Global Executive Banking

Transcription

1 Global Executive Banking IMPORTANT INFORMATION ABOUT OPENING A NEW ACCOUNT AT CITIGROUP To help the United States Government fight terrorism and money laundering, Federal law requires us to obtain, verify, and record information that identifies each person or business that opens an account or establishes a relationship. What this means for you: When you open an account or establish a relationship, we will ask for your name, date of birth, street address, and a government issued identification number (for U.S. persons, you must also provide a social security number or taxpayer identification number). Federal law requires us to obtain this information. We may also ask to see other government issued identification or other identifying documents that will allow us to identify you. We appreciate your cooperation. Information from a credit bureau may be used to determine your account eligibility. ACCOUNT APPLICATION Do not use correction fluid to make corrections, as this will void your application. If you wish to designate a Power of Attorney (POA) on your account, please include a completed, notarized POA Designation Form available by contacting us or downloading from our website at Please mark non-applicable fields N/A If you cross out any information, please initial the change. Account Relationship Package:* Citi Global Executive Account Package Citi Global Executive Preferred Account Package *Please refer to the Marketplace Addendum for Global Executive Banking customers for the minimum requirements for each account package. Account Ownership: (please check only one) Individual Joint with Right of Survivorship (JTWROS) (signing individually) Uniform Transfers to Minors Account (UTMA) Add New Account Owner/Signer: (please indicate the Account Numbers on which the new Account Owners should be added) ACCOUNT TITLE: Print complete name clearly. (Max. of 20 letters for last name, 12 letters for first name and 12 letters for middle name.) Primary Applicant Name: (Minor s Name if UTMA account) Co-Applicant Name (A): (Custodian s Name if UTMA account) If there will be more than one Co Applicant, please print and fill out additional copies of pages 4 and 5 for each additional Co Applicant. Co-Applicant Name (B): Co-Applicant Name (C): 1

2 PRIMARY APPLICANT INFORMATION (Minor s Name if UTMA account) ACCOUNT TITLE: Print complete name clearly Are you an existing Global Executive Banking customer? Yes No Account Number(s) If Yes, please indicate if you want the balances on this account to be included ( linked ) as part of your existing relationship in order to potentially receive lower fees and higher interest rates. Please note your total relationship balance tier will be displayed on your statement if you select this option. Yes No Do you have an existing account with another Citibank or Citigroup Affiliate? Yes No If Yes, please specify the country where your account was opened Branch location where your account was opened (city) Account number EMPLOYER INFORMATION Citigroup Employee: Yes No If Yes, please provide: GEID Department MSSB Employee? Yes No CGMI Employee? Yes No Citigroup Subsidiary Employee: Yes No Reg O Officer: Non official Official Employer name: Your title/position: Corporate address: CITIZENSHIP & TAX REPORTING STATUS Your Citizenship Status: U.S. Citizen Non-Resident Alien Resident Alien Country of Citizenship (if non-u.s. resident): Country of Tax Reporting (if non-u.s. person): Date of Birth: mm/dd/yyyy U.S. Social Security/Tax Identification Number: (if applicable) SECURITY INFORMATION Name of First School Attended AND Mother s Maiden Name IDENTIFICATION Passport (preferred) Other Government ID only if no passport available: ID Type: Other Govt. Issued Identification: ID Type Issuing Entity Other Identification: ID Type Issuing Entity 2

3 PRIMARY APPLICANT INFORMATION (Minor s Name if UTMA account) ADDRESS AND TELEPHONE Current Permanent residential address (DO NOT USE P.O. Box/ C/O /Business address) Previous Residential Address 1: (Required only if you have lived at your current address for less than 2 years.) Include apartment or suite number if applicable. (Max. 35 letters) DO NOT USE A P.O. BOX Previous Residential Address 2: (Required only if you have lived at your previous address for less than 2 years.) Include apartment or suite number if applicable. (Max. 35 letters) DO NOT USE A P.O. BOX Mailing Address (if different from residential address): include apartment number if applicable (Max. 35 letters) Postal Code: Phone & fax numbers: Please include country code, city code, and extension number Home Phone Number: (must match residential/permanent address) Business Phone Number: Country Code City Code Line Number Country Code City Code Line Number Extension Cellular Phone Number: Fax Number: Country Code City Code Line Number Country Code City Code Line Number 3

