
(ii)
“ ”
(A)
(B)
(C) ”
”
(D)
(E) Contracts (Rights of Third Parties) Act, Chapter 53B of Singapore
Contracts (Rights of Third Parties) Act, Chapter 53B of Singapore
3) CITIBANK INTERNATIONAL JUNIOR ACCOUNT :
JUNIOR JOINT ACCOUNT HOLDER (please provide a photocopy of your Child’s birth certificate/valid passport):
:
Relationship to Account Holder : C/NO:
Name of Child (Underline surname) :
Gender : Birth Date : M D Y
Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Tel : +( ) (Home ) (Handphone )
Email :
The terms and conditions contained in this Addendum for Citibank International Junior Account (“Junior Account”) applies only to Junior Accounts and are to be
read in conjunction with and in addition to Citibank’s Terms and Conditions (“Terms and Conditions”). All definitions contained in the Terms and Conditions shall
apply to this Addendum for Junior Account unless otherwise defined.
1. I/We hereby request you to add the child, whose particulars are set out above (“Child”) to the Junior Account.
2. The Junior Account is an account held by me/us in such manner as you may permit from time to time.
3. I/We shall specify the name of the Child in the application on the opening of the Junior Account. I/We may only specify a person who is less than 21 years of age
as the Child.
4. There shall only be one Child in a Junior Account at any time unless you otherwise agree.
5. I/We shall not replace the Child Account holder during the existence of the Junior Account. You are not obliged to accept any replacement of the Child Account
holder unless you are satisfied that it is only a change in the name and is supported by legal documentation to your satisfaction.
6. I/We hereby declare that the Junior Account is not a trust account. The monies in the Junior Account are my/our property and I/we shall be entitled to operate
the Junior Account as I/we think fit. When the Child has attained the age of 15 (or as deemed appropriate by you) and I/we may request you to provide, and you
may, at your sole discretion, provide the Child with a Citicard and ATM-PIN.
7. No investment products, overdraft, checking or credit facilities are or will be made available through the Junior Account.
8. Where I/we have requested you to provide, and you have agreed to provide, the Child with a Citicard and an ATM-PIN, I/we hereby declare that the Child is duly
authorised by me/us to give instructions pertaining to the Junior Account on my/our behalf and you are entitled to accept and rely on instructions in respect of
any transaction concerning the Junior Account from the Child as if such instructions were issued by me/us on the terms and subject to the conditions set out in
the Terms and Conditions. Such authorisation shall continue until you receive written notice from me/us that I/we have revoked the authorization given to the
Child, which I/we may do at any time, and at my/our sole and absolute discretion. I/We further consent to you recording the Child’s telephone conversations with
you to provide evidence of instructions and other verbal communications.
9. For and in consideration of your agreement to include the Child’s name in the Junior Account and (where applicable) in consideration of your issuing the Child
with a Citicard and/or ATM PIN at my/our request, I/we hereby undertake to indemnify you fully and hold you harmless from and against any and all claims and to
reimburse you upon demand for any and all payments, losses, costs, expenses (including legal fees incurred by you on a full indemnity basis) and damages which
you may suffer, sustain, make, or be required to make to any person, resulting from, in connection with or pursuant to the carrying out of any instructions given
by the Child or by me/us. This indemnity shall be binding on my/our legal personal representatives.
10. I/We undertake that, immediately upon the Child attaining the age of 21, I/we shall obtain the ratification by the Child of all actions and transactions effected on or
with the Junior Account prior thereto. I/We further undertake to procure the Child to execute such ratification document(s) as may be provided by you (“Ratification
Document(s)”). Until such Ratification Document(s) has been signed by the Child and received by you, you are not obliged to act on any instructions given by me/
us or the Child for the withdrawal of the monies in the Junior Account.
11. I/We further undertake that immediately upon the Child attaining the age of 21, I/we will instruct you to close the Junior Account and to open another account with
you, (a) in my/our sole name, (b) in the joint names of myself/ourselves and the Child, or (c) in the Child’s sole name. The opening of the new account shall be at
your discretion, and in the case of (b) and (c) as aforesaid, shall be subject to my procuring the Child’s execution of the Ratification Documents.
12. If I/we fail to procure the Child’s execution of the Ratification Documents and/or fail to give instructions to close the Junior Account within [45] days of the Child
turning 21, you are hereby authorised to close the Junior Account on my/our behalf, open a new Account(s) in my/our names or release the monies in the Junior
Account to me/us by way of a check, cashier’s order or telegraphic transfer issued in favour of me/us.
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Specified Security including but not limited to any documents which may be required to create, confirm or perfect any security which has been or may be given or
required to be given in favour of (a) Citibank Singapore Ltd prior to the Effective Date and/or (b) the Transferee Bank on or after the Effective Date and, in
connection therewith, I hereby authorize Citibank Singapore Ltd to, at any time and at its absolute discretion, date and/or re-date and deliver to the Transferee
Bank any such Additional Security Document so executed and signed by me but if I shall fail to provide and/or execute or sign any Additional Security Documents
by such time as may be specified by the Transferee Bank, I shall be deemed to have given to Citibank Singapore Ltd notice of cancellation and repayment of such
credit facility on and from the Effective Date, whereupon it shall so be cancelled and I shall be obliged to and shall promptly repay, together with accrued interest
thereon, any amount which is outstanding under, or, if so required, provide cash cover, for such credit facility to Citibank Singapore Ltd.
(D) I consent to the disclosure by Citibank Singapore Ltd to the Transferee Bank or any other person of any and all information relating to me, the Account(s), the
provision of any banking services and/or products to me from time to time in connection with any of the Citibank Accounts, Related Agreements and Specified
Security and any other security, guarantee and assurance given for the purpose of securing my obligations and/or for securing the obligations of any other person
or persons and any other information whatsoever which may be required in connection with the Transfer; and
(E) I agree that the benefit of the terms of these terms and conditions may be enforced by the Transferee Bank in accordance with the Contracts (Rights of Third
Parties) Act, Chapter 53B of Singapore. Save as expressly provided, no person who is not a party to these terms and conditions has any rights under the Contracts
(Rights of Third Parties) Act, Chapter 53B of Singapore to enforce any terms of these terms and conditions.
