The Bank Reserves the Right to Use Its Discretion When Responding to Requests to Opennew

Application to become a customer

1 / Personal Data
1.1 / Surname
1.2 / First name
1.3 / Date of birth (day/month/year)
1.4 / Gender / Male Female
1.5 / Residential address
Postal code, Town/City
Country
1.6 / Mailing address (if different from residential address)
Postal code, Town/City
Country
1.7 / Home telephone number
1.8 / Mobile telephone number
1.9 / E-mail
1.10 / Passport number
1.11 / Country where passport was issued
1.12 / Citizenship
1.13 / Country of birth
1.14 / Employer
1.15 / Employers’ telephone no
1.16 / Work e-mail

The bank reserves the right to use its discretion when responding to requests to opennew accounts

·  The bank is obliged to collect this information according to local anti money laundering laws when establishing a new customer relationship

·  Please use block letters and fill in all spaces. If you need assistance filling in the form, please contact us at the following e-mail address:

Type of account: Savings account (mandatory) 12 months fixed rate deposit

2 / Expected Business
2.1 / Cross border transactions to/from your account in Norway will only be accepted to/from the following countries: EU/EEA, Switzerland, USA, Canada, Australia, New Zealand, Singapore or Japan / Please confirm that you have read and agree to this conditions:
Yes No
2.2 / Are you liable to pay tax outside of Norway
If yes, please specify each country
If you are liable liable to pay tax outside of Norway, please state your tax identification number / Yes No
2.3 / Amount you will deposit in DNB
(minimum the equivalent of €100.000)
2.4 / Will your account be used by other than yourself? / Yes No
2.5 / Origin / main source of the funds
Kindly explain how the money is obtained and provide documentation to support your explanation.
e.g.:
·  Tax return / tax assessment
·  Notification of sale
or
·  Statement from your bank explaining the origin of the funds
2.6 / The applicant’s connection to Norway (if any)
2.7 / Main bank in your home country
2.8 / Do you hold other accounts in DNB / Yes No
2.9 / Other relevant information (if any)

The following enclosures must be attached to the application when sending it to us:

·  Copy of passport in which the picture, signature, name, date of issuance, place of issuance and issuer are clearly visible / legible. The copy must be certified and stamped as a true copy by an embassy / consulate, DNB office or another bank in an EU/EEA country, Switzerland, USA, Canada, Australia, New Zealand, Singapore or Japan

·  Confirmation from your main bank of your home address and customer relationship

·  Signed form / memo containing the terms and conditions

Please send your application with enclosures by post to:

DNB Bank ASA

Spesialprodukter

0021 Oslo

Norway

Place and date: / Place and date:
Applicant’s signature: / Stamp, employee ID no. and signature

DNB Bank ASA, Spesialprodukter, N-0021 Oslo, Norway, tlf. 0047 915 03000

e-mail: