Personal (Member) Application
For Bank Accounts and Term Deposits
Applicant Information
Title
Please Select
Mr.
Ms.
Mrs.
Dr.
Other
Full Legal Name (the “Applicant”)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Date of Birth
*
/
Month
/
Day
Year
Birth Date
SIN
*
Social Insurance No
Email
*
example@example.com
Employer Name
*
Occupation (Role / Title)
*
Doctor, Teacher, Manager, Etc
Employment Type
*
Industry: Financial Services, Healthcare, Engineering, etc
Personal Phone
*
Work Phone
Identification #1
(must be a photo ID)
Document Type
Please Select
Drivers License
Permanent Residence Card
Passport
Ontario Photo ID Card
Canadian Citizenship Card with Photo
Other
Reference Number
ID Reference #
Expiry Date
/
Month
/
Day
Year
Date
Place and Country of Issue
Ie: Toronto, Canada
Identification #2
Document Type
Please Select
Drivers License
Permanent Residence Card
Passport
Ontario Photo ID Card
Canadian Citizenship Card with Photo
Reference Number
ID Reference #
Expiry Date
/
Month
/
Day
Year
Date
Place and Country of Issue
Ie: Toronto, Canada
Politically Exposed Person (PEP) Declaration
I declare that I am not a PEP.
I declare that I am a PEP, as described on the Politically Exposed Person Statement, attached
Are you a Canadian Resident?
Yes
No
Witness
Applicant Information 2
Title
Please Select
Mr.
Ms.
Mrs.
Dr.
Other
Co-applicant Name
First Name
Last Name
Co-applicant Address
Street Address
Street Address Line 2
City
Province
Postal Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Date of Birth (2)
/
Month
/
Day
Year
Birth Date
SIN (2)
Social Insurance No
Co-applicant Email
example@example.com
Co-applicant Employer Name
Occupation (Role / Title)
Doctor, Teacher, Manager, Etc
Employment Type
Industry: Financial Services, Healthcare, Engineering, etc
Personal Phone
Work Phone
Document Type
Please Select
Drivers License
Permanent Residence Card
Passport
Ontario Photo ID Card
Canadian Citizenship Card with Photo
Other
Reference Number
ID Reference #
Expiry Date
/
Month
/
Day
Year
Date
Place and Country of Issue
Ie: Toronto, Canada
Document Type
Please Select
Drivers License
Permanent Residence Card
Passport
Ontario Photo ID Card
Canadian Citizenship Card with Photo
Reference Number
ID Reference #
Expiry Date
/
Month
/
Day
Year
Date
Place and Country of Issue
Ie: Toronto, Canada
Politically Exposed Person (PEP) Declaration
I declare that I am not a PEP.
I declare that I am a PEP, as described on the Politically Exposed Person Statement, attached
Are you a Canadian Resident?
Yes
No
Sukuk - Savings Account / Term Deposit Confirmation
TERM DEPOSIT DETAILS – SHARIAH COMPLIANT
Amount (the “Principal”)
*
Amount you will deposit into your halal bank account
Type of Deposit Product / Account
Halal Savings Bank Account (No Fee account)
1 Year Redeemable - up to 72% returns
1 Year Non-Redeemable - up to 80% return
Other - Call me to discuss options
Depositor's Signature- Applicant 1
*
Depositor’s Signature- Applicant 2
Date
*
/
Month
/
Day
Year
Date of Acceptance ie. Today's Date
DISCLAIMER AND TERMS & CONDITIONS
A Representative will be in contact with you to confirm the details of your submission with respective terms prior to any initialization of the deposit.
Do not worry, we will not initiate the transfer till one of our representatives are in touch with you.
Thank you for your submission and we will be in touch.
Initials for Term Deposit Type
Your initials, ie. For Mustafa Khan type MK
File Upload and Terms & Conditions
ID # 1 - File Upload
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Attach your 1st ID
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of
ID # 2 - File Upload
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Attach your 2nd ID
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of
Other - File Upload
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Any other information you wish to share
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of
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