Zip code/ 邮编 City/ 城市 Country/ 国家 Postal address if different from residential address / 邮寄地址如果和上面的住址信息不同, 请填写如果与上面的住址信息相同, 可以不填写 Street name/ 街道名称

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1 Application Form Multi Currency Account (EUR USD RMB) 多币种账户开户申请表 ( 欧元美元人民币 ) With this form you can apply for the Multi Currency Account. If you only like to save online we refer you to our website to apply for the Internet Saving package with registered counter account online. 此申请表可用于免费申请我行的多币种账户若您只需要储蓄功能, 推荐您登录网址 : 使用我行的在线开户服务在线开户需要一个荷兰本地银行账户作为绑定账户, 在线开户仅支持我行账户与绑定账户之间互转 Please complete this form with block letters. Incomplete forms will not be processed. 请使用工整的字体填写表格, 不完整填写的表格将被拒绝处理敬请谅解 1 Personal Details Accountholder(s)/ 个人信息 Accountholder 1/ 账户持有人 1 Accountholder 2/ 账户持有人 2 Gender/ 性别 Male/ 男 Female/ 女 Male/ 男 Female/ 女 Initials/ 名的首字母 First names/ 名 Nickname/ 昵称 Prefix/ 前缀 ( 荷兰人专用 ) Surname/ 姓 Date of Birth/ 出生日期 (DD/MM/YYYY 日 / 月 / 年 ) Place of Birth/ 出生地 Country of Birth/ 出生国家 Marital status/ 婚姻状况 Proof of Identity/ 身份证明 Nationality/ 国籍 Type of ID proof/ 身份证件类型 Passport/ 护照 Residence permi Passport/ 护照 Residence permit/ / 荷兰居住证荷兰居住证 EU-ID card/ NL Driving licens EU-ID card/ NL Driving license/ 欧盟荷兰身份证 / 荷兰驾驶证欧盟荷兰身份证欧盟荷兰身份证 Number ID proof/ 证件号码 Issue date/ 证件签发日 Expiry date/ 证件到期日 Issuing city/ 证件签发地 Issuing country/ 证件签发国家 TAX Number/ BSN 号码 ( 税号 ) Residential Address / 住址信息 Street name/ 街道名称 House number+affix/ 门牌号 1 / 10

2 Zip code/ 邮编 City/ 城市 Country/ 国家 Postal address if different from residential address / 邮寄地址如果和上面的住址信息不同, 请填写如果与上面的住址信息相同, 可以不填写 Street name/ 街道名称 House number+affix/ 门牌号 Zip code/ 邮编 City/ 城市 Country/ 国家 Other contact details / 其他联系方式 Telephone number/ 电话号码 Fax number/ 传真号码 address/ 地址 2 Personal Characteristics and Preferences / 账户用途说明及其他 Expected use of account? Domestic payments/ 本地汇款 Domestic payments/ 本地汇款 Multiple answers possible. International Payments/ 国际汇款 International Payments/ 国际汇款账户的用途 ( 可多选 ) To which countries do you expect to To which countries do you expect to transfer funds? 您可能向哪些国家汇款? transfer funds? 您可能向哪些国家汇款? Incoming payments/ 入账 Incoming payments/ 入账 What is the expected origin/ source of What is the expected origin/ source of the the incoming payment? (Salary, Saving, incoming payment? (Salary, Saving, etc) etc) 您的入账来源是什么? 如工资您的入账来源是什么? 如工资个人储蓄等个人储蓄等 From which countries do you expect From which countries do you expect to receive funds? 您会从哪些国家收到 to receive funds? 您会从哪些国家收到汇款? 请写明汇款? 请写明 Cash deposit and withdrawals/ Cash deposit and withdrawals/ 现金存款现金提取现金存款现金提取 Saving/ 储蓄 Saving/ 储蓄 Others, please explain briefly: 其他, 请简要说明 : Others, please explain briefly: 其他, 请简要说明 : 2 / 10

