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Clear FormAPPLICATION - ISSUANCE OF HOME REMITTANCE CARD
The Manager
National Bank of Pakistan
Branch: Tokyo, Japan

Date
RECEIVER INFORMATION (BENEFICIARY)

Name

Date of Birth

S/O, D/O, W/O

Place of Birth

CNIC/POC NO:--Nationality

Address

RelationshipContact #Politically Exposed Person (PEP)

Yes

No

Purpose of RemittanceFamily Maintenance

SavingOther (Specify)

Bank Name
Branch name & City
IBAN/Account No.
Type of Account

PKR

USD
APPLICANT INFORMATION (REMITTER)

Name

Date of Birth

S/O, D/O, W/O

Place of BirthContact (Mobile)#NationalityCNIC/POC NO:-

Politically Exposed Person (PEP)
Occupation
Company/Business
Name
Source of Funds
Address-Yes (I am or family is PEPs)

General Employee

Self-Employed

Unemployed

Other (Specify)

CNIC Issue Date
No (I am or family is not PEPs)
Student

Housewife/HousemakerContact #SalaryBusiness

Savings

Other (Specify)〒

Signature:

I am a Pakistani national living in Japan and intend to frequently remit amounts to Pakistan as detailed below. I request to issue me Home Remittance Card to avoid submission of identical
documents every time, required under the revised Japanese rules/Laws. I confirm that above-mentioned beneficiary is not related to any PEPs, Sanction, Adverse Media or Enforcement party.
Please make the remittance every time to the above beneficiary at my risk and responsibility unless otherwise advised. I will submit fresh application for every remittance with my signature,
my current address, phone number, amount to be remitted and other necessary information.
I AGREE AND ACCEPT THAT INFORMATION ON THIS APPLIACTION MAY BE TRANSMITTED TO THE PAYEE BANK/BANKS CONCERNED.

Only for Office UseCustomer Name

Provided My #Customer Number

CIR Dated

Approver Sign.

Personal info.
Explained

National Bank of Pakistan – Japan Operation

お客様 各位

Dear Customer,「個人情報」および「反社会勢力」に関し、下記内容をご理解の上、同意いただきますようお願い申し上げます。
With regard to the “Personal Information” and “Antisocial Forces “, please read the following contents and agree.

個人情報

Personal Information

弊行は、現行の「個人情報の保護に関する法律」に基づき、お客様の個人情報を、下記業務ならびに利用目的の達成に必要な範囲で利用致します。

Based on the existing “Personal Information Protection Law”, National Bank of Pakistan, TokyoBranch (hereafter “the Bank”) announces to use the customers’ Personal Information only forthe following business and to achieve purpose of use.

１． 業務内容
・銀行法及び関連法に定められている業務及び銀行が営む事ができる業務に付随する業務
1.Nature of business・ Business stipulated in the Banking Law and the related laws and regulations, as well as
business incidental to the business that a bank may engage in.

２． 利用目的収集した個人情報について、弊行の上記業務遂行及びお客様とのお取引を適切かつ円滑に履行するために利用いたします。なお、特定の個人情報の利用目的が、法令等に基づき限定されている場合には、当該利用目的以外で利用いたしません。

2.Purpose of Use
The purpose of use of the collected personal information in the Bank is to implement it for thesake of the above-mentioned banking services and to enable the Bank to handle transactions
with customers properly and smoothly. However, when the purpose of use of specific personal
information is limited by laws and regulations, the Bank will comply with such laws andregulations.

第三者提供
弊行は、現行法に定める場合を除いて、収集した個人情報をお客様の同意なしに第三者へ提供することはしません。
3.

3.Restriction of Provision to A Third Party
The collected personal information shall not, except as provided in the existing laws, beprovided to any third party without obtaining the prior consent of the person.

開示請求
弊行は、収集した個人情報について、法令に基づくご本人からの開示・訂正・削除・利用停止等の請求に応じます。
4.

4.Requests for Disclosure and Other Actions
The collected personal information shall be disclosed, corrected, deleted, suspended to use or
such other request for similar actions in respect of your personal information pursuant to laws
and regulations.

