A C T I O N   F O R M

Yes! Please open a Citibank Account in my/our name(s).
I have indicated my/our choice of account(s) and the details in the spaces provided.

MY NAME

(As per passport or identity card; please underline surname.)

Mr/Mrs/Ms/Mdm
Nationality
Date of Birth
 /  / 
mm dd yy
Passport No.
Issue Date
Place of Issue
Occupation
Mother's Maiden Name

MY JOINT ACCOUNT HOLDER'S NAME

(As per passport or identity card; please underline surname.)

Mr/Mrs/Ms/Mdm
Nationality
Date of Birth
 /  / 
mm dd yy
Passport No.
Issue Date
Place of Issue
Occupation

MY/OUR ADDRESS
Home Address
Office Address
Tel: (Home)

 (Office)

 (Handphone)
E-Mail Address:

 Fax:

ADDITIONAL INFORMATION ABOUT MYSELF

Type & Source of Funds to open this account
Type:  Cash     Travellers Cheques     Telegraphic Transfer/Inward Remittance   
Source of Funds:  Personal savings     Business     Sales of investments     Others   

Planned Banking Activity
How much are you planning on investing with Citibank Singapore long-term?
 Under US$100,000     US$100,001 to US$500,000     US$500,001 to US$1,000,000     Above US$1,000,000   

What is your objective in opening an account?
 Savings/Investments     Business needs     Others 

Other than from your occupation, please tell us of any other ways you earn your income.
 Investments     Director's fees     Others 

* Account holders must be aged 21 years and above.


TIME DEPOSIT ACCOUNT

Deposit amount(minimum deposit: US$50,000 or equivalent)
Choice of Currency/Tenure (please tick one)
 Australian $    Canadian $    Deutschemark    Dutch Guilder    ECU  
 French Franc    Hong Kong $*    Indonesian Rupiah**    Japanese Yen    New Zealand $  
 Ringgit Malaysia    Singapore $*    Spanish Peseta*    Sterling Pound    Swiss Franc  
 Thai Baht*    US $  
 
Tenure:  1 week     1 month     2 month     3 month     6 month     9 month     12 month   

TRANSACTIONAL ACCOUNTS

Please tick in the relevent boxes
Minimum Amount My Deposit Amount
 US$*/S$ Savings Account US$5,000/S$5,000

 US$/S$ Checking Account US$5,000/S$5,000

 CitiAccess Account US$5,000
US$20,000

 MaxiSave Account US$5,000

* Only for non-residents of Singapore

AGREEMENT

ACCOUNT SIGNATURE REQUIREMENTS

 Single (any one to sign)   

 Joint (sign jointly)   

 Others (please specify)  

  • I/We confirm that the information given by me/us is complete and accurate.
  • I/We authorize Citibank, N.A. (Singapore branch) (the "Bank") to carry out any instructions concerning the above Account(s) provided such instructions are duly given in accordance with the signature requirements prescribed by me/us herein.
  • I/We thereby request to open an account ("Account(s)") with the Bank on the terms of the Bank’s prevailing Account Terms and Conditions, and the same (as amended, supplemented or modified from time to time at the Bank’s sole discretion) will bind me/us as if incorporated into this Action Form in respect of the Account(s) and any Products and Services which the bank may make available to me/us.
  • Where I/we request in future for Products and Services under the Account(s) to be made available to me/us, I/we may be required to sign such additional documents as the Bank may require and the same shall be supplemental to, and be construed as one with, this Action Form.

MY SIGNATURE   MY JOINT ACCOUNT HOLDER'S SIGNATURE



Signature


Date


Signature


Date

PLEASE NOTE

Please attach the following documents to this Action Form:
  • Bank Reference Request, duly completed by your reference bank
  • Photocopy of passport for each account holder
  • Check, draft, or remittance instructions, as appropriate
Mail to:
  • Citibank, N.A., Robinson Road P. O. Box 0361, Singapore 900711
Accounts closed within 6 months of opening are subject to a US$100 fee per account.

FOR BANK USE

 
Input
Authorised

MA
    

Referal Code:
Broker Base:
Within SDN list   Yes   No 		1.  WI   SW   OR   Others
2. Intro'd by   Bank Staff   Bank Cust
3.  Indirect   Mktg Prog   Internet   Others
For CCSU use only
Approved by:

Signature verified by: Date:

Card No. Processed by:

Authorised by & Date: