BANK ACCOUNT APPLICATION FORM

Instructions: Please fill out this form in BLOCK LETTERS. Ensure all sections are completed.

SECTION 1: PERSONAL INFORMATION

Full Name: ____JENNY SMITH_____

Date of Birth (DD/MM/YYYY): _________12/05/1990___________

Gender: ☐ Male ☐ Female ☐ Other

Marital Status: ☐ Single ☐ Married ☐ Divorced ☐ Widowed

Country of Origin: __UNITED STATES__

SECTION 2: CONTACT DETAILS

Residential Address (Present Address):

123 MAIN STREET
NEW YORK, NY 10001

Permanent Address (if different from above):

Phone Number: ______555-123-4567___

Email Address:_.smith@example.com_

SECTION 3: EMPLOYMENT STATUS

Employment Status:
☐ Employed ☐ Self-Employed ☐ Unemployed ☐ Student ☐ Retired

Occupation/Job Title (if employed): ___MARKETING MANAGER_______

Employer's Name (if applicable): ______ABC CORPORATION______

Employer's Address (if applicable): ___456 WALL STREET
NEW YORK, NY 10005_______

SECTION 4: INCOME DETAILS

Monthly Income Range:
☐ Below $500
☐ $500 - $1,000
☐ $1,000 - $2,000
☐ $2,000 - $5,000
☐ Above $5,000

SECTION 5: ACCOUNT DETAILS

Type of Account Required:
☐ Savings Account
☐ Current Account
☐ Fixed Deposit Account

SECTION 6: IDENTIFICATION

(Provide details of one identification document.)

ID Type (e.g., Passport, Driver’s License): __DRIVER'S LICENSE__

ID Number: ____DL123456____

SECTION 7: DECLARATION

I hereby declare that the information provided above is true and correct to the best of my knowledge. I agree to abide by the terms and conditions of the bank.

Signature: ___JENNY SMITH___

Date: ___15/03/2025_________