4 CO-APPLICANT INFORMATION (Minor s Name if UTMA account) ACCOUNT TITLE: Print complete name clearly Are you an existing Global Executive Banking customer? Yes No Account Number(s) If Yes, please indicate if you want the balances on this account to be included ( linked ) as part of your existing relationship in order to potentially receive lower fees and higher interest rates. Please note your total relationship balance tier will be displayed on your statement if you select this option. Yes No Do you have an existing account with another Citibank or Citigroup Affiliate? Yes No If Yes, please specify the country where your account was opened Branch location where your account was opened (city) Account number EMPLOYER INFORMATION Citigroup Employee: Yes No If Yes, please provide: GEID Department MSSB Employee? Yes No CGMI Employee? Yes No Citigroup Subsidiary Employee: Yes No Reg O Officer: Non official Official Employer name: Your title/position: Corporate address: CITIZENSHIP & TAX REPORTING STATUS Your Citizenship Status: U.S. Citizen Non-Resident Alien Resident Alien Country of Citizenship (if non-u.s. resident): Country of Tax Reporting (if non-u.s. person): Date of Birth: mm/dd/yyyy U.S. Social Security/Tax Identification Number: (if applicable) SECURITY INFORMATION Name of First School Attended AND Mother s Maiden Name IDENTIFICATION Passport (preferred) Other Government ID only if no passport available: ID Type: Other Govt. Issued Identification: ID Type Issuing Entity Other Identification: ID Type Issuing Entity 4

5 CO-APPLICANT INFORMATION (Minor s Name if UTMA account) ADDRESS AND TELEPHONE Current Permanent residential address (DO NOT USE P.O. Box/ C/O /Business address) Previous Residential Address 1: (Required only if you have lived at your current address for less than 2 years.) Include apartment or suite number if applicable. (Max. 35 letters) DO NOT USE A P.O. BOX Previous Residential Address 2: (Required only if you have lived at your previous address for less than 2 years.) Include apartment or suite number if applicable. (Max. 35 letters) DO NOT USE A P.O. BOX Mailing Address (if different from residential address): include apartment number if applicable (Max. 35 letters) Postal Code: Phone & fax numbers: Please include country code, city code, and extension number Home Phone Number: (must match residential/permanent address) Business Phone Number: Country Code City Code Line Number Country Code City Code Line Number Extension Cellular Phone Number: Fax Number: Country Code City Code Line Number Country Code City Code Line Number 5

