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Self Declaration Form

This document is a self-declaration form used by BRAC Bank Ltd. for customers to declare their occupation, income sources, and other details. The form collects information on the customer's occupation type, occupation details including designation, organization, nature of business, monthly income range, source of funds, and a general declaration section. The customer needs to sign the form to confirm the provided information is true and correct. The bank official also signs after receiving and checking the details.

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muslimnsw
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465 views

Self Declaration Form

This document is a self-declaration form used by BRAC Bank Ltd. for customers to declare their occupation, income sources, and other details. The form collects information on the customer's occupation type, occupation details including designation, organization, nature of business, monthly income range, source of funds, and a general declaration section. The customer needs to sign the form to confirm the provided information is true and correct. The bank official also signs after receiving and checking the details.

Uploaded by

muslimnsw
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Self-Declaration Form (Regarding Income, Profession & Source of Fund)

Date: ______/______/___________
Manager
BRAC Bank Ltd.
Branch/Unit/Sub-Branch/AB Outlet/Booth

Account Number:

Account Title:

Occupation Type : (Please put √ mark multiple if applicable)


□ Private Service □ Government Service □ Business □ Student □ House-wife □ Land-Lord/ Land-Lady □ Farmer
□ Professional (Doctor/ Lawyer/ Accountant/ Engineer/ Architect/ Mariners etc.) □ Defense/ Law Enforcement Agencies
□ Retired □ Freelancer □ Consultancy/Trainer/Coach □ Sportsman □ Others (Please specify) …………………………….…
Occupation Details : (Please fill up multiple fields if applicable)
For Service holder
Designation: ………………………………………………………………………………………………………………………………
Name of the Organization: ………………………………………………………………………………………………………………
For Businessmen
Name of the Business entity: ……………………………………………………………………………………………………………
Nature of Business Details of Business/Products Nature of Business Details of Business/Products
□ Manufacturing ……………………………….…. □ Service Provider …………………………………...…..
□ Trading ……………………………….…. □ Distributor ………………………………..….…..
□ Export-Import …………………………….……. □ Retailer ……………………………..………...
□ Wholesaler …………………………….……. □ Cottage/Small Industry ……………………………..………...
□ Agro Business …………………………….……. □ e-Commerce/Online Seller ……………………………..…….…..
□ Consultancy/Training ……………………………….…. □ MFS Agent/ Business …………………………………..…..
□ C&F Agent ……………………………….…. □ Others (Please specify) …………………………………..…..
For Professionals (Doctor/ Lawyer/ Accountant/ Engineer/ Architect/ Mariner etc.)
Name of the profession: ………………………………………………………………………………………………………………...
Name of the Entity/Firm: …………………………………………………………………………………………………………………
For Housewife/ Student/ Unemployed
Please provide details of fund provider/ earning member of the family/ Beneficial Owner (BO):
Relationship with the fund provider/ earning member/ BO: ………………………………………………………………………..….
Occupation of fund provider/ earning member/ BO: ……………………………………………………………………………………
Occupation Details of BO: …………………………………………………………………………………………………………………
For Landlord/ Retired Person/ Consultant/ Others (please provide details below):

Monthly Income : (in BDT equivalent) (Please put √ mark)


□ Less than 15,000 □ 15,001 - 50,000 □ 50,001 - 150,000 □ 150,001 - 250,000 □ 250,001 - 350,000
□ 350,001 – 500,000 □ 500,001 – 10,00,000 □ More Than 10,00,000 (please try to obtain supporting documents)
Source of Fund / Income Generating From: (Please put √ mark multiple if applicable):
□ Salary, Bonus, Allowance, Incentives □ Rent □ Agro/Fishery/Livestock □ Business □ Remittance** □ Govt. Bonds/ SP/ WEDB/
Treasury Bond □ Savings/ Pension Scheme/ Retirement Benefits □ Providing Professional Services □ Freelancing
□ Commission □ Online Selling/ e-Commerce □ Consultancy/Training □ Sports/ Coaching □ Mariner’s Remuneration &/ Benefits
□ Others (Please specify) …….. …………………………………………………………………………………………………………….………
** In case of your source of income is Remittance, please provide name and details of the fund provider in General Declaration (in next page).

RB-CSF BRAC BANK LIMITED


General Declaration / Clarification (about Income/Profession/Source of Fund)
Please use the below section for declaring other Source of Income/ Clarification in details

I/we confirm that the above mentioned information given is/are true and correct.

Account Holder’s/ Walk-in-Customer’s Joint Account Holder’s Signature


Signature (If any)

FOR BANK USE ONLY Customer ID:

Received By: Checked/Supported By:

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