Individual Account

Opening Form
 D O C U M E N TAT I O N R E Q U I R E M E N TS

1. Duly Completed Account Opening Form.

2. Two (2) independent and satisfactory references (Referees must be current account holders).
Any Referee who maintains current account with Greenwich Merchant Bank Limited must have done so for a
minimum of six (6) months.

3. One (1) recent clear passport size photograph of each Signatory to the account.

4. Residence Permit for Non-Nigerians.

5. Means of Identification of Signatory - International Passport, Driver's License, National ID Card or Permanent Voter's
Card.

6. Proof of Residential Address such as Tax Clearance Certificate, Utility Bills, Rent Agreement, Home Ownership
Document e.t.c. which should bear the current address of the Signatory.

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 ACCOUNT OPENING FORM
INDIVIDUAL CURRENCY
(Indicate the type of account to open by ticking the applicable box below) $ € ¥ £ Others

INVESTMENT ACCOUNT CURRENT ACCOUNT

TICK AS APPROPRIATE
THIS FORM SHOULD BE COMPLETED IN CAPITAL LETTERS

PERSONAL INFORMATION

Title Surname First Name

Other Name (s) Mother’s Maiden Name

Marital Status (Tick as appropriate) Single Married Others Gender F M

(Specify)

Place of Birth Date of Birth D D M M Y Y Y Y

Nationality Religion (Optional)

Are you a bearer of another country’s passport? Yes No if yes, state the country

BVN

Purpose of Account
FOR NON-NIGERIANS
Residence Permit No.

Issue Date D D M M Y Y Y Y Expiry Date D D M M Y Y Y Y

CONTACT DETAILS

Residential Address

City/Town LGA State

Mailing Address (Tick box if same as above)

Phone Number 1 Phone Number 2

E-mail

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 VALID MEANS OF IDENTIFICATION (Tick as appropriate)

International Passport Driver’s License National ID Card Permanent Voter’s Card Others

If others, specify

Identi cation Document No.

Issue Date D D M M Y Y Y Y Expiry Date D D M M Y Y Y Y

OCCUPATION DETAILS

Employed Self Employed Retired Others

(Specify)

Business / Employer’s Name

Business / Employment Address

City / Town LGA State

Office Phone Number

Nature of Business

Source(s) of Funds to the Account 1.

2.

3.

DETAILS OF NEXT OF KIN

Title Surname First Name

Other Name(s)

Date of Birth D D M M Y Y Y Y
Gender F M

Relationship

Phone Number 1 Phone Number 2

E-mail Address

Contact Details

City / Town LGA State

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 ACCOUNT SERVICE(S) REQUIRED

Electronic Banking Preferences (Tick appropriately) Transaction Alert Preferences (Tick appropriately)

Internet banking Mobile banking SMS alert E-mail alert

Charges: Terms and conditions apply. Please refer to the website www.greenwichbankgroup.com for further information

ACCOUNT(S) HELD WITH OTHER BANKS

S/N BANK ACCOUNT NAME ACCOUNT NUMBER

1.

2.

3.

4.

MANDATE

SPECIMEN SIGNATURE Passport photograph

Please write your rst,

middle & last name at
the back of passport

OUR DATA PROTECTION POLICY

Greenwich Merchant Bank Limited is committed to protecting your personal data and preserving the con dentiality of information
provided. Your personal data provided on this medium will be used for account opening and other lawful processing in line with
applicable data protection regulations. By signing below, you are consenting to the processing of your personal data in line with the
Bank's Privacy Policy. Please refer to the website www.greenwichbankgroup.com for further information.