6 CITIBANK BANKING CARD Citibank Banking Card: All new Applicants receive Citibank Banking Cards with the debit card feature unless you tell us otherwise. If you would prefer not to receive a Citibank Banking Card please indicate this below. For existing Account Owners, the new account will be automatically linked to their existing Citibank Banking Card for more convenient access. If you prefer not to have this account linked to your existing Citibank Banking Card, please indicate this below. Existing Customer: New Customer: Primary Account Owner: Co Account Owner: Co Account Owner: Co Account Owner: Do not link to my existing card Do not link to my existing card Do not link to my existing card Do not link to my existing card No, do not send a card No, do not send a card No, do not send a card No, do not send a card To link money market accounts and certificates of deposit to your account relationship package, please contact CitiPhone Banking or your Financial Consultant. CHECKBOOK - If you require a checkbook for this account, please contact us once the account is funded. Address where you want to receive the New Account Welcome Package (DO NOT USE P.O. Box) Permanent Mailing Other If you want to receive the New Account Welcome Package at another address, please provide it below. Address (Max. 35 letters) WELCOME PACKAGE MAILING INFORMATION Where we may call you during the account opening process and leave a message if needed? Country Code City Code Line Number COMMUNICATION INFORMATION By providing an address below, you agree that we may contact you via to expedite your account opening process. You also agree that we may use the address you provided for account servicing and maintenance requests/messages once your account is opened. You understand that you will not be able to reply to these system generated s. To protect your privacy, we will not request or send confidential account information through this channel. The preference you select upon enrollment in Citibank Online will govern future electronic communications we may send you. DEFINITION OF TERMS ACCOUNT AGREEMENT In this agreement, I, we, my, me, us and our refer to the Applicant(s) signing below and you, your refer to Citibank N.A. through Global Executive Banking, as applicable. By signing this application and the signature cards, I/we certify and/or acknowledge that: The information above is accurate to the best of my/our knowledge, information and belief. I/We agree to inform you of any changes to the information provided during my/our account opening process. I/We hereby expressly authorize the disclosure of my/our account or other relevant information to any Citigroup businesses, Legal or Compliance Personnel in order to conduct the necessary account opening and approval process(es). My/Our signature(s) below indicate(s) my/our waiver of any rights I/we may have under applicable local laws or other laws including, but not limited to, Privacy or Secrecy Laws prohibiting such disclosure. I/We have received a copy of the Citibank Client Manual Consumer Accounts, the Citibank, N.A. Marketplace Addendum for Global Executive Banking customers and the Consumer Deposit Accounts rate sheet, collectively referred to as Account Disclosures, which outlines all the terms and conditions associated with my/our account(s) at Citibank, N.A. I/We have read and understand all the material outlined in the Account Disclosures and agree to be bound by the same. I/We agree to the Account Disclosures for the account(s) or service(s) mentioned herein, and that the same Account Disclosures and signature requirements will apply to any additional Citibank accounts I/we may subsequently apply for and establish with Citibank and its subsidiaries and affiliates. I/We agree that Citibank may make changes to these Account Disclosures at any time without prior notice to me/us unless otherwise required by law. Written communications and notices, including but not limited to confirmations and statements of account will be sent to the mailing address provided on this application, or at such other address as I/we may hereafter provide you in writing. All communications so sent, whether by mail, telegraph, messenger or otherwise, shall be deemed given to me/us personally, whether actually received or not. I/We are responsible for being aware of all information contained in the statements and notices received at the mailing address relevant to my/our account(s) with 6

