开 户 申 请 书 及 客 户 资 料 备 考（ 私人账户）

Private Opening Application Form and Information Reference

Please complete this application form by ticking in (√) in the appropriate box and using BLOCK CAPITALS. All the fields marked with * are not mandatory. Please ensure the form has been appropriately signed.

请在适用空格内打（√ ）, 并使用正楷或大写字母填写本表。所有带*的部分为非必填项目, 并请您按照要求签名。

Account Holder Identity Details账户持有人身份资料

Title称谓: Mr先生 □ Mrs夫人 □ Miss小姐 □ Mr先生□ Mrs夫人□ Miss小姐□

Name in Chinese Name in Chinese

中文姓名 中文姓名

Name in English Name in English

英文姓名 英文姓名

Birthday Birthday

出生日期 出生日期

Natonality & ID No. Natonality & ID No.

国籍和证件号码 国籍和证件号码

Present Permanent Residential Address 现永久居住地址

Please provide a correspondence address, if it is not the same as your Present Permanent Residential Address.

如果您的联系地址不同于现永久居住地址，请提供具体细节。

Correspondence Address联系地址

Reason for difference with Present Permanent Residential Address

银行账单Statement 请邮寄我处Send to me/us □ 暂存贵行Keep in your Bank(Hold-Mail)□

Contact Details 联系方式

*Office Tel. No. Home Tel/Fax. No.

单位联系电话 家庭电话、传真

Mobile Email address

移动电话 电邮地址

Employment Details职业资料

Employed full-time □ Embassy staff □ Self-employed □ Retired□ Restaurant Owner □

全日制雇员 使领馆工作人员 自雇 退休 餐饮业主

Full-time education□ Other (please specify)

全日制学生 其他（请具体注明）

Occupation Position

职业 职位

Name of Employer

工作单位名称:

Address of Employer

工作单位地址:

Regular Income Level收入状况

Annual Salary income: *All other income

年工资收入 所有其他收入

Activity Scale

业务经营状况

Reason for opening account Source of opening deposit

开户原因 开户存款来源

*Proof of source of income *Evidence of Address

收入证明文件 住址证明文件

Declaration and signature声明与签字

1. What is /are the service(s) you are looking for? Deposit □ Loan□ Structured Product□ Securities□ Derivatives□

您/您们需要银行提供何种服务？ 存款 贷款 结构性产品 证券 金融衍生产品

2. What is/are your investment objective(s)? Long term长线□ Medium Term中线□ Capital Growth增值□

您/您们的投资目标？ Dividend Growth股息收入□ Secured担保□ Dynamic动态□

其它Or specify:

3. How would you qualify your experience of the financial markets? NIL □ 1 to 5 years □ 5 to 10 years □ >10 years □

您/您们的金融市场投资经验？ 无 1到5年 5到10年 超过10年

4. Categorization of customer subscribing investment services as detailed in the G T C： 零售客户Retail Client □

我/我们同意根据银行开户章程中客户分类标准确定我/我们的账户种类为: 专业客户Professional Client□

5. Are you a US tax payer according to the US tax regulations? Yes □ No □

您/您们是否为美国纳税人? 是 否

6. Are you or have you or does a close relative(s) exercise a mandate? No □ If Yes: Public □ Electoral □

您/您们或者您/您们的亲属中有无社会公众人物? 不是 如果是：公众人物 参选人

7. Do you want to give a Power of Attorney Application to a designated person to act on behalf of the account? Yes □ No □

您/您们是否需要授权指定有关人士以您/您们的账户名义办理银行交易? 是 否

8. You declare that you are the sole economical beneficiary of this account. Yes □ No □

兹声明您/您们是此账户的实际受益人。 是 否

9. You confirm that all the information given on this form is true and complete. Acknowledge to have read and agree with the General Terms and Conditions as well as the risk disclosure provided by the bank.

您/您们确认本表格中所提供的信息真实、完整，已阅读并接受《开户合约》中所有条款，同时确认已经完全了解银行风险披露声明涉及的所有内容。

10. Do you want to sign a Facsimile Indemnity Form application to authorize transaction by Fax? Yes □ No □

您/您们是否需要通过传真办理有关银行业务? 是 否

11. Do you need telephone confirmation from bank to verify your FAX instruction? Yes □ No □

您/您们是否需要银行对传真指令进行电话回复确认 ？ 是 否

12. Iinstructions of signature(s) below will be effective by Any one□ Both two□

账户印鉴使用说明： 单签有效 双签有效

Ssignature of the account holder

账户持有人预留签字样式

Date and name of the first account holder （第一账户持有人正楷签名及日期）

Date and name of the second account holder （第二账户持有人正楷签名及日期）

……………………………………………………………………………………………………

For Bank use only银行专用:

客户账号：Client’s A/C No__________________________

是否同意开立此账户(如拒绝,需注明原因)Approval to open the account, or if not, the reason:

经办员 MADE BY 负责人Authorized Signature 日期Date:

--------------- ---------------------------- ----------------------------------------

中国银行开户申请表