In this Application Form:
“Citibank Accounts” means all and any accounts (whether held singly or jointly with any other persons) as may be opened or maintained by me with Citibank
Singapore Ltd from time to time (including but not limited to the Account(s), savings, deposits, investment and secured / unsecured lending facilities);
“Effective Date” means such date as may be notified by either Citibank Singapore Ltd and/or the Transferee Bank;
“Related Agreements” means any agreements, documents and/or instrument(s) made or entered into in connection with the Account(s) and any acknowledgements
(including but not limited to risk disclosure statements and acknowledgements), information (including but not limited to information provided in respect of risk
profiling), instructions, orders, directions, mandates, powers and or authorities of all descriptions given and/or provided by me, to Citibank Singapore Ltd for the
purpose of the provision of banking services and/or products to me from time to time in connection with any of the Citibank Accounts;
“Specified Security” means all security (including, without limitation, any guarantee or assurance, security document, mortgage, charge, pledge, instructions, orders,
directions, mandates and/or authorities) given made or entered into prior to the Effective Date in favour of Citibank Singapore Ltd for the purpose of securing any of
my obligations to Citibank Singapore Ltd, arising in connection with any of the Citibank Accounts and/or Agreements and/or for securing the obligations of any other
person or persons to Citibank Singapore Ltd.
DISCLOSURE OF INFORMATION
I authorize the transfer and disclosure of any information relating to me, to and between the branches, subsidiaries, representative offices, affiliates and agents of
Citibank Singapore Ltd and third parties selected by any of them, wherever situated, for confidential use (including for use in connection with the provision of any
Products or Services to me, and for data processing, statistical and risk analysis purposes, global cash services and dealings in Securities on the Stock Exchange of
Singapore and any other relevant authorities and agencies pertaining thereto). Citibank Singapore Ltd and any Citibank branch, subsidiary, representative office,
affiliate, agent or third party selected by any of them shall be entitled to transfer and disclose any information as may be required by applicable law, court, regulator
or legal process.
Without prejudice to the generality of the foregoing, where Citibank Singapore Ltd is a member of, or subscriber for the information sharing services of, any credit
bureau recognized by the Monetary Authority of Singapore (“MAS”) under or pursuant to the Banking Act (Chapter 19), I authorize:
(a) Citibank Singapore Ltd to transfer and disclose to any such credit bureau; and (b) any such bureau to transfer and disclose to any fellow member or subscriber as
may be recognized as such by MAS, any information relating to me and/or any of my Citibank Account(s) (and for such purposes) as may be permitted under or pursuant
to the Banking Act (Chapter 19).
Without prejudice to the generality of the foregoing, I hereby consent to the disclosure to any assignee or transferee of any and all information relating to the Citibank
Account(s) and any security, guarantee and assurance provided to secure my obligations thereunder and any other information which may be required in relation to
or in connection with any novation, assignment or transfer as contemplated hereby.
For the purpose of complying with applicable US tax laws, I waive any bank secrecy, privacy or data protection rights related to my Citibank Account(s).
LANGUAGE PREVAILING
In the event of any inconsistencies between the different languages of this Application, the English language version shall prevail.
13. If I am the sole adult holder of the Junior Account, in the event of my death, you shall be entitled to close the Junior Account and to pay the balance of monies
therein to my legal personal representatives. If there are more than 1 adult holder of the Junior Account, in the event of the death of anyone of us, you shall
forthwith be entitled to close the Junior Account and the credit balance shall be transferred to a new Junior Account to be opened by you in the name of the
surviving adult holder/s and the Child. The provisions contained in this Addendum shall also continue to apply to the new Junior Account opened pursuant hereto.
14. The obligations set out in this Addendum shall be joint and several.
1.
2.
3. 2 1
4.
5.
6.
7.
8.
9.
10. 2 1
11. 2 1 a b
c c
12. 2 1 4 5
13.
14.
I/We have read, understood and agree to the terms contained in this Addendum.
X XCitibank Customer (Parent) Citibank Customer (Parent)
Name : Name :
ID/Passport No. : ID/Passport No. :
SIGNHERE
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X X X X
9) AGREEMENTS :
INVESTMENT FUNDS AND FIXED INCOME SECURITIES
In respect of any Investment Funds and Fixed Income Securities which I may purchase from time to time in your name or in the name of any nominee(s) appointed by
you, I understand that Fund units and Fixed Income Securities (a) are not bank deposits nor are they insured by you; (b) do not form part of your obligations nor that
of Citigroup or their affiliates; and (c) are subject to investment risks, which may include the loss of the whole principal amount invested therein.
RISK DISCLOSURE ACKNOWLEDGMENT
I hereby acknowledge and confirm that (i) I have read and fully understood the nature and contents of the section entitled “Risk Acknowledgment” in the prevailing
Account Terms and Conditions which sets out the possible risks associated with my investment in Investment Funds, foreign currencies, commodities and/or securities
(including but not limited to Fixed Income Securities) and (ii) I am fully aware of and understand the nature and extent of possible risks.
AGREEMENT (Please refer to the Citibank International Personal Bank Account Terms & Conditions)
I wish to apply for the Account(s) and request that the Automatic Overdraft and other Products and Services indicated above be made available to me. By signing this
Application Form (which I may do so in two or more counterparts, each of which shall be deemed an original, but all of which shall constitute one instrument), I confirm
that I have received a copy of the prevailing Account Terms and Conditions and agree that the same (as may be amended, supplemented or modified from time to time
at your sole discretion) will bind me as if incorporated into this Application Form in respect of any Products and Services under the Account(s) which may be made
available to me.