7 Citibank, N.A. opened through Global Executive Banking. You may, at your discretion, mail certain correspondence, such as certifications, legal notices, account term amendments, certain confirmations, and other special documentation, to my/our domicile address of record in your files, directly, without sending it to the mailing address designated on the Application. I/We assume all risks associated with the use of the this mailing address per my/our instructions and I/we agree that, Citibank, N.A., Citigroup, and their branches, affiliates, subsidiaries, officers, directors, employees or agents are not liable for, and will be held harmless by me/us, from any claims, suits or damages resulting from the mailing of written communications and notices to the mailing address indicated in your account records, including losses or damages resulting from your failure to receive such statements and notices. Products and services offered by Citi and its affiliates are subject to the applicable local laws and regulations of the jurisdiction where they are booked and offered. Products and services through Citibank, N.A. are governed by U.S. Federal law and regulations. To the extent that such laws and regulations do not apply, these products and services shall be governed by and be construed in accordance with the laws of the U.S. State of the Citibank Branch in which my/our account(s) is/are located. By signing this application and the signature cards, I/we also certify and/or acknowledge that: I/We have received this application and other account opening documentation at my/our request and that any and all prior communications with you pertaining to account opening and product offering were solicited by me/us (initiated by me/us) or on my/our behalf. I/We am/are expressly inquiring and requesting information about the following types of products and services, to the extent permitted by all applicable laws: banking deposit and lending products and services, Citibank Banking Cards and Citibank online services. My/Our country of citizenship, domicile or residence may have laws, rules and regulations, I/we am/are solely responsible for, that govern or affect my/our application for and use of your accounts, products and services, including laws, rules and regulations regarding taxes, exchange and/or capital controls. I/We acknowledge and certify that neither Citibank nor any other Citibank Affiliated Organization has any responsibility for, my/our compliance with any laws, regulations or rules applicable to my/our use of the products and services provided by Citibank under this Agreement including, but not limited to, any laws, regulations or rules, in my/our or any other jurisdiction, relating to tax, foreign exchange and capital control, and for reporting or filing requirements that may apply as a result of my/our country of citizenship, domicile, residence or taxpaying status. I/We understand that transactions may be executed outside of my country and without any participation from any Citigroup or Citibank subsidiary, branch or affiliate in my country. Some products may not be registered with the Financial Regulatory body of my country governing such financial products, nor may they be governed or protected by the laws and regulations of my country. I/We understand that the translation of this application from English to another language is provided to you for convenience only, and I/we understand and agree that the English language version of this application will control and be conclusive in the event of any difference in meaning between the translation and the English language version. X Primary Applicant signature / / Date (mm/dd/yyyy) X Co Applicant (A)/New Account Owner signature / / Date (mm/dd/yyyy) X Co Applicant (B) signature / / Date (mm/dd/yyyy) X Co Applicant (C) signature / / Date (mm/dd/yyyy) Global Executive Banking is a service of Citibank, N.A., providing banking and borrowing products and services Citigroup Inc. Citi with Arc Design is a service mark of Citigroup Inc. or Citibank, N.A., used and registered throughout the world. 7

8 Global Executive Banking ACCOUNT SIGNATURE CARD DATE: Branch: New York Account Title (Name(s) of account owner(s)): Check appropriate box: Individual Joint with Right of Survivorship (JTWROS) (signing individually) Uniform Transfers to Minors Account (UTMA) Account Number(s ) (For bank use only): TERMS By signing this card, I: (1) authorize Citibank ( you ) to accept instructions from me to open/close accounts, apply for credit and request services, without my further original signature. You may accept my oral or electronic instructions with the same effect as if I had signed them. (2) agree to follow your security procedures and to provide my signature upon request. You may at any time refuse to accept such instructions. (3) authorize you to record and moni tor my telephone calls as evidence of my instructions and for service quality purposes. (4) authorize you to obtain a consumer report in connection with the application, update or renewal of any loan or deposit account I apply for and I understand that you may obtain such reports. I also authorize you to use these consumer reports to co nsider me for other programs with Citibank. Upon request, you will inform me if a consumer report has been obtained and will give me the name and address of the agency fur nishing the report. (5) agree to be bound by any agreement governing any account opened in the title indicated on this card, and (6) understand and acknowledge that such account agreement provides that either Citibank or I can require that any disputes between us concerning the Citibank account I have opened or concerning my other Citibank deposit will be resolved by binding arbitration. Primary Account Owner Signature Co Account Owner A Co Account Owner B Co Account Owner C Global Executive Banking ACCOUNT SIGNATURE CARD 2 DATE: Account Title (Name(s) of account owner(s)): Account Number(s) (For bank use only): Primary Account Owner Name/Signature: (Please sign within the box below) DATE Co-Account Owner A Name/Signature: (Please sign within the box below) DATE Co-Account Owner B Name/Signature: (Please sign within the box below) DATE Co-Account Owner C Name/Signature: (Please sign within the box below) DATE Signature certification unit