CUSTOMER’S NAME

SIGNATURE Date D D M M Y Y Y Y

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 GENERAL TERMS AND CONDITIONS

Introduction Holder's accounts towards satisfaction of any of the Account

These Terms and Conditions are applicable to all accounts whether Holder's liabilities to the Bank or to any other account or in any
opened on the date of signing these Terms and Conditions or on a other respect whether such liabilities are present or future,
prior/later date. The undersigned undertakes and agrees to be actual or contingent, primary, several or joint. The debit
bound by these Terms and Conditions. balance of any one of the Account Holder's accounts will be
secured by the credit balance of any other Account Holder's
Operation of Account accounts opened in any currency. The Bank may debit any of
1. The Account Holder is personally liable for any overdraft or the Account Holder's accounts opened at any of its business
obligation arising from, or in connection with the account(s) offices with the amount of any bills, guarantees, cheques and
and the Bank is hereby authorized to debit the account(s) with drawings, given, presented or purchased and signed by the
all interest, commission and/or other banking charges and Account Holder.
expenses (including legal charges) incurred in connection with
the account(s). 9. Any delay or omission by the Bank in exercising or enforcing
(whether wholly or in part) any right or remedy arising in
2. The Account Holder agrees to maintain the minimum balance respect of the account(s) shall not be construed as a waiver of
and to comply with all other conditions applicable to his/her such right or remedy.
accounts, including Investment, Current and Domiciliary
Accounts. The Bank may decide from time-to-time at its sole Right of Set-off
discretion without prior notice to the Account Holder to 10. The Bank may at any time and without notice to the Account
impose service charges on the account(s) if the minimum credit Holder, combine all or any of the Account Holder's accounts
balance in such account(s) is/are less than the balance and liabilities to the Bank in Nigeria (or elsewhere) whether
prescribed by the Bank. severally or jointly with any person and set off all or any monies
standing to the credit of the Account Holder in such accounts
3. The Bank reserves the right to debit the Account Holder's including the Account Holder's deposits with the Bank
account in case of erroneous credit made to the account. (whether matured or not) towards satisfaction of any of the
Account Holder's liabilities to the Bank, whether as principal or
4. The Account Holder agrees to assume full responsibility for the surety, actual or contingent, severally or jointly, primary or
genuineness, correctness and validity of all endorsements collateral with any other person and the Bank may apply any
appearing on all cheques, orders, bills, notes, negotiable necessary currency conversion at the Bank's own rate of
instruments and receipts or other documents deposited in the exchange other than the prevailing rate. Exchange risks
Account Holder's account. associated with any collateral, cash or otherwise used in
satisfaction of outstanding debt shall be borne by the Account
5. If a cheque credited to the Account Holder's account is Holder.
returned dishonoured, the same may be transmitted to the
Account Holder through the last known address either by Currency Conversion
bearer or by post. 11. The Bank will not be held liable for any exchange loss incurred
by the Account Holder in converting/transferring the balance
6. The Account Holder agrees to notify the Bank of any from one currency account to another currency account on the
disagreement with entries on the Account Holder's Bank instruction of the Account Holder or the use of any e-banking
Statements within fteen (15) days of the dispatch of the Bank platform to carry out transactions in a currency other than the
Statement. Failing receipt by the Bank of a notice of currency of the account.
disagreement of entries within 15 days from the date of
dispatch of the Account Holder's Bank Statement, it will be
assumed by the Bank that the Statement as rendered is correct. Dormant Account
12. If the Bank classi es an account as dormant, any balance in the
7. Withdrawal from any Domiciliary Account shall be made only in account will remain the Account Holder's property. If the
line with the mode allowed by extant laws and regulatory Account Holder dies, it will form part of the Account Holder's
directives. estate unless the account is a Joint Account, in which case it will
pass to the surviving Account Holder. Interest will continue to
be paid where it applies to the Account Holder's account. The
Collateral Account Holder can contact the Bank at any time in relation to
8. All monies, securities, bonds, collaterals, shares, shipping any fund in the Account Holder's dormant account and the
documents, banknotes, gold or other valuables and property Bank will reinstate the Account Holder's account subject to
of whatever nature which are held in the name of the Account con rming the Account Holder's identity.
Holder by the Bank whether in any type of account or
otherwise shall be so held as security to guarantee the
settlement of any debit balance due to the Bank arising under Closure of Account
these general terms and conditions or any credit or facility 13. The Bank shall have the right at any time and at its absolute
granted or that may be granted to the Account Holder in future. discretion by giving written notice to the Account Holder to
Furthermore, the Account Holder agrees to keep such within close the account without giving any reason for taking such
the Bank's possession as collateral against credit facilities until action, and without incurring any liability whatsoever to the
the Account Holder fully pays all indebtedness to the Bank Account Holder in so doing. In the event of such closure, the
including due interests, commission expenses and other due Bank will return any amount standing to the Account Holder's
charges. If the Account Holder does not pay such indebtedness credit to his/her registered address or issue bank drafts for the
to the Bank upon rst request, the Account Holder herewith Account Holder's pick-up at the branch of account domicile,
authorizes the Bank to set off the outstanding balance without after deduction of any tax, charges and fees (if applicable.)
having to notify or inform the Account Holder beforehand. This
authorization is irrevocable and the Account Holder cannot 14. If the Bank discontinues a product that the Account Holder has
cancel it without the Bank's written consent. The Bank shall with the Bank, the Bank may close the Account Holder's
have the right to always set off the balance in the Account account by giving the Account Holder a notice. A suitable