In addition, I agree to the transfer to an entity in the Citibank group which is an affiliate of Citibank Singapore Ltd (the “Transferee Bank”) of all my Citibank Accounts
(as hereinafter defined), with effect on and from the Effective Date (as hereinafter defined) on the following terms and conditions:
(A) all of the rights, title, interests, benefits, obligations and liabilities of Citibank Singapore Ltd in connection with the Citibank Accounts and all Related Agreements
(as hereinafter defined) and all Specified Security (as hereinafter defined), shall be transferred to, arise in favour of, bind and may be relied and acted upon by the
Transferee Bank to the same extent as if the Transferee Bank had been originally a party to, was originally the beneficiary or otherwise had the benefit (whether
expressly or impliedly) of and/or was the addressee or recipient of, all of such Citibank Accounts, Related Agreements and Specified Security and I confirm that all
such Specified Security shall continue to be valid and effective in favour of the Transferee Bank for the purpose of securing all obligations which are or may be
outstanding (and which are so transferred to the Transferee Bank) on the Effective Date as well as any new and/or additional obligations to the Transferee Bank
which may arise on or after the Effective Date;
(B) Citibank Singapore Ltd shall be fully discharged and released from all of its obligations and liabilities in connection with the Citibank Accounts, the Related
Agreements and the Specified Security so transferred by it but shall retain all rights, title, interests, benefits, obligations and liabilities in connection with any
Citibank Accounts, Related Agreements and Specified Security not so transferred by it and, in this regard, I acknowledge that if, notwithstanding any provision
hereof, Citibank Singapore Ltd at its sole discretion, on or after the Effective Date, allows any drawdown or utilisation of, or if it lends or makes any advances or
other accommodation under, any credit facility granted or made available and not transferred by it, all of such drawings, utilisations, advances or accommodation
shall continue to be secured by all security (including any guarantee or assurance) given or provided prior to the Effective Date to or in favour of Citibank
Singapore Ltd;
(C) I agree and undertake to, at the request of Citibank Singapore Ltd or the Transferee Bank, execute and sign any document and/or any security (including any
guarantee or assurance) (the “Additional Security Documents”) which may be required for the purpose of securing any existing or future obligations of mine or
any other person or persons, to Citibank Singapore Ltd and/or the Transferee Bank in connection with the Citibank Accounts, the Related Agreements and the
❐ Home Address : ❐ Office Address : ❐ Other Address :
Home/Apt No.:
Street Name:
Street Name:
Street Name:
City :
Country :
Postal Code :
(If Joint Account Holders’ address differs fromPrimary Account Holder’s):
:
5) BANK REFERENCES :
Banking with : Branch/Location : Account Type :
Other Citibank accounts :
❐ Yes, I have a Citibank bank account No. in (Account No. /Branch/Country)
❐ Yes, I have a Citibank credit card No. in (Account No. /Branch/Country)
❐ No, I do not have any other Citibank accounts or credit cards.
6) ADDITIONAL INFORMATION ABOUT MYSELF / FAMILY :
Type & source of funds to open this account :
Type : ❐ Cash ❐ Check ❐ Travellers Cheque ❐ Telegraphic Transfer/Inward Remittance
Source of Funds : ❐ Personal Savings ❐ Business ❐ Sale of investments ❐ Others
In the long term, I am planning on investing with Citibank Singapore Ltd (US$) :
❐ $100,000 ❐ $100,001 - $500,000 ❐ $500,001 - $1,000,000 ❐ > $1,000,000
My objective in opening an account :
❐ Savings/Investments ❐ Business needs ❐ Others
Other than from my occupation, I also earn income from :
❐ Savings/Investments ❐ Director’s/Consultancy Fee ❐ Rental
❐ Capital Gains ❐ Inherited Wealth ❐ Others
4) MY / OUR ADDRESS (please tick which address you’d like to be contacted at) :
(Signature )(Signature ) (Signature ) (Signature )
SIGNHERE
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❐ HOLD MAIL SERVICE :
Please hold my bank statements, advices and mail (collectively the mail) for a maximum of 12 months. I am aware of the risks associated with the Hold Mail Service. At
the end of 12 months, you will forward my uncollected mail to:
12 12 :
Address :
Please debit the Hold Mail charges from my transaction account:
❐ FAX BANKING :
❐ Yes (please sign X below) X ❐ No
❐ Special Instructions (for Fax Banking) :
Outward remittances will be made to the following named beneficiary :
Name : Maximum remittance amount (US$) :
Bank : Account No. :
Bank address : Country :
X X X X(Signature )(Signature ) (Signature ) (Signature )
SIGNHERE
8) POWER OF ATTORNEY
Signing Authority Signing Authority Signing Authority Signing Authority Signing Authority ❐ Single ❐ Joint
Effective from the date hereof, I hereby authorize and fully empower the abovenamed for me on my behalf and in my name, signing in accordance with the signature
specimen(s) above, jointly and/or severally with an authorized signatory and/or severally to draw checks upon, change my mailing address and otherwise to operate
and/or close any or all my account(s) and/or terminate any or all of my facilities with you, whether such account(s) be in credit or otherwise and whether such
facilities be active or otherwise and to exercise, give, make, issue and enter into all instructions, powers, authorities, instruments and transactions in respect of my
account(s) and/or facilities (including but not limited to placing of orders, transfer of funds to third parties and settlement of transactions) whether oral or written,
and in the same manner and to the same extent as I am so able pursuant to the Citibank International Personal Bank Account Terms and Conditions and any other
applicable terms and conditions, as these may be revised, amended, supplemented or modified from time to time.
I confirm that such authority shall remain in force and be binding on me until receipt by you of written instructions from me cancelling same.
I further confirm that I shall be bound by and that you shall not incur any liability whatsover to me or any other party whatsoever by reason of your acting in
accordance with the exercise of any or all of the above powers given to the person(s) authorized above.
Signature of Attorney
Name of Attorney
Signature of Attorney
Name of Attorney
Children Name(s) Date of Birth (M D Y) Please tick one box Occupation
1 ❐ Son
❐ Daughter
2 ❐ Son
❐ Daughter
3 ❐ Son
❐ Daughter
4 ❐ Son
❐ Daughter
5 ❐ Son
❐ Daughter
6 ❐ Son
❐ Daughter
7) BANKING PRODUCTS AND SERVICES REQUIRED (please tick as applicable) :
❐ I anticipate opening a Foreign Currency
❐ Time Deposit ❐ Transaction Account
I understand that foreign currency investments are subject to exchange rate fluctuations which may provide both opportunities and risks. I may experience a loss
when I convert foreign currency back to my home currency. I also understand that exchange controls may be applicable from time to time to certain foreign
currencies. I should therefore determine whether any foreign currency investment is suitable for me in the light of my investment objectives, my financial means and
my risk profile.