3 For which employer or in which sector do you work?/ 您任职的公司名称或者工作所在行业 What is your (public) position?/ 您的 ( 公共 ) 职位 3 Which additional products and agreements do you wish?/ 其他产品或服务申请 UnionPay Debit Card/ 银联借记卡 Yes/ 是 No/ 否 Not possible with joint Accounts/ 联名账户不享受借记卡服务 Internet Banking/ Yes/ 是 No/ 否 (please c Yes/ 是 No/ 否 (please 网上银行 part 4) ( 请填写第 4 部分 ) complete part 4) ( 请填写第 4 部分 ) Do you wish to receive Yes/ 是 No/ 否 Yes/ 是 No/ 否 our newsletters/ advertisements?/ 您是否愿意 Usually our newsletters and advertisements will be sent by . If you do not like to receive this information it may still occur that you receive information if ICBC Amsterdam is legally 订阅我行的资讯及促销信息等? obliged to inform you. 通常我行的资讯及促销信息等是通过电子邮件发出的如您不想收到此类信息, 在法律允许的情况下, 我行仍会向您发出一些特定的信息, 敬请谅解 If you did apply for Internet Banking you can manage the settings below yourself online. You can continue with part 5 declaring and signing ICBC Amsterdam. 如您申请网上银行, 您可自行于网上银行设置以下服务请您直接进入第 5 部分 If you did not apply for Internet Banking we request you to complete part 4 Bank statements and Easy Saving. 如果您不申请网上银行, 请您填写第 4 部分 4 Bank statements and Easy Saving/ 银行对账单及便利储蓄 Bank statements instead of Internet Banking 不申请网上银行, 请申请银行对账单 ICBC Amsterdam is legally obliged to inform its customers about the mutations/ transaction history of their accounts. This is one of the reasons we give Internet banking to your availability. If you choose not to apply for Internet Banking Please indicate below in which frequency and manner you like to receive your bank statements. 工银欧洲有法律义务告知客户其账户余额及交易明细这也是我行为您提供方便快捷的网上银行的初衷如果您选择不申请网上银行, 请于下表填写清楚您想以何种方式及频率收到银行对账单 Debit Card without Internet Banking 不申请网上银行且申请银联借记卡 If you do not want to apply for Internet Banking but do apply for the UnionPay Debit Card, we recommend you to choose a high frequency of bank statements so that you are able to monitor your account movements timely. Registration of your address is required. If you dispute any transaction it is your responsibility to inform the Bank as soon as possible! 如果您不申请网上银行但申请了银联借记卡, 我们推荐您选择较高频率的银行对账单以便及时监控账户变化您需向我行提供您的邮箱地址如果您发现账户有任何异常变化, 请及时向我行反映 Easy Saving 便利储蓄 Easy Saving gives you the possibility to install a limit on your current account. Any balance which exceeds the limit 3 / 10

4 will, during our end-of-the-day processing, automatically be transferred to your callable ICBC saving account. 便利储蓄功能能让您在支付账户设置一个限额, 任何超过该限额的款项将于日终自动转入您的活期储蓄账户 Accountholder 1/ 账户持有人 1 Accountholder 2/ 账户持有人 2 Bank statements/ 对账单 By mail/ 普通信件 by / 电子邮件 By mail/ 普通信件 by / 电子邮件 Only month end Daily/ 每日 frequency possible/ Weekly/ 每周只于每月末提供 Monthly/ 按月 Month end/ 每月末 ICBC Amsterdam Account number/ 账户号码 : Only month end Daily/ 每日 frequency Weekly/ 每周 possible/ Monthly/ 按月只于每月末提供 Month end/ 每月末 (To be complete by bank)/ 由银行填写 Easy Saving / 便利储蓄 No/ 否 Yes/ 是 Desired limit/ 期望限额 : Currency/ 币种 : EUR/ 欧元 USD/ 美元 RMB/ 人民币 5 Declare and signing ICBC Amsterdam/ 阅读各类章程并签名 By signing I agree with the General Banking Conditions and ICBC Amsterdam Terms and Conditions Retail Customers 本人签名表示同意并清楚了解相应的产品使用章程 : 个人客户产品章程和银行总章程及细则 Date/ 日期 Place/ 城市 Signature 1/ 签名 1 Signature 2/ 签名 2 4 / 10