5
 GENERAL TERMS AND CONDITIONS (Contd.) 16.9 Either party may terminate this service upon seven days'
notice. However, the Bank may terminate this service
alternative account (if there is one) will be indicated to the with or without notice if circumstances so warrant.
Account Holder. If the Account Holder does not give the Bank
instructions to the contrary, the Bank will transfer the funds to Change in Terms, Conditions and Regulations
that account when the Bank closes the Account Holder's 17. It is agreed that the Bank shall have the right to modify the
account. nature, conditions, and stipulations of these general terms and
15. The Account Holder may close his/her account for any reason conditions including the rate of interest, commissions and
and the Account Holder's existing credit balances shall be paid other conditions to any account by a written notice to the
provided that: Account Holder or by notice through any other medium. Any
(a) The Account Holder destroys all cheques issued on the such amendments shall be binding on the Account Holder
account; from the date of the said notice whether or not the Account
(b) The Account Holder repays any money owed the Bank Holder actually received the notice.
including the amount of any cheque, card transactions or
other payment instructions and any charges or interest 18. The Account Holder agrees to accept as due noti cation any
incurred which the Bank had not debited to the account. notice of change in conditions governing the account directed
to the Account Holder's last known address or through any
The Account Holder hereby agrees that the Bank's action in other medium and to be bound by such change.
closing the account shall be effective and binding upon the
Account Holder as from the date of the said notice. The Account Accounts of Non-Residents and USA Persons
Holder hereby irrevocably waives in advance any right, 19. If the Account Holder resides outside Nigeria, the Account
whether legal or otherwise, that the Account Holder may have Holder shall ensure that the account complies with any law or
against the Bank in any proceedings whatsoever to complain rules applicable where the Account Holder resides, including
about the Bank's actions and/or decisions to close the account. any tax, foreign exchange or capital controls and with all
payments, reporting or ling requirements that may apply as a
Transaction Noti cation Services result of the Account Holder's country of citizenship, domicile
16. The use of Transaction Noti cation Service shall be subject to or residence. The Account Holder agrees to provide the Bank
the following terms and conditions: with such information as the Bank may reasonably require from
time to time, enabling the Bank or any of its subsidiaries to
16.1 The Transaction Noti cation Service is an information
comply with any applicable law. Where an Account Holder does
service which is given after the occurrence of a
not provide the requisite documentation in line with the
transaction. All transaction messages sent by alerts are
United States Foreign Accounts Tax Compliance Act (FATCA)
therefore presumed and treated as having been
requirements within 90 days from the date of the request, the
authorized by the Account Holder and the Bank shall
Bank may at its sole discretion close the account.
therefore have no liability whatsoever to the Account
Holder.
20. The Account Holder must contact the Bank immediately or at
16.2 The Account Holder hereby accepts responsibility for the the latest within 30 (thirty) days if the Account Holder becomes
con dentiality and security of the alert and shall ensure a USA citizen. If the Account Holder becomes a USA citizen,
that his/her mobile device is in safe custody and that the he/she must complete and return to the Bank as soon as
Account Holder alone has access to his/her email alert. reasonably possible any relevant USA tax or waiver
16.3 The Bank shall not be liable for any loss arising from the documentation that applies to the him/her and that the Bank
Account Holder's inability to receive noti cation due to may request from time to time.
system downtime arising from:
(a) Circumstances beyond its control, including strikes Account Information Changes and Information Sharing
and disputes. 21. The Account Holder must contact the Bank immediately or at
(b) System maintenance upgrading or similar the latest within 30 (thirty) days if at any time in the future there
circumstance. is a material change to the information that he/she had
previously provided to the Bank.
(c) Failure of service provider to deliver noti cation on
time.
22. Except where the Bank is negligent or in willful default, the
16.4 The Account Holder agrees to pay the Bank's fees and Bank shall have no responsibility to the Account Holder if any
commission as may be speci ed from time-to-time, for information the Bank holds about the Account Holder is or
the provision of this service. The Account Holder hereby becomes inaccurate, incomplete or stale.
authorizes the Bank to debit any of his/her account(s)
with such fees and commission. 23. Subject to applicable local laws, the Account Holder hereby
16.5 The Account Holder agrees that his/her rights under this agrees that Greenwich Merchant Bank Limited or any of its
agreement are personal and therefore not assignable or subsidiaries and affiliates can share the Account Holder's
transferable. information with domestic or foreign regulators/tax
authorities where necessary to establish his/her tax liability in
16.6 If the Bank provides by email, any con dential
any jurisdiction, where required by domestic or foreign
information requested by the Account Holder, the
regulators/tax authorities. The Account Holder agrees that the
Account Holder agrees that the Bank shall not be liable if
Bank may withhold or pay out from the Account Holder's
the information provided is lost or intercepted, altered or
account(s) such amounts as may be required according to
misused by a third party.
applicable laws, regulations, agreements with regulators or
16.7 Where the Account Holder's mobile device is lost, authorities.
missing or stolen, the Account Holder undertakes to
make a report to the Bank within 24 hours for the service 24. The Account Holder agrees to comply with all terms and
to be terminated. conditions issued by the Bank governing the use of electronic
16.8 The Bank shall not be liable for any information that is banking services which the Bank may from time to time offer
disclosed to any unauthorized person due to the Account and provide to the Account Holder in order to ensure banking
Holder's negligence. convenience.