❐ Citibank Online Statement Facility (Optional) Alternative Email :
Yes, I would like to apply for your Online Statement Facility, where I will receive my Statement of Accounts in electronic form instead of in paper form, where I am the
principal account holder. Upon approval of this application, I understand I will receive an email notification at the preferred email address that I specify in the
application form (or failing which, at the alternative email above), informing me when my Statements of Accounts are available for viewing online. I accept and agree
to be bound by the Citibank Online User Agreement (as amended from time to time) which is available when I log-on to CItibank Online, and to pay any fee associated
with the use of the Online Statement Facility. I shall abide by any and all laws, rules, regulations and official issuances applicable to the Online Statement Facility, now
existing or which may hereinafter be enacted, issued or enforced under any jurisdiction. I understand that you may, in your absolute discretion, reject my application
for the Online Statement facility.
(Online Statement Facility)
(Citibank Online User Agreement ) Citibank Online
I maintain my liquid investments in (pls indicate all locations that apply) :
❐ Home country ❐ United States ❐ Europe ❐ Asia Pacific ❐ Others
Senior public office (eg. ministerial or diplomatic positions) :
❐ Yes, I/my immediate family members hold/have held senior public office (please elaborate).
❐ No, I/my immediate family members do not hold, and have never held senior public office.
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❐ HOLD MAIL SERVICE :
Please hold my bank statements, advices and mail (collectively the mail) for a maximum of 12 months. I am aware of the risks associated with the Hold Mail Service. At
the end of 12 months, you will forward my uncollected mail to:
12 12 :
Address :
Please debit the Hold Mail charges from my transaction account:
❐ FAX BANKING :
❐ Yes (please sign X below) X ❐ No
❐ Special Instructions (for Fax Banking) :
Outward remittances will be made to the following named beneficiary :
Name : Maximum remittance amount (US$) :
Bank : Account No. :
Bank address : Country :
X X X X(Signature )(Signature ) (Signature ) (Signature )
SIGNHERE
8) POWER OF ATTORNEY
Signing Authority Signing Authority Signing Authority Signing Authority Signing Authority ❐ Single ❐ Joint
Effective from the date hereof, I hereby authorize and fully empower the abovenamed for me on my behalf and in my name, signing in accordance with the signature
specimen(s) above, jointly and/or severally with an authorized signatory and/or severally to draw checks upon, change my mailing address and otherwise to operate
and/or close any or all my account(s) and/or terminate any or all of my facilities with you, whether such account(s) be in credit or otherwise and whether such
facilities be active or otherwise and to exercise, give, make, issue and enter into all instructions, powers, authorities, instruments and transactions in respect of my
account(s) and/or facilities (including but not limited to placing of orders, transfer of funds to third parties and settlement of transactions) whether oral or written,
and in the same manner and to the same extent as I am so able pursuant to the Citibank International Personal Bank Account Terms and Conditions and any other
applicable terms and conditions, as these may be revised, amended, supplemented or modified from time to time.
I confirm that such authority shall remain in force and be binding on me until receipt by you of written instructions from me cancelling same.
I further confirm that I shall be bound by and that you shall not incur any liability whatsover to me or any other party whatsoever by reason of your acting in
accordance with the exercise of any or all of the above powers given to the person(s) authorized above.
Signature of Attorney
Name of Attorney
Signature of Attorney
Name of Attorney
Children Name(s) Date of Birth (M D Y) Please tick one box Occupation
1 ❐ Son
❐ Daughter
2 ❐ Son
❐ Daughter
3 ❐ Son
❐ Daughter
4 ❐ Son
❐ Daughter
5 ❐ Son
❐ Daughter
6 ❐ Son
❐ Daughter
7) BANKING PRODUCTS AND SERVICES REQUIRED (please tick as applicable) :
❐ I anticipate opening a Foreign Currency
❐ Time Deposit ❐ Transaction Account
I understand that foreign currency investments are subject to exchange rate fluctuations which may provide both opportunities and risks. I may experience a loss
when I convert foreign currency back to my home currency. I also understand that exchange controls may be applicable from time to time to certain foreign
currencies. I should therefore determine whether any foreign currency investment is suitable for me in the light of my investment objectives, my financial means and
my risk profile.
❐ Citibank Online Statement Facility (Optional) Alternative Email :
Yes, I would like to apply for your Online Statement Facility, where I will receive my Statement of Accounts in electronic form instead of in paper form, where I am the
principal account holder. Upon approval of this application, I understand I will receive an email notification at the preferred email address that I specify in the
application form (or failing which, at the alternative email above), informing me when my Statements of Accounts are available for viewing online. I accept and agree
to be bound by the Citibank Online User Agreement (as amended from time to time) which is available when I log-on to CItibank Online, and to pay any fee associated
with the use of the Online Statement Facility. I shall abide by any and all laws, rules, regulations and official issuances applicable to the Online Statement Facility, now
existing or which may hereinafter be enacted, issued or enforced under any jurisdiction. I understand that you may, in your absolute discretion, reject my application
for the Online Statement facility.
(Online Statement Facility)
(Citibank Online User Agreement ) Citibank Online
I maintain my liquid investments in (pls indicate all locations that apply) :
❐ Home country ❐ United States ❐ Europe ❐ Asia Pacific ❐ Others
Senior public office (eg. ministerial or diplomatic positions) :
❐ Yes, I/my immediate family members hold/have held senior public office (please elaborate).
❐ No, I/my immediate family members do not hold, and have never held senior public office.
