Date: Customer Name: Father's Name: Mother's Name: Spouse's Name (if applicable): Product Type: [_] Lifestyle Card CJACCACard []Travel Card [] Payrott LJOthers Permanent Address: Malling Address: Purpose of card usage: Date of Birth: Mobile/Phone: 1. 2 E-mail; Primary Secondary Passport/NID/Other Photo ID/Driving License No. TIN (If any): Photocopy of above mentioned ID obtained (If applicable): Yes Profession: Name of Present Organization/ Institution: Address of Organization: Academic Qualification: Grade/Year/Semester & Yearly Tuition Fee (if Student Expected Monthly Number of Transaction 010 0-50 Approximately Monthly Expense: Taka Source of Funding: [J] Own Income Guardians/ Parents Scholarship Salary Others (please specify) Guardian/ Parent's Occupation: Organization Name and Address: Does the customer have any Credit Card with EBL? Yes Does the customer have any other account with EBL? Yes If yes, please mention the A/C No. How the account was opened? Branch Direct Sales Agent Name of Account Opening Officer: Employee ID Signature and Seal of CSM/RM/DST/PST Signature and Seal of BM/SSM/SM/BDM