PLEASE COMPLETE THE FORM ACCURATELY Untitled 1 Questions marked by * are required. 1.) PERSONAL DATA (Account Owner must be at least 18 years of age. This section can be used for joint investors, where applicable) Title: * Dr. Mr. Mrs Miss Others Surname: * First Name: * Middle Name: Mother's Maiden Name (if any): Address: * Nearest B/Stop City: * State: * Your Email Address: * Date of Birth: * 2.) FORM OF IDENTIFICATION & SOURCE OF FUNDING Kindly indicate by ticking the form of identification provided below and Email photocopy of the supporting documents to: [email protected]. Please note that due to Anti-money Laundering Legislation, the account may not be opened until the required documents are verified. Tick as appropriate National Identity Card Driver’s License International Passport Student Identity Card (if a student) Corporate Identity Card (if employed) 3 months receipts from public utilities voters Card Business/Employers Name (Educational Institution, if currently a student): Business/Employer or School's Full Address: City: State: Phone: Fax: Objectives for opening the account: * Sources of wealth or income * 3.) NEXT OF KIN Title (ii): * Dr. Mr. Mrs Miss Others First Name* Last Name* Middle Name (if any): Mother's Maiden Name (if any): Street Address: * City: * State: * Postal Address: City: State: Daytime Phone Number: * Evening Phone Number: 4.) REFEREE Title: * Dr. Mr. Mrs Miss Others First Name: * Last Name: * Mother's Maiden Name (if any): Street Address: * City: * State: * Postal Address: Daytime Phone Number: * 5.) BANK DETAILS Bank Name: * Bank Account Number: * Bank Account Name: * Bank Sort Code/bank verification number: * Date Account Opened (dd/mm/yyyy): State: * LGA: * Declaration * Please be informed that in compliance with the anti- money laundry legislation, transaction above N1,000,000.00 and N5,000,000.00 for individual and corporate organization respectively, will be reported to the Central Bank of Nigeria (CBN) or Securities and Exchange Commission (SEC). By clicking the Submit button below, you 1.) Confirm that the information given on this account opening form is true; 2.) That accounts are to be adequately funded and debited balances, if any, must be cleared within 3 days of its occurrence; 3.) hereby declare that you understand the conditions stated above and that you agree to abide with the said conditions. Agree Disagree Please upload a recent Passport Photograph *