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X X X X
9) AGREEMENTS :
INVESTMENT FUNDS AND FIXED INCOME SECURITIES
In respect of any Investment Funds and Fixed Income Securities which I may purchase from time to time in your name or in the name of any nominee(s) appointed by
you, I understand that Fund units and Fixed Income Securities (a) are not bank deposits nor are they insured by you; (b) do not form part of your obligations nor that
of Citigroup or their affiliates; and (c) are subject to investment risks, which may include the loss of the whole principal amount invested therein.
RISK DISCLOSURE ACKNOWLEDGMENT
I hereby acknowledge and confirm that (i) I have read and fully understood the nature and contents of the section entitled “Risk Acknowledgment” in the prevailing
Account Terms and Conditions which sets out the possible risks associated with my investment in Investment Funds, foreign currencies, commodities and/or securities
(including but not limited to Fixed Income Securities) and (ii) I am fully aware of and understand the nature and extent of possible risks.
AGREEMENT (Please refer to the Citibank International Personal Bank Account Terms & Conditions)
I wish to apply for the Account(s) and request that the Automatic Overdraft and other Products and Services indicated above be made available to me. By signing this
Application Form (which I may do so in two or more counterparts, each of which shall be deemed an original, but all of which shall constitute one instrument), I confirm
that I have received a copy of the prevailing Account Terms and Conditions and agree that the same (as may be amended, supplemented or modified from time to time
at your sole discretion) will bind me as if incorporated into this Application Form in respect of any Products and Services under the Account(s) which may be made
available to me.
In addition, I agree to the transfer to an entity in the Citibank group which is an affiliate of Citibank Singapore Ltd (the “Transferee Bank”) of all my Citibank Accounts
(as hereinafter defined), with effect on and from the Effective Date (as hereinafter defined) on the following terms and conditions:
(A) all of the rights, title, interests, benefits, obligations and liabilities of Citibank Singapore Ltd in connection with the Citibank Accounts and all Related Agreements
(as hereinafter defined) and all Specified Security (as hereinafter defined), shall be transferred to, arise in favour of, bind and may be relied and acted upon by the
Transferee Bank to the same extent as if the Transferee Bank had been originally a party to, was originally the beneficiary or otherwise had the benefit (whether
expressly or impliedly) of and/or was the addressee or recipient of, all of such Citibank Accounts, Related Agreements and Specified Security and I confirm that all
such Specified Security shall continue to be valid and effective in favour of the Transferee Bank for the purpose of securing all obligations which are or may be
outstanding (and which are so transferred to the Transferee Bank) on the Effective Date as well as any new and/or additional obligations to the Transferee Bank
which may arise on or after the Effective Date;
(B) Citibank Singapore Ltd shall be fully discharged and released from all of its obligations and liabilities in connection with the Citibank Accounts, the Related
Agreements and the Specified Security so transferred by it but shall retain all rights, title, interests, benefits, obligations and liabilities in connection with any
Citibank Accounts, Related Agreements and Specified Security not so transferred by it and, in this regard, I acknowledge that if, notwithstanding any provision
hereof, Citibank Singapore Ltd at its sole discretion, on or after the Effective Date, allows any drawdown or utilisation of, or if it lends or makes any advances or
other accommodation under, any credit facility granted or made available and not transferred by it, all of such drawings, utilisations, advances or accommodation
shall continue to be secured by all security (including any guarantee or assurance) given or provided prior to the Effective Date to or in favour of Citibank
Singapore Ltd;
(C) I agree and undertake to, at the request of Citibank Singapore Ltd or the Transferee Bank, execute and sign any document and/or any security (including any
guarantee or assurance) (the “Additional Security Documents”) which may be required for the purpose of securing any existing or future obligations of mine or
any other person or persons, to Citibank Singapore Ltd and/or the Transferee Bank in connection with the Citibank Accounts, the Related Agreements and the
❐ Home Address : ❐ Office Address : ❐ Other Address :
Home/Apt No.:
Street Name:
Street Name:
Street Name:
City :
Country :
Postal Code :
(If Joint Account Holders’ address differs fromPrimary Account Holder’s):
:
5) BANK REFERENCES :
Banking with : Branch/Location : Account Type :
Other Citibank accounts :
❐ Yes, I have a Citibank bank account No. in (Account No. /Branch/Country)
❐ Yes, I have a Citibank credit card No. in (Account No. /Branch/Country)
❐ No, I do not have any other Citibank accounts or credit cards.
6) ADDITIONAL INFORMATION ABOUT MYSELF / FAMILY :
Type & source of funds to open this account :
Type : ❐ Cash ❐ Check ❐ Travellers Cheque ❐ Telegraphic Transfer/Inward Remittance
Source of Funds : ❐ Personal Savings ❐ Business ❐ Sale of investments ❐ Others
In the long term, I am planning on investing with Citibank Singapore Ltd (US$) :
❐ $100,000 ❐ $100,001 - $500,000 ❐ $500,001 - $1,000,000 ❐ > $1,000,000
My objective in opening an account :
❐ Savings/Investments ❐ Business needs ❐ Others
Other than from my occupation, I also earn income from :
❐ Savings/Investments ❐ Director’s/Consultancy Fee ❐ Rental
❐ Capital Gains ❐ Inherited Wealth ❐ Others
4) MY / OUR ADDRESS (please tick which address you’d like to be contacted at) :
(Signature )(Signature ) (Signature ) (Signature )
SIGNHERE
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Specified Security including but not limited to any documents which may be required to create, confirm or perfect any security which has been or may be given or
required to be given in favour of (a) Citibank Singapore Ltd prior to the Effective Date and/or (b) the Transferee Bank on or after the Effective Date and, in
connection therewith, I hereby authorize Citibank Singapore Ltd to, at any time and at its absolute discretion, date and/or re-date and deliver to the Transferee
Bank any such Additional Security Document so executed and signed by me but if I shall fail to provide and/or execute or sign any Additional Security Documents
by such time as may be specified by the Transferee Bank, I shall be deemed to have given to Citibank Singapore Ltd notice of cancellation and repayment of such
credit facility on and from the Effective Date, whereupon it shall so be cancelled and I shall be obliged to and shall promptly repay, together with accrued interest
thereon, any amount which is outstanding under, or, if so required, provide cash cover, for such credit facility to Citibank Singapore Ltd.