反社会的勢力でないことの表明・確約に関する同意について
Representation and warranties of non-Antisocial Forces

私（名義人が法人の場合には、当該法人の役員等を含む。以下同じ。）は、現在、暴力団、暴力団員、暴力団員でなくなった時から５年を経過しない者、暴力団準構成員、暴力団関係企業、総会屋等、社会運動等標ぼうゴロまたは特殊知能暴力集団等、その他これらに準ずる者 （以下これらを「暴力団員等」という。） に該当しないこと、および次の各号のいずれにも該当しないことを表明
し、かつ将来にわたっても該当しないことを確約いたします。
暴力団員等が経営を支配していると認められる関係を有すること
暴力団員等が経営に実質的に関与していると認められる関係を有すること
自己、自社もしくは第三者の不正の利益を図る目的または第三者に損害を加える目的をもってするなど、不当に暴力団員等を利用していると認められる関係を有すること
暴力団員等に対して資金等を供給し、または便宜を供与するなどの関与をしていると認められる関係を有すること
役員または経営に実質的に関与している者が暴力団員等と社会的に非難されるべ き関係を有すること➁私は、自らまたは第三者を利用して次の各号の一つにでも該当する行為を行わないことを確約いたします。
暴力的な要求行為
法的な責任を超えた不当な要求行為
取引に関して、脅迫的な言動をし、または暴力を用いる行為
風説を流布し、偽計を用いまたは威力を用いて貴行の信用を毀損し、または貴行の業務を妨害する行為
その他前各号に準ずる行為-a racketeer attempting to extort money from a company by threatening to causetrouble at thegeneral stockholders’ meeting (“Soukaiya”) or acting as if advocating legitimate social causes(“Shakai undou nado hyoubou goro”), or a special intelligence organized crime group (“Tokusyuchinou boryoku syudan”), etc., etc.
-a person or organization equivalent to any of the above howsoever described.
In addition, I /We (when the nominee is a corporation, the directors, etc. of such corporation
concerned are included) declare that neither I nor any concerned is or will in the future fall within
any of the following:
Operating an entity having such relationship with Boryokudanin, etc. that shows their control
over the entity’s management.
Operating an entity having such relationship with Boryokudanin, etc. that shows theirsubstantial involvement in the entity’s management.
Operating an entity having such relationship with Boryokudanin, etc. that shows reliance on
Boryokudanin, etc. for the purpose of unfairly benefiting oneself, one’s own company or thirdparties or of damaging third parties.
Operating an entity having such relationship that shows provision of funds or facilities toBoryokudanin, etc.
Operating an entity of which Board members or people substantially involved in its
management have socially condemnable relationship with Boryokudanin, etc.
➁ I /We (when the nominee is a corporation, the directors, etc. of such corporation concerned areincluded) undertake not to conduct, either in person or by engaging a third party, any of thefollowing:
Claims made with forceful behavior and acts of violence;
Unjust claims exceeding legal responsibilities;
Use of threatening action or statements, or violent acts and behaviors in connection with anytransaction between the parties;
Acts and behaviors which may damage the credit or obstruct the business of the bank byspreading false rumors or the use of fraudulent means or by force;
Other acts and behavior equivalent to the above howsoever described.

私は、上記➀の各号のいずれかに該当し、もしくは➁の各号のいずれかに該当する行為をし、または➀にもとづく表明・確約に関しての虚偽の申告をしたことが判明した場合には、預金、借入金全ての銀行取引が停止され、または通知により預金、借入金全ての銀行取引の解約をされても異議を申しません。また、これにより損害が生じた場合でも、いっさい私の責任といたします。
I/We (when the nominee is a corporation, the directors, etc. of such corporation concerned areincluded.),when fall under any of the items of Article ➀ 、 or commit to any of the acts of Article➁,or when any of the representation and warranties turn out to be false, will not object yourstopping all banking transaction such as Deposit, Loan, etc. or terminating them by your notice.
Moreover, as a result even when any damage is caused by above action, I/We will assume allresponsibility.

□上記の利用目的の明示を受け、これを確認しました。（□にマーク）□I have reviewed above purpose of use and agreed and acknowledged.（Please mark.）➀➀I /We (when the nominee is a corporation, the directors, etc. of such corporation concerned areincluded) declare that I nor any of concerned is or will in the future fall within any of thefollowing (herein after “Boryokudanin, etc.”):an organized crime group (“Boryokudan”);-a member of a Boryokudan (“Boryokudanin”);-a former Boryokudanin who has withdrawn from a Boryokudan but less than 5 years haveelapsed since;-a sub-member of a Boryokudan (“Boryokudan jyunkoseiin”);-a corporation related to a Boryokudan (“Boryokudan kanren gaisha”);

Date

日付Address住所Name

氏名

Signature

署名