account opening form8 banking/account... · account number account number account number completed...

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BANK ACCOUNT APPLICATION FOR ALL ACCOUNT HOLDERS AND SIGNATORIES *Account name Mailing Address for account statements CUSTOMER INFORMATION Initial investment Monthly commitment ($250 min/$25,000 max) ($1,000 min) Fixed Term Deposit options 1 year 2 year 3 year 4 year 5 year Butterfield Account to be debited (18 digits) CHEQUES Name, address and phone number(s) to appear on cheques: BMD USD BMD USD BMD USD other ACCOUNT INFORMATION Chequing options Value Regular Power Volume e-Chequing Strata Saving Young Savers Yes No Stub No stub The Applicant(s) apply(ies) to open an account with The Bank of N.T. Butterfield & Son Limited, which shall be governed by the Retail General Terms & Conditions as modified from time to time and as posted on the Bank's website or Banking Centre Welcome areas. *(Mandatory field) JOINT ACCOUNT MANDATE - To be completed by Joint Account holders: For the purpose of this mandate, I/We authorise The Bank of N.T. Butterfield & Son Limited to accept instructions from* in the manner detailed in the Bank’s Terms & Conditions until we give the Bank notice to the contrary in writing. *Insert “either of us” or “all jointly” or as the case may be. First Applicant Second Applicant Third Applicant *First & middle names (If self-employed please state nature of business) Day Evening Day Evening Day Evening *Occupation E-mail address *Last name *Street address and postal code *Nationality ID type and number, (e.g. passport) *Date of birth (dd/mm/yyyy) *Phone details Employer (if applicable) Resident Non-resident Bermudian Non-Bermudian Resident Non-resident Bermudian Non-Bermudian Resident Non-resident Bermudian Non-Bermudian ATM/DEBIT CARD & YOUTH ATM CARD Name (Print) Signature Date Relationship to account holder Declaration of parent/guardian of account holder aged 10 up to 16 years old: I give the above named young person permission to obtain and operate a Youth ATM card. Request to apply Deposit only Existing cardholder(s) New cardholder(s) Primary account Other existing account Butterfield Card number (16 digits) No. of copies per deposit book DEPOSIT BOOKS Name to appear on deposit books: Yes No 2 part (1 copy) 3 part (2 copies) 4 part (3 copies) INTERNET BANKING Yes No Yes No Yes No Yes No Yes No Yes No User ID Login (8-14 characters) Define currency for viewing your accounts Secret Question (Max of 50 characters) Secret Answer (Max of 50 characters) City of Birth Would you like the option of sending wires? If so, please specify the limit (Max $100,000) $ $ $ Collect From: Head Office Waterfront St.George’s Somerset Mail Private Banking Rosebank Request to apply Deposit only Existing cardholder(s) New cardholder(s) Primary account Other existing account Request to apply Deposit only Existing cardholder(s) New cardholder(s) Primary account Other existing account Account name 1 year Supersaver Plus 3 year 5 year * * * * * * $ $ No. of cheque books required: RET 70 123 Rev 08-10

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Page 1: Account Opening Form8 Banking/Account... · Account number Account number Account number Completed by (Print) Date CIF # Staff Yes No Client New Existing Staff Yes No Client New Existing

BANK ACCOUNT APPLICATION FOR ALL ACCOUNT HOLDERS AND SIGNATORIES

*Account name

Mailing Address for account statements

CUSTOMER INFORMATION

Initial investment Monthly commitment ($250 min/$25,000 max)($1,000 min)

Fixed Term Deposit options 1 year 2 year 3 year 4 year 5 year

Butterfield Account to be debited (18 digits)

CHEQUES

Name, address and phone number(s) to appear on cheques:

BMD USD BMD USD

BMD USD other

ACCOUNT INFORMATION

Chequing options Value Regular Power Volume e-Chequing StrataSaving Young Savers

Yes No Stub No stub

The Applicant(s) apply(ies) to open an account with The Bank of N.T. Butterfield & Son Limited, which shall be governed by the Retail General Terms & Conditions as modified from time to time and as posted on the Bank's website or Banking Centre Welcome areas.*(Mandatory field)

JOINT ACCOUNT MANDATE - To be completed by Joint Account holders: For the purpose of this mandate, I/We authorise The Bank of N.T. Butterfield & Son Limited to accept instructions from*

in the manner detailed in the Bank’s Terms & Conditions until we give the Bank notice to the contrary in writing. *Insert “either of us” or “all jointly” or as the case may be.

First Applicant Second Applicant Third Applicant

*First & middle names

(If self-employed please state nature of business)

Day Evening Day Evening Day Evening

*Occupation

E-mail address

*Last name

*Street address and postal code

*Nationality

ID type and number, (e.g. passport)

*Date of birth (dd/mm/yyyy)

*Phone details

Employer (if applicable)

Resident Non-resident

Bermudian Non-Bermudian

Resident Non-resident

Bermudian Non-Bermudian

Resident Non-resident

Bermudian Non-Bermudian

ATM/DEBIT CARD & YOUTH ATM CARD

Name (Print) Signature Date Relationship to account holder

Declaration of parent/guardian of account holder aged 10 up to 16 years old:I give the above named young person permission to obtain and operate a Youth ATM card.

