Online Forms – Temporary Link Customers Account Opening & identification form - Retail Customer 1. Account Category * Regular Saving Account Saving plus Account Student Account Regular Current Account Current Account Protection Scheme Hawala Saving Account Modified Youth Saving Account Interest plus Bonus Account Other (Specify)Other (Specify) Do you need a Passbook * Yes No 2. Personal Information of Applicant First Name * Father's Name * Grandfather's Name * TIN Number (For current account) Date of Birth * Place of Birth Gender * Male Female Nationality * Marital Status Married Single OtherOther Section Buttons Permanent Address Country * AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Region * City * Mobile Number * Subcity Woreda House No. Section Buttons Is your current address the same as permanent address * Yes No Current Address Country * AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Region * City * Mobile Number * Subcity Woreda House No. Section Buttons Fax Email Website P.O.Box ID Type * Number * Issuer * Issue Date Expiry Date Section Buttons Occupation * Public Sector Employee Unemployed International Organization Employee Private Sector Employee Housewife Self-employed Religious Organization Employee NGO Employee Student Retired Other (Specify)Other (Specify) Name of Employer Position Held Profession Monthly Income * 0 - 650 Birr 651 - 25,000 Birr 25,001 - 50,000 Birr 50,001 - 100,000 Birr 100,001 - 150,000 Birr 150,001 - 200,000 Birr 200,001 - 250,000 Birr Above 250,000 BirrAbove 250,000 Birr 3) Please choose the Alternate channel services you would like to have * Amex Gold Card Amex Green Card Amole Mobile/Internet Banking SMS Banking 4. Please choose language for SMS Service * Amharic English Somali Afan Oromo TigrinyaTigrinya 5. Initial Deposit * By Cheque Transfer Amount * 6. Account maintained in other branches of Dashen Bank [Applicable only if you already have account(s)] Account No. Branch Account Status Active Inactive Account No. Branch Account Status Active Inactive Account No. Branch Account Status Active Inactive Section Buttons 7. Cheque Requisition * 25 8. Which Media of communication is suitable for your ongoing relationship with the Bank Telephone SMS Email P.O.BoxP.O.Box OtherOther 9. How did you hear about the Bank TV Advertisement Newspaper Advertisement Customer referral Radio Advertisement Radio Advertisement Customer relationship personnel OtherOther Notice for Current Account Holders Only 1. If your account does not show any movement for six months, the amount will be considered as dormant and be transferred to Inactive Accounts. If the A/C shows zero balance for consecutive 3 months, the A/C will be closed. 2. If the balance in each inactive account is less than birr 200, a charge of birr 20 will be deducted at the end of every six months, and if the balance is birr 20 or less, the whole balance thereof will be charged and the account will be closed. In this case the customer should return the remaining cheque leaves to the Bank. 3. The bank will dispatch statement of account monthly and for inactive accounts every six months. 4. A cheque drawn against insufficient funds shall entail penalties as per the prevailing (current) NBE’s directives. 5. The Bank may send SMS alert to provide information on transactions. The service is provided “As available” without making any further investigation and doesn’t warrant its fitness for another purpose. The Bank doesn’t warrant that this service will always be uninterrupted or the information provided is accurate and current at the time it is received. 6. The Bank reserves itself the right to alter or add to these rules at any time. Confirmation * I certify that the document and information presented for the application is complete, accurate & factual Select Branch Submit Customers Account Opening & identification form - MSME & Corporate 1. Account Category * Regular Saving Account / መደበኛ የቁጠባ ሂሳብ Hybrid Deposit Account Interest plus Bonus Account Regular Current Account Current Account Protection Scheme Hawala Saving Account Other (Specify)Other (Specify) Do you need a Passbook * Yes No 2. Type of Entity * Sole Proprietors PLC Unions and coop Embassy Religious Institution Government Partnership Share Company CorporationCorporation Agent Political Org OtherOther 3. Application Detail Name of the Organization / Individual * TIN Number (For current account) Section Buttons Permanent Address Country * AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Region * City * Mobile Number * Subcity Woreda House No. Section Buttons Fax Email * Website P.O.Box Business Sector * Number of Shareholders (For Corporate entities) Annual Sales Turnover * Total Asset Value Total Capital Value Section Buttons Annual Income * 0 - 1,000,000 Birr 1,000,001 - 3,000,000 Birr 3,000,001 - 15,000,000 Birr 15,000,001 - 30,000,000 Birr 30,000,001 - 60,000,000 Birr 60,000,001 - 100,000,000 Birr If >100,000,000, Please SpecifyIf >100,000,000, Please Specify To be filled only by Sole Proprietorship Date of Birth Place of Birth Gender Male Female Nationality Marital Status Married Single OtherOther Section Buttons 4. Initial Deposit By Cheque Transfer OtherOther 5. Account maintained in other Branches of Dashen Bank Account No. Branch Account Status Active Inactive Account No. Branch Account Status Active Inactive Account No. Branch Account Status Active Inactive Section Buttons 6. Cheque Requisition * 25 7. Please choose the Alternate channel services you would like to have Amex Gold Card Amex Green Card Amole Mobile/Internet Banking SMS Banking 8. Please choose language for SMS Service * Amharic English Somali Afan Oromo TigrinyaTigrinya 8. Which Media of communication is suitable for your ongoing relationship with the Bank * Telephone SMS Email P.O.BoxP.O.Box OtherOther 9. How did you hear about the Bank * TV Advertisement Newspaper Advertisement Customer referral Radio Advertisement Radio Advertisement Customer relationship personnel OtherOther 10. Identification of those who have authority to open and operate the account and specimen signature 10.1. Name * Address (For Corporate entities) Telephone Number * ID Number Section Buttons 10.2. Name Address (For Corporate entities) Telephone Number ID Number Section Buttons 10.3. Name Address (For Corporate entities) Telephone Number ID Number Section Buttons 10.4. Name Address (For Corporate entities) Telephone Number ID Number Section Buttons 10.5. Name Address (For Corporate entities) Telephone Number ID Number Section Buttons Notice for Current Account Holders Only 1. If your account does not show any movement for six months, the amount will be considered as dormant and be transferred to Inactive Accounts. If the A/C shows zero balance for consecutive 3 months, the A/C will be closed. 2. If the balance in each inactive account is less than birr 200, a charge of birr 20 will be deducted at the end of every six months, and if the balance is birr 20 or less, the whole balance thereof will be charged and the account will be closed. In this case the customer should return the remaining cheque leaves to the Bank. 3. The bank will dispatch statement of account monthly and for inactive accounts every six months. 4. A cheque drawn against insufficient funds shall entail penalties as per the prevailing (current) NBE’s directives. 5. The Bank may send SMS alert to provide information on transactions. The service is provided “As available” without making any further investigation and doesn’t warrant its fitness for another purpose. The Bank doesn’t warrant that this service will always be uninterrupted or the information provided is accurate and current at the time it is received. 6. The Bank reserves itself the right to alter or add to these rules at any time. Confirmation * I certify that the document and information presented for the application is complete, accurate & factual Section Buttons Submit
