KYC form sample – Smart Platform

Personal Information

Full Name in Arabic *

Full Name in English as written in passport (if any)

Gender *

Male

Female

Mother Full Name *

Nationality *

Does the customer hold other Nationality? *

Yes

No

Please mention the other Nationality *

Place of birth *

Date of Birth *

Marital Status *

Married

Single

OtherOther

Full Name of husband / wife *

No. of family members

Address *

Address

City

District

Mahalla

Alley

House

The nearest point *

Does the customer have residency in another country? *

Yes

No

Please mention the other residency country *

Phone Number *

Email Address *

ID Information

Passport number *

Passport issue date *

Passport expiry date *

Does the customer hold Unified National Card *

Yes

No

Unified National Card number *

Unified National Card issue date *

Unified National Card expiry date *

National ID number *

National ID issue date *

National ID expiry date *

Nationality certificate number *

Job Information

Employer Name

Workplace address

Career Title

Business ID number

Job number

Monthly Salary

Account Currency *

Iraqi Dinar

US Dollar

Current Residence *

Own

Rent

Other income sources

Account holder signature form *

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