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.
n 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 www.globalexecutivebanking.citi.com.
n Please mark non-applicable fields – N/A
n If you cross out any information, please initial
the change.
Account Relationship Package:* l Citi Global Executive Account Package l 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)
l Individual
l Joint with Right of Survivorship (JTWROS) (signing individually)
l Uniform Transfers to Minors Account (UTMA)
l 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)
l Dr. l Mr. l Mrs. l Ms.
Last
First
Middle
Co-Applicant Name (A): (Custodian’s Name if UTMA account)
l Dr. l Mr. l Mrs. l Ms.
Last
First
Middle
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):
l Dr. l Mr. l Mrs. l Ms.
Last
First
Middle
First
Middle
Co-Applicant Name (C):
l Dr. l Mr. l Mrs. l Ms.
Last
GEBAPP MS 0813
1
PRIMARY APPLICANT INFORMATION (Minor’s Name if UTMA account)
ACCOUNT TITLE: Print complete name clearly
l Dr. l Mr. l Mrs. l Ms.
Last
First
Are you an existing Global Executive Banking customer?
Middle
l Yes l 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. l Yes l No
Do you have an existing account with another Citibank or Citigroup Affiliate?
If “Yes”, please specify the country where your account was opened
Branch location where your account was opened (city)
l Yes
l No
Account number
EMPLOYER INFORMATION
Citigroup Employee: l Yes l No
If “Yes,” please provide: GEID
Department
MSSB Employee? l Yes l No CGMI Employee? l Yes l No Citigroup Subsidiary Employee: l Yes l No Reg O Officer: l Non official l Official
Employer name:
Your title/position:
Corporate address:
CITIZENSHIP & TAX REPORTING STATUS
Your Citizenship Status:
l U.S. Citizen l Non-Resident Alien l 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
l Name of First School Attended
l Mother’s Maiden Name
AND
IDENTIFICATION
l Passport (preferred) l Other Government ID only if no passport available:
Issuing country:
Other Govt. Issued Identification:
Issuing country:
Other Identification:
Issuing country:
GEBAPP MS 0813
ID Type:
Number:
Date Issued mm/dd/yyyy:
Expiration mm/dd/yyyy:
Issuing
Entity
ID Type
Number:
Date Issued mm/dd/yyyy:
Expiration mm/dd/yyyy:
Issuing
Entity
ID Type
Number:
Date Issued mm/dd/yyyy:
2
Expiration mm/dd/yyyy:
PRIMARY APPLICANT INFORMATION (Minor’s Name if UTMA account)
Last
First
Middle
ADDRESS AND TELEPHONE
Current Permanent residential address (DO NOT USE P.O. Box/”C/O”/Business address)
City and State: (Max. 32 letters)
Address since: mm/yyyy
Postal Code: (if applicable)
Country:
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
City and State: (Max. 32 letters)
Address since: mm/yyyy
Postal Code: (if applicable)
Country:
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
City and State: (Max. 32 letters)
Address since: mm/yyyy
Postal Code: (if applicable)
Country:
Mailing Address (if different from residential address): include apartment number if applicable (Max. 35 letters)
Address since: mm/yyyy
City and State: (Max. 32 letters)
Postal Code:
Country:
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
Country Code
City Code
Line Number
Cellular Phone Number:
Country Code
GEBAPP MS 0813
City Code
City Code
Line Number
City Code
Line Number
Fax Number:
Line Number
Country Code
3
Extension
CO-APPLICANT INFORMATION (Minor’s Name if UTMA account)
ACCOUNT TITLE: Print complete name clearly
l Dr. l Mr. l Mrs. l Ms.
Last
First
Are you an existing Global Executive Banking customer?
Middle
l Yes l 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. l Yes l No
Do you have an existing account with another Citibank or Citigroup Affiliate?