5 Self-certification form to establish US tax status / 美国税务状况申报表 Registration of your personal data / 个人信息注册 Financial institutions are legally required to verify whether their clients are U.S. persons. As a financial institution we therefore have to ask you several questions. If you are a U.S. person we are legally bound to report your data to the Dutch tax authorities. The Dutch tax authorities will report this data to the United States tax authorities. 依照法律规定, 金融机构需要辨别客户是否为美国身份纳税人因此, 我们根据相关要求向您询问以下问题如果您是美国身份纳税人, 我行会将您的相关信息报送荷兰税务机构, 然后通过它交换至美国税务局 Several definitions in this form are underlined. Please find an explanation of these terms in the glossary. 所有的术语在申请表后附有相关的注释 1. General Information / 基本信息 1a First and middle Initials / 名 1b Title / 称谓 1c Last name / 姓 1d Date of birth / 生日 dd-mm-yy 1e Account number/iban 账号 /IBAN 号 2. Liable to tax in the United States? / 是否需要向美国缴税? 2a Are you a US Person?/ 是否为美国身份纳税人? Yes / 是 please proceed with 2b/ 前往 2b (You may be liable to tax in the United States. Therefore, we are legally bound to report your data to the Dutch tax authorities. The Dutch tax authorities will report this data to the United States tax authorities.) ( 如果您需要向美国纳税, 我们将会将您的信息报告给荷兰税务局, 然后由其转报告给美国税务局 ) No/ 否 please proceed with 2c/ 前往 2c 2b Please provide your US TIN?/ 请提供您的美国税号? please proceed with 3 2c Is your place of birth located in the United States? Yes/ 是前往 3 是否出生于美国? Please attach the following documents to the form: A copy of a valid passport (not a driver s licence), and A copy of a Certificate of loss of nationality of the United States. 5 / 10

6 请附带提供以下证明 : 您在有效期内的护照的复印件 ; 以及, 您放弃美国国籍的证明文件的复印件 No/ 否 Please attach a copy of a valid passport/identification card to the form. 请提供您在有效期内的护照 / 身份证的复印件 3. Declaration and signature / 申明并签字确认 I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct and complete. I declare that I will inform the financial institution within 30 days about any changes that may occur in above-mentioned information. 本人在此申明, 所提供的相关信息 : 完整准确无误本人在此申明, 今后如有任何信息的更改, 将在 30 天内向相关金融机构报告 Signatory date dd-mm-yy 签署日期 City / 城市 Full name / 姓名 Signature/ 签字 6 / 10

7 * Self-certification form to establish US tax status / 美国税务状况申报表 Registration of your personal data / 个人信息注册 Financial institutions are legally required to verify whether their clients are U.S. persons. As a financial institution we therefore have to ask you several questions. If you are a U.S. person we are legally bound to report your data to the Dutch tax authorities. The Dutch tax authorities will report this data to the United States tax authorities. 依照法律规定, 金融机构需要辨别客户是否为美国身份纳税人因此, 我们根据相关要求向您询问以下问题如果您是美国身份纳税人, 我行会将您的相关信息报送荷兰税务机构, 然后通过它交换至美国税务局 Several definitions in this form are underlined. Please find an explanation of these terms in the glossary. 所有的术语在申请表后附有相关的注释 1. General Information / 基本信息 1a First and middle Initials / 名 1b Title / 称谓 1c Last name / 姓 1d Date of birth / 生日 dd-mm-yy 1e Account number/iban 账号 /IBAN 号 2. Liable to tax in the United States? / 是否需要向美国缴税? 2a Are you a US Person?/ 是否为美国身份纳税人? Yes / 是 please proceed with 2b/ 前往 2b (You may be liable to tax in the United States. Therefore, we are legally bound to report your data to the Dutch tax authorities. The Dutch tax authorities will report this data to the United States tax authorities.) ( 如果您需要向美国纳税, 我们将会将您的信息报告给荷兰税务局, 然后由其转报告给美国税务局 ) No/ 否 please proceed with 2c/ 前往 2c 2b Please provide your US TIN?/ 请提供您的美国税号? please proceed with 3 2c Is your place of birth located in the United States? Yes/ 是前往 3 是否出生于美国? Please attach the following documents to the form: A copy of a valid passport (not a driver s licence), and 7 / 10