(D) I consent to the disclosure by Citibank Singapore Ltd to the Transferee Bank or any other person of any and all information relating to me, the Account(s), the
provision of any banking services and/or products to me from time to time in connection with any of the Citibank Accounts, Related Agreements and Specified
Security and any other security, guarantee and assurance given for the purpose of securing my obligations and/or for securing the obligations of any other person
or persons and any other information whatsoever which may be required in connection with the Transfer; and
(E) I agree that the benefit of the terms of these terms and conditions may be enforced by the Transferee Bank in accordance with the Contracts (Rights of Third
Parties) Act, Chapter 53B of Singapore. Save as expressly provided, no person who is not a party to these terms and conditions has any rights under the Contracts
(Rights of Third Parties) Act, Chapter 53B of Singapore to enforce any terms of these terms and conditions.
In this Application Form:
“Citibank Accounts” means all and any accounts (whether held singly or jointly with any other persons) as may be opened or maintained by me with Citibank
Singapore Ltd from time to time (including but not limited to the Account(s), savings, deposits, investment and secured / unsecured lending facilities);
“Effective Date” means such date as may be notified by either Citibank Singapore Ltd and/or the Transferee Bank;
“Related Agreements” means any agreements, documents and/or instrument(s) made or entered into in connection with the Account(s) and any acknowledgements
(including but not limited to risk disclosure statements and acknowledgements), information (including but not limited to information provided in respect of risk
profiling), instructions, orders, directions, mandates, powers and or authorities of all descriptions given and/or provided by me, to Citibank Singapore Ltd for the
purpose of the provision of banking services and/or products to me from time to time in connection with any of the Citibank Accounts;
“Specified Security” means all security (including, without limitation, any guarantee or assurance, security document, mortgage, charge, pledge, instructions, orders,
directions, mandates and/or authorities) given made or entered into prior to the Effective Date in favour of Citibank Singapore Ltd for the purpose of securing any of
my obligations to Citibank Singapore Ltd, arising in connection with any of the Citibank Accounts and/or Agreements and/or for securing the obligations of any other
person or persons to Citibank Singapore Ltd.
DISCLOSURE OF INFORMATION
I authorize the transfer and disclosure of any information relating to me, to and between the branches, subsidiaries, representative offices, affiliates and agents of
Citibank Singapore Ltd and third parties selected by any of them, wherever situated, for confidential use (including for use in connection with the provision of any
Products or Services to me, and for data processing, statistical and risk analysis purposes, global cash services and dealings in Securities on the Stock Exchange of
Singapore and any other relevant authorities and agencies pertaining thereto). Citibank Singapore Ltd and any Citibank branch, subsidiary, representative office,
affiliate, agent or third party selected by any of them shall be entitled to transfer and disclose any information as may be required by applicable law, court, regulator
or legal process.
Without prejudice to the generality of the foregoing, where Citibank Singapore Ltd is a member of, or subscriber for the information sharing services of, any credit
bureau recognized by the Monetary Authority of Singapore (“MAS”) under or pursuant to the Banking Act (Chapter 19), I authorize:
(a) Citibank Singapore Ltd to transfer and disclose to any such credit bureau; and (b) any such bureau to transfer and disclose to any fellow member or subscriber as
may be recognized as such by MAS, any information relating to me and/or any of my Citibank Account(s) (and for such purposes) as may be permitted under or pursuant
to the Banking Act (Chapter 19).
Without prejudice to the generality of the foregoing, I hereby consent to the disclosure to any assignee or transferee of any and all information relating to the Citibank
Account(s) and any security, guarantee and assurance provided to secure my obligations thereunder and any other information which may be required in relation to
or in connection with any novation, assignment or transfer as contemplated hereby.
For the purpose of complying with applicable US tax laws, I waive any bank secrecy, privacy or data protection rights related to my Citibank Account(s).
LANGUAGE PREVAILING
In the event of any inconsistencies between the different languages of this Application, the English language version shall prevail.
13. If I am the sole adult holder of the Junior Account, in the event of my death, you shall be entitled to close the Junior Account and to pay the balance of monies
therein to my legal personal representatives. If there are more than 1 adult holder of the Junior Account, in the event of the death of anyone of us, you shall
forthwith be entitled to close the Junior Account and the credit balance shall be transferred to a new Junior Account to be opened by you in the name of the
surviving adult holder/s and the Child. The provisions contained in this Addendum shall also continue to apply to the new Junior Account opened pursuant hereto.
14. The obligations set out in this Addendum shall be joint and several.
1.
2.
3. 2 1
4.
5.
6.
7.
8.
9.
10. 2 1
11. 2 1 a b
c c
12. 2 1 4 5
13.
14.
I/We have read, understood and agree to the terms contained in this Addendum.
X XCitibank Customer (Parent) Citibank Customer (Parent)
Name : Name :
ID/Passport No. : ID/Passport No. :
SIGNHERE
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(a)
(b) (c)
(i)
(ii)
“ ”
(A)
(B)
(C) ”
”
(D)
(E) Contracts (Rights of Third Parties) Act, Chapter 53B of Singapore
Contracts (Rights of Third Parties) Act, Chapter 53B of Singapore
3) CITIBANK INTERNATIONAL JUNIOR ACCOUNT :
JUNIOR JOINT ACCOUNT HOLDER (please provide a photocopy of your Child’s birth certificate/valid passport):
:
Relationship to Account Holder : C/NO:
Name of Child (Underline surname) :
Gender : Birth Date : M D Y
Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Tel : +( ) (Home ) (Handphone )
Email :
The terms and conditions contained in this Addendum for Citibank International Junior Account (“Junior Account”) applies only to Junior Accounts and are to be
read in conjunction with and in addition to Citibank’s Terms and Conditions (“Terms and Conditions”). All definitions contained in the Terms and Conditions shall
apply to this Addendum for Junior Account unless otherwise defined.