9 Global Executive Banking Application Guide GENERAL INFORMATION All sections of the application must be completed in order to open your account. Please mark non-applicable fields N/A. If you cross out any information, please initial the changes. Using correction fluid/white-out to make corrections will void your application. If you wish to open an Interest Checking account, please contact us. You can easily open and link Citibank Savings Accounts including Money Market and Certificate of Deposit accounts once your checking account is open. Once your account application is received, a Global Executive Banking Account Opening Specialist will contact you. If you have questions about the account opening process, please contact your Account Opening Specialist, or call Global Executive Banking Customer Service at , 24 hours a day, seven days a week. ACCOUNT TITLE Provide the complete names(s) of the Applicant(s) who will be signers on the account. Name(s) should match the primary and/or secondary identification provided. PRIMARY APPLICANT INFORMATION Provide the name of the Applicant who will be the primary Account Holder on the account. EMPLOYER INFORMATION This information is required for all Account Applicants. CITIZENSHIP AND TAX REPORTING STATUS Provide the country of citizenship and country of tax reporting on the application if the Account Applicant is a non-resident of the U.S. SECURITY INFORMATION This information may be used for identification purposes when you contact us by phone. IDENTIFICATION DOCUMENTS (ID) Each Account Applicant must provide information from two (2) primary/government issued forms of identification. Please make sure to complete all fields of information requested. If you are unable to provide two (2) primary forms of identification, you may provide one (1) primary form and two (2) secondary forms of identification. Please refer to the enclosed Checklist for a list of acceptable primary and secondary forms of identification. Identification Documents must be verified in person by a Citibank employee, U.S Consulate representative, or a U.S. Notary. In some cases this requirement may be met based on other information. Your Account Opening Specialist will inform you if this applies in your case. ADDRESS AND TELEPHONE Provide a residential street address in your account application. P.O. Box, In Care of, or Business addresses cannot be accepted. Complete the Address since field for your permanent residential address and, if applicable, your previous permanent residential address(es). Provide a mailing address. You may provide a corporate address or a personal P.O. Box as your mailing address. Your home telephone number must be the one at your residential street address. If you don t currently have a permanent home telephone number, please indicate N/A. CO-APPLICANT INFORMATION Provide the name and personal information for any additional Applicants on pages 4 and 5. Up to three Co-Applicants may be accepted. If you have more than one additional Applicant, print and complete pages 4 and 5 for each Co-Applicant. If areas of information are the same as that of the Primary Account Applicant, the additional Applicant may write SAME in the respective section of the application. Please do not leave it blank. CITIBANK BANKING CARD Indicate if you would not like to receive a Citibank Banking Card with the Debit Card feature or link it to your existing account. CHECKBOOK If you require a checkbook for this account, please contact us once the account is funded. WELCOME PACKAGE MAILING INFORMATION Provide the address where your Welcome Package should be sent. COMMUNICATION INFORMATION Please provide us with an address where we may contact you. SIGNATURE CARDS Each Account Applicant must sign both signature cards. The signature(s) of every Account Applicant must appear on both signature cards. TERMS AND CONDITIONS Please read and sign where indicated. Each Account Applicant must sign. You may view our deposit accounts and services features such as rates, fees and terms and conditions collectively referred to as Account Disclosures through our website at You will receive a copy of these Account Disclosures in your Welcome Package by no later than 10 days after account opening. Please contact us at if you would like to receive a copy prior to applying for an account. Global Executive Banking is a service of Citibank, N.A., providing banking and borrowing products and services. GEB ACCCOVERSHEETMS Citigroup Inc. Citi with Arc Design is a service mark of Citigroup Inc. or Citibank, N.A., used and registered throughout the world.