8 A copy of a Certificate of loss of nationality of the United States. 请附带提供以下证明 : 您在有效期内的护照的复印件 ; 以及, 您放弃美国国籍的证明文件的复印件 No/ 否 Please attach a copy of a valid passport/identification card to the form. 请提供您在有效期内的护照 / 身份证的复印件 3. Declaration and signature / 申明并签字确认 I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct and complete. I declare that I will inform the financial institution within 30 days about any changes that may occur in above-mentioned information. 本人在此申明, 所提供的相关信息 : 完整准确无误本人在此申明, 今后如有任何信息的更改, 将在 30 天内向相关金融机构报告 Signatory date dd-mm-yy 签署日期 City / 城市 Full name / 姓名 Signature/ 签字 8 / 10

9 Glossary Certificate of loss of nationality of the United States A Certificate of loss of nationality of the United States is considered proof that United States citizenship has been terminated. A United States citizen can file a request for this certificate with the United States government. Upon receipt of this certificate the person will no longer be considered a United States citizen. There are other certificates to prove a person s loss of nationality. For more information please visit and search for Loss of citizenship and nationality. IBAN IBAN is an abbreviation of International Bank Account Number. This account number is constructed in the same manner in every country. The number consists of various elements including the following information: the country code (NL for the Netherlands); a control number (two digits); the code of the bank (four characters in the Netherlands); one or more zeros; and the account number The IBAN consists of 18 characters in the Netherlands. Passport / Identification card This document certifies the identity of an individual. This document must be issued by a recognised government institution. In order to establish the residence and nationality of the individual, a valid copy of one of the documents below should be attached to this form: (Dutch or other country) passport; Dutch driver s licence; Identification card issued by a member state of the European Union. A foreign driver s licence is not a permitted form of identity certificate for this form. U.S. person When are you considered a U.S. person? As an individual, you are a U.S. person if one of the following situations is applicable to you: You are a citizen of the United States You are a resident of the United States (including the following U.S. territories: Puerto Rico, Guam or the U.S. Virgin Islands). You currently possess or have previously been in the possession of a U.S. green card. Please consult your tax advisor to determine which type of U.S. green card may qualify you as a U.S. person. Please visit for more information about U.S. green cards. In which other cases could an individual be considered a U.S. person? As an individual, you could be considered a U.S. resident and therefore a U.S. person if you have spent 183 days or more in the United States during the past three years, including at least 31 days in the current calendar year. The days are calculated as follows: All days in the United States in the current year; and 1/3 of the days in the United States of the last year; and 1/6 of the days in the United States of the year before last year. When are you considered a United States citizen? You are a United States citizen if one of the following situations applies to you: 1 You were born in the United States. 2 You were born in Puerto Rico. 3 You were born in Guam. 4 You were born in the U.S. Virgin Islands. 5 You became a naturalized United States citizen. 6 At least one of your parents is a United States citizen. In this case other requirements must be met to be considered a United States citizen. Please refer to for these requirements. When is a person liable to tax as a U.S. person? If you satisfy the requirements to be considered a U.S. person, you could be liable to tax in the United States. However, there may be exceptions. For example, a student visa or diplomatic status could provide an exemption for certain tax liabilities. There could potentially be additional circumstances where a person could be liable to or exempt from tax in the United States. Please note the items mentioned above should not be considered an exhaustive list. Please consult your tax advisor or go to for more information. U.S. TIN (U.S. federal taxpayer identification number) The Taxpayer Identification Number (TIN) is your personal identification number for tax administration purposes with the United States tax authorities (IRS), this is also known as a as U.S. federal taxpayer identification number. There are several types of U.S. TINs: For residents and citizens of the United States the Taxpayer Identification number is the Social Security Number (SSN). This is the United States equivalent of the Burgerservicenummer (BSN). You can request a social security number via IRS form SS-5 or Non-U.S. individuals who are United States taxpayers can request an Individual Tax Identification Number (ITIN via IRS form W-7 or More information about identification numbers and the process to request these numbers is available on 9 / 10