1. I/We hereby request you to add the child, whose particulars are set out above (“Child”) to the Junior Account.
2. The Junior Account is an account held by me/us in such manner as you may permit from time to time.
3. I/We shall specify the name of the Child in the application on the opening of the Junior Account. I/We may only specify a person who is less than 21 years of age
as the Child.
4. There shall only be one Child in a Junior Account at any time unless you otherwise agree.
5. I/We shall not replace the Child Account holder during the existence of the Junior Account. You are not obliged to accept any replacement of the Child Account
holder unless you are satisfied that it is only a change in the name and is supported by legal documentation to your satisfaction.
6. I/We hereby declare that the Junior Account is not a trust account. The monies in the Junior Account are my/our property and I/we shall be entitled to operate
the Junior Account as I/we think fit. When the Child has attained the age of 15 (or as deemed appropriate by you) and I/we may request you to provide, and you
may, at your sole discretion, provide the Child with a Citicard and ATM-PIN.
7. No investment products, overdraft, checking or credit facilities are or will be made available through the Junior Account.
8. Where I/we have requested you to provide, and you have agreed to provide, the Child with a Citicard and an ATM-PIN, I/we hereby declare that the Child is duly
authorised by me/us to give instructions pertaining to the Junior Account on my/our behalf and you are entitled to accept and rely on instructions in respect of
any transaction concerning the Junior Account from the Child as if such instructions were issued by me/us on the terms and subject to the conditions set out in
the Terms and Conditions. Such authorisation shall continue until you receive written notice from me/us that I/we have revoked the authorization given to the
Child, which I/we may do at any time, and at my/our sole and absolute discretion. I/We further consent to you recording the Child’s telephone conversations with
you to provide evidence of instructions and other verbal communications.
9. For and in consideration of your agreement to include the Child’s name in the Junior Account and (where applicable) in consideration of your issuing the Child
with a Citicard and/or ATM PIN at my/our request, I/we hereby undertake to indemnify you fully and hold you harmless from and against any and all claims and to
reimburse you upon demand for any and all payments, losses, costs, expenses (including legal fees incurred by you on a full indemnity basis) and damages which
you may suffer, sustain, make, or be required to make to any person, resulting from, in connection with or pursuant to the carrying out of any instructions given
by the Child or by me/us. This indemnity shall be binding on my/our legal personal representatives.
10. I/We undertake that, immediately upon the Child attaining the age of 21, I/we shall obtain the ratification by the Child of all actions and transactions effected on or
with the Junior Account prior thereto. I/We further undertake to procure the Child to execute such ratification document(s) as may be provided by you (“Ratification
Document(s)”). Until such Ratification Document(s) has been signed by the Child and received by you, you are not obliged to act on any instructions given by me/
us or the Child for the withdrawal of the monies in the Junior Account.
11. I/We further undertake that immediately upon the Child attaining the age of 21, I/we will instruct you to close the Junior Account and to open another account with
you, (a) in my/our sole name, (b) in the joint names of myself/ourselves and the Child, or (c) in the Child’s sole name. The opening of the new account shall be at
your discretion, and in the case of (b) and (c) as aforesaid, shall be subject to my procuring the Child’s execution of the Ratification Documents.
12. If I/we fail to procure the Child’s execution of the Ratification Documents and/or fail to give instructions to close the Junior Account within [45] days of the Child
turning 21, you are hereby authorised to close the Junior Account on my/our behalf, open a new Account(s) in my/our names or release the monies in the Junior
Account to me/us by way of a check, cashier’s order or telegraphic transfer issued in favour of me/us.
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11) US TAX DECLARATION & ACCEPTANCE :
By checking the appropriate box and signing below, I accept the terms and conditions of this agreement and declare my tax status under US tax law. I understand that
a false statement or misrepresentation of tax status by a US person could lead to penalties under US law.
(A) NON-US PERSON I represent and warrant that I am not a US person (i.e. a citizen or lawful resident (green card holder) of the United States) for purposes of US
federal income tax and that I am not acting on behalf of a US person. If my tax status changes and I become a US citizen or resident of the United States I must
notify Citibank Singapore Ltd within 30 days. In the event that I shall become (a) United States person(s), I agree that you shall be entitled to do all acts and things
you deem necessary to comply with applicable US law, including but not limited to a liquidation of the affected assets and/or a transfer of my account to an
alternate vehicle. I agree to bear all costs and expenses incurred by the Bank as a result thereof.
(B) US PERSON In respect to Section 12, I declare under penalties or perjury that:
1) The number shown in Section 12 is my correct US taxpayer identification number, and
2) I am not subject to backup withholding as a result of failure to report all interest and dividends or the IRS has notified me that I am no longer subject to
backup withholding.
3) For purposes of complying with applicable US tax laws, I waive any bank secrecy privacy or data protection rights related to my account.
(C) I understand that the Bank assumes no liability for any tax withheld on any reportable payments made to a customer under the US Tax Rules.
(A)
30
(B) 12
1) 12
2)
3)
(C)
❐ Joint Account ❐ Power of Attorney Relationship to Account Holder : C/NO:
Mr/Mrs/Mdm/Ms (Underline surname) :
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
❐ Joint Account ❐ Power of Attorney Relationship to Account Holder : C/NO:
Mr/Mrs/Mdm/Ms (Underline surname) :
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
10) MAKING GLOBAL INVESTMENT OPPORTUNITIES AVAILABLE TO YOU :
Please provide me with global market information and research, and from time to time, information on specific banking and investment opportunities which
you consider may be of interest to me. I understand that the provision of the said information and services (if any) to me arise out of your advisory relationship
with me.
(
“MAS”) Banking Act (Chapter 19)
(a) (b) MAS
Base No:
112
SIGNHERESIGNHERE
SIGNHERESIGNHERE
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X
Name :
Please tick one box ❐ A ❐ B - US Tax ID No.
(Please provide your taxpayer identification number in order to
avoid backup withholding of US tax at the rate of 31% on interest,
dividends and other reportable payments credited to your
account.)
