[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[To open a new account at this bank, before it asks the individual’s national identification number, the application enquires about the religion.]

 

[Emblem]

Pasargad Bank

Branch:-----

 

Data form for Real Clients

[Name of the Bank in English]

Date:-----

Place of photo

 

Please provide your personal data to make a request for me to issue and assign a customer number to you.

 

First name: -----

Last name: -----

Father’s name: -----

Birth Certificate number: -----

Birth Certificate serial number: -----

Place of Birth: -----

Date of Birth: -----

District number where the Birth Certificate was issued: -----

Religion: -----

National Identification number: -----

Commercial Number: -----

Place of Issue: -----

Nationality: -----

Employment: -----

Sex: Male-Female: -----

Marital status: -----

Residency status: citizen – non-citizen

Education: -----

Address: -----

Postal code: -----

Telephone: -----

Fax: -----

Mobile phone: -----

Electronic mail: -----

Employer’s address: -----

Postal code: -----

Employer’s telephone number: -----

Fax: -----

Signature of the customer – representative of the customer

Issuing the customer number by the Bank: -----

Customer’s signature sample (please sign in black ink and completely within the square) : -----

Signature of the bank manager:-----

Customer number was issued and a sample of the signature above was registered on the computer

Branch:------

Date:------

Seal and the signature of the bank:------