If “Yes”, please specify the country where your account was opened
Branch location where your account was opened (city)
l Yes
l No
Account number
EMPLOYER INFORMATION
Citigroup Employee: l Yes l No
If “Yes,” please provide: GEID
Department
MSSB Employee? l Yes l No CGMI Employee? l Yes l No Citigroup Subsidiary Employee: l Yes l No Reg O Officer: l Non official l Official
Employer name:
Your title/position:
Corporate address:
CITIZENSHIP & TAX REPORTING STATUS
Your Citizenship Status:
l U.S. Citizen l Non-Resident Alien l 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
l Name of First School Attended
l Mother’s Maiden Name
AND
IDENTIFICATION
l Passport (preferred) l Other Government ID only if no passport available:
Issuing country:
Other Govt. Issued Identification:
Issuing country:
Other Identification:
Issuing country:
GEBAPP MS 0813
ID Type:
Number:
Date Issued mm/dd/yyyy:
Expiration mm/dd/yyyy:
Issuing
Entity
ID Type
Number:
Date Issued mm/dd/yyyy:
Expiration mm/dd/yyyy:
Issuing
Entity
ID Type
Number:
Date Issued mm/dd/yyyy:
4
Expiration mm/dd/yyyy:
CO-APPLICANT INFORMATION (Minor’s Name if UTMA account)
Last
First
Middle
ADDRESS AND TELEPHONE
Current Permanent residential address (DO NOT USE P.O. Box/”C/O”/Business address)
City and State: (Max. 32 letters)
Address since: mm/yyyy
Postal Code: (if applicable)
Country:
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
City and State: (Max. 32 letters)
Address since: mm/yyyy
Postal Code: (if applicable)
Country:
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
City and State: (Max. 32 letters)
Address since: mm/yyyy
Postal Code: (if applicable)
Country:
Mailing Address (if different from residential address): include apartment number if applicable (Max. 35 letters)
Address since: mm/yyyy
City and State: (Max. 32 letters)
Postal Code:
Country:
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
Country Code
City Code
Line Number
Cellular Phone Number:
Country Code
GEBAPP MS 0813
City Code
City Code
Line Number
City Code
Line Number
Fax Number:
Line Number
Country Code
5
Extension
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:
lDo not link to my existing card
lNo, do not send a card
Co Account Owner:
l No, do not send a card
l Do not link to my existing card
Co Account Owner:
l Do not link to my existing card
l No, do not send a card
Co Account Owner:
l Do not link to my existing card
l 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.
WELCOME PACKAGE MAILING INFORMATION
Address where you want to receive the New Account Welcome Package (DO NOT USE P.O. Box)
If you want to receive the New Account Welcome Package at another address, please provide it below.
l Permanent
l Mailing
l Other
Address (Max. 35 letters)
City and State: (Max. 32 letters)
Postal Code: (if applicable)
Country:
Where we may call you during the account opening process and leave a message if needed?
Country Code
City Code
Line Number
EMAIL COMMUNICATION INFORMATION
By providing an email address below, you agree that we may contact you via email to expedite your account opening process. You also agree that we may
use the email 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 emails. To protect your privacy, we will not request or send confidential account information through this
channel. The email preference you select upon enrollment in Citibank Online® will govern future electronic communications we may send you.
Email:
ACCOUNT AGREEMENT
DEFINITION OF TERMS
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
GEBAPP MS 0813
6
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
X
Co Applicant (B) signature
/
/
/
/
X
Date (mm/dd/yyyy)
Co Applicant (A)/New Account Owner signature
X
Date (mm/dd/yyyy)
Co Applicant (C) signature
/
/
/
/
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Global Executive Banking is a service of Citibank, N.A., providing banking and borrowing products and services.
© 2013 Citigroup Inc.
Citi with Arc Design is a service mark of Citigroup Inc. or Citibank, N.A., used and registered throughout the world.
GEBAPP MS 0813
7
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)
Co-Account Owner C Name/Signature:
(Please sign within the box below)
DATE
_____________________________________________________________________________________________________________________________________________
DATE
________________________________________________________________________________________________________________________________________
Signature certification unit
Global Executive Banking Application Guide
GENERAL INFORMATION
ADDRESS AND TELEPHONE
• All sections of the application must be completed in order to open your account.
Please mark non-applicable fields “N/A”.
• Provide a residential street address in your account application. “P.O. Box,” “In Care
of,” or “Business” addresses cannot be accepted.
• If you cross out any information, please initial the changes. Using correction
fluid/white-out to make corrections will void your application.
• Complete the “Address since” field for your permanent residential address and,
if applicable, your previous permanent residential address(es).
• 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.
• Provide a mailing address. You may provide a corporate address or a personal
P.O. Box as your mailing address.
• 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
740-834-1369, 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
• 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 usonce the account is funded.
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.
WELCOME PACKAGE MAILING INFORMATION
SECURITY INFORMATION
EMAIL COMMUNICATION INFORMATION
Provide the address where your Welcome Package should be sent.
This information may be used for identification purposes when you contact us by
phone.
Please provide us with an email address where we may contact you.
IDENTIFICATION DOCUMENTS (ID)
Each Account Applicant must sign both signature cards. The signature(s) of every
Account Applicant must appear on both signature cards.
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.
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
www.globalexecutivebanking.citi.com. 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 740-834-1369 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.
© 2013 Citigroup Inc.
Citi with Arc Design is a service mark of Citigroup Inc. or Citibank, N.A., used and registered throughout the world.
GEB ACCCOVERSHEETMS 0813
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
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
www.globalexecutivebanking.citi.com.
Returning Application and Documentation
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 33610 USA
If you would like us to review your documents for completeness, prior to mailing them
to us, you may fax* or email your documents to Global Executive Banking. Please
contact your Account Opening Specialist for details.
We will require your original signed application and tax forms, along with all documentation,
to open your account.
* Facsimile/Email 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/email as a means of transmission.
Global Executive Banking is a service of Citibank, N.A., providing banking and borrowing products and services.
© 2013 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