Customer’s Full Name *
Nationality
Gender
—Please choose an option—MaleFemale
ID Type
—Please choose an option—Saudi IDPassportIqamaOthers
ID No
Date of Issue
Date of Expiry
Place of Issue
Date of Birth
Marital Status
—Please choose an option—SingleMarriedDivorcedWidow
No. of Dependents
Residence Type
—Please choose an option—OwnRentEmp.Res.
Residence Address
Postal Code
P.O. Box
Country
City
Mobile No.
Home Tel.
E-mail Address
Fax No.
Language of Correspondence
—Please choose an option—EnglishArabic
Main Bank Name
Branch
IBAN Bank Account No
Recurring
—Please choose an option—Upon RequestMonthlyDailyPer each Transaction
Through
—Please choose an option—FaxMailSMSE-mail
Approximate annual income (in SAR)
—Please choose an option—25,000 - or Less25,001 - 50,00050,001 - 100,000100,001 - 250,000250,001 - 500,000500,001 - 1,000,0001,000,001 - 5,000,0005,000,000 - over
Source of Funds
—Please choose an option—InheritanceReal EstateBusinessSalaryOthers
Approximate net worth (excluding residence) (in SAR)
—Please choose an option—25,000 - or Less25,001 - 100,000100,001 - 500,000500,001 - 1,000,0001,000,001 - 5,000,0005,000,001 - 10,000,00010,000,001 - 50,000,00050,000,000 - over
Academic Qualifications
—Please choose an option—High SchoolPre-High SchoolUniversityPost Graduate
Employment Status
—Please choose an option—RetiredEmployeeStudentBusinessUnemployed
Employment Category
—Please choose an option—Govt. MilitaryGovt. CivilianPrivateOthers
Employer's Name
Job Title
Date of Joining
Employer's Address
Work Fax
Work Tel.
Passport No
Name as in Passport
Address in Country of Origin
I agree to be classified as
—Please choose an option—Execution Customer OnlyCustomerCounter party
I have read and agree / agreed with the terms and conditions
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