Prefix
Mr.Mrs.Ms.

First Name

Middle Name

Last Name

Home Address

Date of Birth

Gender
MaleFemale

Marital Status
MarriedSingle

Tel No (Mobile)

Residential Address

Email Address

Country of Residence
Select CountryIndiaUAEUKUSAOther

Mother’s Name

Father’s Name

Identification Type
National IDPassportDriver's License

Others (Please Specify)

ID Number of Customer

ID Issue Date

ID Expiry Date

ID Issue Country
Select CountryIndiaUAEUKUSAOther

Tax Identification Number (TIN)

Transaction Profiling

Name of employer

Address

Telephone

Email Address

Business Line

Job Title

Occupation or Position Held

Date of Employment

Transaction Profiling

The Purpose of the Account
Investment

Source of Funding
SalaryBusiness IncomeInvestment Income

Others

Expected Annual Income

Investment Categories

Category Initial Investment Range

Retail Investor
D3,000 - 66,000

High Network Individual (HNI)
D98,000 - 315,000

Institutional Investors
D460,000 - 1,000,000

In case of A Minor

Minor’s Date of Birth

Name of parent / nature guardian

Address of guardian

Relationship with minor
FatherMotherSisterBrother

Others (Please specify)

For minors, financial institutions shall identify and verify the identity of the parent or guardian.

The identification details of the minor shall be confirmed from the birth certificate.

Name of Applicant

Upload Your Signature

Date

Disclaimer

I hereby declare that I have read and clearly understand the information required above,
and by doing so, I have completed the form with authentic and genuine information.
Beelagroup have the right to nullify this application, if it is found during verification
that the information or any part of the information was incorrect, ingenuine, and not
representing correct fact. Beelagroup is not liable for any consequence arising from
inauthentic information provided by the applicant.

Name

Upload Signature

Date