10 Checklist for Citibank Banking Application for Global Executive Banking customers Required Documents and Information for New Relationships GENERAL Important Information about Opening a New Account at Citigroup To help the United States Government fight terrorism and money laundering, Federal law requires us to obtain, verify, and record information that identifies each person or business that opens an account or establishes a relationship. What this means for you: When you open an account or establish a relationship, we will ask for your name, street address, date of birth, and a government issued identification number (for U.S. person, you must also provide a social security number or taxpayer identification number). Federal law requires us to obtain this information. We may also ask to see other government issued identification or other identifying documents that will allow us to identify you. We appreciate your cooperation. Please make sure the following information is included with your Application. Account application form completed, signed and dated per the Account Application Form Instructions included in this package. Two Signature cards - Each signed and dated by the Account Applicant. Identification Documents (ID)* Account Applicant must provide legible copies of two (2) primary/government issued forms of identification. Identification Documents must be verified in person by a Citibank employee, U.S Consulate representative, or a U.S. Notary. In some cases this requirement may be met based on other information. Your Account Opening Specialist will inform you if this applies in your case. If you are unable to provide two (2) primary forms of identification, you may provide one (1) primary form, as listed below, and one (1) secondary forms of identification. Contact us to find out other types of acceptable identification. PRIMARY FORMS OF IDENTIFICATION INCLUDE: Valid passport with picture and signature Valid national Identification card from the country of citizenship with picture, date of birth, signature and with an acceptable issued and expiration date Valid U.S. Driver License with photograph and signature Active U.S. Armed Forces Identification card with picture Mexican Voter s Registration Card Please forward all of the required documents to: Global Executive Banking Citibank, N.A. Customer Service Center 3800 Citibank Drive Zone A1-03 Tampa, Florida USA If you would like us to review your documents for completeness, prior to mailing them to us, you may fax* or your documents to Global Executive Banking. Please contact your Account Opening Specialist for details. Returning Application and Documentation SECONDARY FORMS OF IDENTIFICATION INCLUDE: Valid U.S. Alien Registration / Identification Card* Valid government issued national identification for foreign residents from the country of permanent residency with photograph, date of birth and signature. Valid credit card with a photograph issued by a U.S. financial institution Valid official Professional license or trade ID with a photograph Current school Identification card together with an academic transcript or a bursar s receipt for the current term. W-2 form containing Social Security number US only * This is considered a Primary Identification for Applicants living in the United States only. For others it is considered a Secondary Identification. PROOF OF RESIDENTIAL ADDRESS, IF APPLICABLE Proof of Residential Address This is required only if the identification provided does not specify address or if the address on the identification is not the current address. Photocopy of a recent (issued less than 60 days ago) utility bill, financial statement, credit card or bank statement that reflects an address that matches the residential address on your application. EMPLOYER REFERENCE Required by the Applicant covered under a corporate-paid program Your Account Opening Specialist will provide you with the form to be used, as applicable. U.S. TAX CERTIFICATION FORMS United States (U.S.) tax certification forms Each Account Applicant must sign, date and submit the appropriate U.S. tax certification Form W-9 or Form W-8BEN (instructions enclosed). Please note: If any of the Account Applicants is a U.S. person (U.S. citizen or U.S. resident), and other Account Applicants are foreign persons, then the Account Applicant who is a U.S. person must be specified as the Primary Account Applicant for tax reporting purposes. EXPLANATION OF U.S. MAILING ADDRESS, IF APPLICABLE Explanation of U.S. Mailing Address (for Tax Certification Reasons) NOTE: Required only for Applicants who complete a Form W-8BEN if the mailing address on the account is a U.S. address. In this case the Account Applicant must specifically indicate the reason for using a U.S. mailing address, either in this form or on a separate letter. One form may be signed by all Account Applicants living at the same address. See sample of Explanation of U.S. Mailing Address under FORMS at We will require your original signed application and tax forms, along with all documentation, to open your account. * Facsimile/ Transmission: Please note that facsimile or e mail transmissions are not encrypted and are not a secure means of transmission. Such an unsecure transmission method may be intercepted by unauthorized individuals and/or involves the risks of possible unauthorized accessing and/or alteration of data and/or unauthorized usage thereof for whatever purposes. If you send us such a transmission, you agree to exempt Citibank from any and all responsibility of any misuse, and hold Citibank harmless for any costs or losses we may incur due to any problems caused by using facsimile/ as a means of transmission. Global Executive Banking is a service of Citibank, N.A., providing banking and borrowing products and services Citigroup Inc. Citi with Arc Design is a service mark of Citigroup Inc. or Citibank, N.A., used and registered throughout the world. GEB ACCCHKLSTMS 0813