10 名词解释放弃美国国籍证明该证明用于客户向外界证明其已经不再具有美国国籍美国公民可以向美国政府申请要求注销其美国国籍, 免除其美国公民的权利及义务此外, 尚有其他可以用于类似用途的文件证明更多详细信息, 请访问并搜索取消公民身份和国籍 IBAN 账号 IBAN 账号是国际银行账号的简称, 众多国家通过统一的规则生成账号该账号包含以下信息 : 国家代码 (NL 代表荷兰 ); 校验位 (2 位数 ); 银行识别码 ( 银行 BIC 代码前 4 位 ); 补足账号长度的 0 ; 以及基本账号位荷兰银行的 IBAN 账号长度为 18 位护照 / 身份证这些证件用于证明个人的身份, 必须有具有法律权威的机关签发为正确录入客户的 4 出生地为美属维京群岛 5 获得法律意义的美国公民资格 6 双亲之一为美国公民则必须配合其他资料以认定美国公民身份更多信息请访问网站. 使用于认定美国身份纳税人的情况如果您是美国身份纳税人, 您就有向美国政府纳税的义务, 但是如果您有相关豁免资格, 则无须缴纳例如, 学生签证持有者或外交人员可以享受税务减免其他特殊情况也可能可以导致见面以上情况并非包含所有场景, 更多信息, 请访问美国税号该税号是您在美国税务局用于税务缴纳的个人编号, 有以下几种形式 : 美国公民和居民的税号等同于起社会保险号您可以通过 SS-5 表格, 或访问网站获取非美国居民 / 公民, 但仍需向美国缴纳税款的个人可以通过 W-7 表格或者访问网站获取更多信息请访问相关信息, 以下有效的法律证件必须提供 : ( 荷兰或其他国家 ) 护照 ; 荷兰驾照 ; 欧盟颁发的身份证外国驾照不能作为有效合法证件美国身份纳税人如何认定是否是美国身份纳税人? 如果您满足以下一项条件, 您将被认定是美国身份纳税人 : 美国公民美属领地居民 ( 波多黎各关岛美属维京群岛 ). 持有美国绿卡或曾经持有美国绿卡请向税务专家确认您所持有绿卡是否适用本条款或访问以获取更多信息其他可能被认定为美国身份纳税人的情况如果您在过去三年中停留美国的时间超过 183 天, 您将被认为是美国居民, 从而被认定为美国身份纳税人停留天数计算方法如下 : 当年经停美国天数 ; 以及前一年经停美国天数的 1/3; 以及再前一年经停美国天数的 1/6 的总和美国公民的认定如果以下任一情况适用, 您被认为是美国公民 : 1 出生地为美国 2 出生地为波多黎各 3 出生地为关岛 10 / 10

* RRB *

* RRB * *9000000000RRB0010040* *9000000000RRB0020040* *9000000000RRB0030040* *9000000000RRB0040040* *9000000000RRC0010050* *9000000000RRC0020050* *9000000000RRC0030050* *9000000000RRC0040050* *9000000000RRC0050050*

Zip code/ 邮编 City/ 城市 Country/ 国家 Postal address if different from residential address / 邮寄地址 如果和上面的住址信息不同, 请填写 如果与上面的住址信息相同, 可以不填写 Street name/ 街道名称

Zip code/ 邮编 City/ 城市 Country/ 国家 Postal address if different from residential address / 邮寄地址如果和上面的住址信息不同, 请填写如果与上面的住址信息相同, 可以不填写 Street name/ 街道名称