31%
Signature : X C
o.R
eg.N
o. 2
00
309
48
5K
0
9/20
05
ACCOUNT TITLE :
ACCOUNT NO. : R/S NO:
1) MY PERSONAL PARTICULARS (please provide a photocopy of passport) :
Mr/Mrs/Mdm/Ms (Underline surname) : C/NO:
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
2) JOINT ACCOUNT HOLDER(S) / POWER OF ATTORNEY (please provide a photocopy of your valid passport):
:
❐ Joint Account ❐ Power of Attorney Relationship to Account Holder : C/NO:
Mr/Mrs/Mdm/Ms (Underline surname) :
Birth Date : M D Y Mother’s Maiden Name :
Nationality : Country of Residence :
Passport No. : Place of Issue :
Issue Date : M D Y Expiry Date : M D Y
Occupation : Job Title :
Self-Employed : ❐ Yes ❐ No Industry of Business :
Name of Company :
Type of Company : ❐ Private Ltd ❐ Public Ltd ❐ Government Owned
❐ Partnership ❐ Sole Proprietorship ❐ Others
My Annual Income (US$) : ❐ $50,000 ❐ $50,001 - $200,000 ❐ $200,001 - $500,000 ❐ > $500,000
Tel : +( ) (Home ) +( ) (Office )
+( ) (Handphone ) Fax : Email :
12) SIGNATURE(S) : Date :
SIGNATURE REQUIREMENTS :
❐ Single (any one to sign) ❐ All to sign ❐ Others
❐ Citibank International Junior Account (Any Parent to sign)
LAWS OF OWN COUNTRY :
I shall be aware of the laws in my country with regards to my banking with you in Singapore or in any other jurisdictions and you shall not be liable for any loss or liability
imposed by my country on me as a result of my non-compliance with any regulations, laws or legal process of my country.
Co.
Reg
.No
. 20
030
94
85
K
09/
200
5
1 ❐ WI ❐ CS
❐ OR ❐ Remote
❐ Others
2 Introduced by:
Bank Staff/Cust
❐ Savings ccy ❐ MaxiSave/Checking (Checkbook Y/N)
❐ TD ❐ US$ Interest Checking (Checkbook Y/N)
Cost Centre: PC Code:
Referral Code: Broker Base:
Branch Code:
PPlus Updated: ❐ Yes ❐ No
Within SDN/PF List ❐ Yes ❐ No
Signature verified by:
Approved by: Date:
Input Authorized
MA
FOR BANK USE
SINGAPORE
© 2005 Citibank
Citibank and Arc Design is a service mark of Citigroup Inc or Citibank, N.A.Citibank is a registered service mark of Citigroup Inc or Citibank, N.A.
Citibank Singapore LtdCo. Reg. No. 200309485K
www.ipb.citibank.com.sg
Telemarketing Hotline(65) 6426-336824-Hour CitiPhone Banking(65) 6224-5757
Fax(65) 6328-8008
23 Church StreetCapital Square #07-01Singapore 049481
40A Orchard RoadMezzanine LevelSingapore 238838(Opposite Dhoby Ghaut MRT)
Banking Hours:Mondays to Fridays: 9.30am – 3.30pmSaturdays (Orchard Road branch only): 9.30am – 12.00pm
09/
200
5
Citibank International Personal Bank Centers
Asia Australia Europe USA
Hong Kong Brisbane London Guam
Singapore Melbourne Jersey Miami
Perth New York
Sydney San Francisco
Account Opening Application
English
ACCOUNT TITLE (Names of all Account Holders): ACCOUNT NO.:
NAME NAME
SIGNATURE X SIGNATURE X
NAME NAME ❐ POA
SIGNATURE X SIGNATURE X
SIGNHERE
13) SIGNATURECARD(All applicants to sign.If Power of Attorney,
please indicate.)❐ Single (any one to sign)
❐ All to sign
❐ Citibank International Junior Account(Any Parent to sign)
❐ Others
SignatureRequirements:
Account Type: ❐ Single ❐ Joint
❐ Joint Junior
No. of Parent(s)
❐ USD Checking Facility via Citibank GuamRequest For:
Please also sign on the “Application For Citibank USD CheckingFacilities” form.
FOR BANK USE ONLY
APPROVED BY: DATE:
¥…'RƒW-2 9/13/05, 1:39 PM1
SINGAPORE
© 2005 Citibank
Citibank and Arc Design is a service mark of Citigroup Inc or Citibank, N.A.Citibank is a registered service mark of Citigroup Inc or Citibank, N.A.
Citibank Singapore LtdCo. Reg. No. 200309485K
www.ipb.citibank.com.sg
Telemarketing Hotline(65) 6426-336824-Hour CitiPhone Banking(65) 6224-5757
Fax(65) 6328-8008
23 Church StreetCapital Square #07-01Singapore 049481
40A Orchard RoadMezzanine LevelSingapore 238838(Opposite Dhoby Ghaut MRT)
Banking Hours:Mondays to Fridays: 9.30am – 3.30pmSaturdays (Orchard Road branch only): 9.30am – 12.00pm
09/
200
5
Citibank International Personal Bank Centers
Asia Australia Europe USA
Hong Kong Brisbane London Guam
Singapore Melbourne Jersey Miami
Perth New York
Sydney San Francisco
Account Opening Application
English
ACCOUNT TITLE (Names of all Account Holders): ACCOUNT NO.:
NAME NAME
SIGNATURE X SIGNATURE X
NAME NAME ❐ POA
SIGNATURE X SIGNATURE X
SIGNHERE
13) SIGNATURECARD(All applicants to sign.If Power of Attorney,
please indicate.)❐ Single (any one to sign)
❐ All to sign
❐ Citibank International Junior Account(Any Parent to sign)
❐ Others
SignatureRequirements:
Account Type: ❐ Single ❐ Joint
❐ Joint Junior
No. of Parent(s)
❐ USD Checking Facility via Citibank GuamRequest For:
Please also sign on the “Application For Citibank USD CheckingFacilities” form.
FOR BANK USE ONLY
APPROVED BY: DATE:
¥…'RƒW-2 9/13/05, 1:39 PM1