Request to apply

Deposit onlyExisting cardholder(s)

New cardholder(s)

Primary account Other existing account

Butterfield Card number (16 digits)

No. of copies per deposit book

DEPOSIT BOOKS

Name to appear on deposit books:

Yes No

2 part (1 copy) 3 part (2 copies) 4 part (3 copies)

INTERNET BANKING Yes No Yes NoYes No

Yes No Yes No Yes No

User ID Login (8-14 characters)

Define currency for viewing your accounts

Secret Question (Max of 50 characters)

Secret Answer (Max of 50 characters)

City of Birth

Would you like the option of sending wires?

If so, please specify the limit (Max $100,000) $ $ $

Collect From: Head Office WaterfrontSt.George’sSomerset MailPrivate Banking Rosebank

Request to apply

Deposit onlyExisting cardholder(s)

New cardholder(s)

Primary account Other existing account

Request to apply

Deposit onlyExisting cardholder(s)

New cardholder(s)

Primary account Other existing account

Account name

1 yearSupersaver Plus 3 year 5 year

*

*

*

*

*

*

$ $

No. of cheque books required:

RET

70 1

23 R

ev 0

8-10

Page 2: Account Opening Form8 Banking/Account... · Account number Account number Account number Completed by (Print) Date CIF # Staff Yes No Client New Existing Staff Yes No Client New Existing

OPERATION OF ACCOUNT (to be answered by any one of the account owners)

*What is the purporse of this account?

Verification of Nationality. Bermudian Residents must provide: i) an original or notarised copy of a passport or ii) a birth certificate and government issued photo identification. Non-Bermudian Residents and Non-Residents must provide an original or notarised copy of a passport. Identification should state the true legal name, date of birth and nationality of the account holder(s).

Verification of Address. A document verifying street address is required. For residents of Bermuda, a recent utility bill, the relevant page of a telephone directory or electoral poll listing is acceptable. For non-residents, a current utility bill showing their street address is acceptable.

Minimum deposit. BM $100 or equivalent is required to open chequing and savings accounts.

Verification of Bermuda Residency (Non-Bermudians only). An official immigration document is required if you are resident in Bermuda and are not Bermudian.

Verification of Main Source of Income (Non-residents only). Non-residents must provide documentation to support their main source of income (e.g. pay slip, letter from employer or trust, investment statement, etc.)

EXISTING Customers are required to provide the following documentation in addition to their completed application form:

Minimum deposit. BM $100 or equivalent is required to open chequing and savings accounts.

Verification of Address only if address listed on existing accounts has changed. For residents of Bermuda, a recent utility bill, the relevant page of a telephone directory or electoral poll listing is acceptable. For non-residents, a current utility bill showing their street address is acceptable.

Photo Identification. Any government issued photo identification stating the true legal name, date of birth and nationality of the account holder(s).

It is Bank policy to verify the source of funds before accepting or executing any transaction.

BANK USE ONLY

(please sign within block)

Applicant signature(s) Second Applicant Third Applicant First Applicant

Date

Why have you chosen to establish the account in Bermuda? (Non-residents only)

Do any of the account holders have a connection with Bermuda (Non-residents only)(e.g. family ties, property ownership, frequent visitor, business related dealings)? If so, please provide details.

*Is this account being held for the benefit of another party other than those named on the account?

*Amount of initial deposit

*Initial funds will be deposited via: Wire Bank draft Internal transfer Personal cheque Cash

Other (please describe)

*Where are the funds coming from? Self or from other Individual / Entity / (Name):

Location of Origin – City, Country

*How were the initial funds acquired?

*Source of incoming future funds (Select all that apply):

Salary Rental Income Commissions & fees

Sales Revenue Investment Income Other (please describe):

*Method of Incoming Funds (Select all that apply):

Wires Bank drafts Direct deposit

Internal transfers Personal cheques Third party cheques

Cash

Other (please describe):

*Method of Outgoing Funds (Select all that apply):

Wires Bank drafts Debit card

Internal transfers Personal cheques Butterfield direct internet banking

Cash

Other (please describe)

*Estimated total monthly incoming funds *Estimated total monthly outgoing funds

(i) I/We will be the beneficial owner(s) or signatory(ies) of the account for which the application is being made.(ii) This account is not being acquired in violation of any applicable law.(iii) I/We confirm that I/we will comply with all tax and exchange control reporting requirements imposed by any applicable jurisdiction in respect to this proposed account.(iv) The information provided above is true to the best of my/our knowledge, information and belief.

We require the additional following documentation to open and operate a personal account.

DECLARATION

REFERENCE AND IDENTIFICATION REQUIREMENTS

ACCOUNT FINANCIAL DETAILS

NEW Customers are required to provide the following documentation in addition to their completed application form:

Yes No

Yes No

BANK USE ONLY

Account number Account number Account number

Completed by (Print) Date

CIF #

YesStaff No Client New Existing YesStaff No Client New Existing YesStaff No Client New Existing

Second applicantFirst applicant Third applicant

Approved byCompliance Name (Print) Signature

$ $

$

Date

If so, please state their name

RET

70 1

23 R

ev 0

8-10

SBNTBRETBR002 11/10