6
 GENERAL TERMS AND CONDITIONS (Contd.) arising from loss of memory of same, or that it has come
to the notice of a third party, the Bank shall, with the
Electronic Banking Terms & Conditions consent of the Account Holder, delete same and
25. The Account Holder con rms and agrees that the following thereafter allow the Account Holder to enter a new
terms and conditions shall govern his/her electronic banking password/PIN provided that the Bank shall not be
transactions with the Bank. responsible for any loss that occurs between the period
25.1. “Service” means the Electronic Banking Services of of such loss of memory of the password/PlN or
Greenwich Merchant Bank Limited (“the Bank”), knowledge of a third party and the time the report is
including ATM Transaction, Internet Banking, Device lodged with the Bank.
Banking, Secure Message Facility and Bills Payment ( g) Once an Account Holder's password/PIN is applied, it
Services. shall be sufficient con rmation of the authenticity of the
25.2. “Usernames and Password” means the enabling code instruction given.
with which the Account Holder accesses the system and (h) The Account Holder shall be responsible for any
which is known to the Account Holder only. instruction given by means of the Account Holder's
25.3. “Account” means a current or investment account or password/PIN. Accordingly, the Bank shall not be
other account(s) maintained with the Bank at any of the responsible for any fraudulent, duplicate or erroneous
Bank's branches in Nigeria and/or other countries. instructions given by means of the Account Holder's
password/PIN
25.4. “PIN” means the Account Holder's Personal Identi cation
Number. 27. Where an ATM card is issued to an Account Holder, the card
shall remain the property of the Bank at all times. The Bank may,
25.5. “Mailing Address” means the Account Holder's mailing at its sole discretion, cancel the ATM card and request its return
address in the Bank's records as updated from time-to- at any time, in which case the Account Holder shall
time. immediately comply with such request.

25.6. “Instruction” means the Account Holder's request to the 28. The ATM card is issued entirely at the risk of the Account Holder
Bank for services. who shall indemnify the Bank for all loss or damage howsoever
caused resulting from the use of the card. The Account Holder
25.7. 'ATM” means Automated Teller Machine that dispenses shall take every possible care to prevent the card from being
cash or receives cash/cheque lodgement and also lost, mislaid or stolen and the Account Holder undertakes not
performs other electronic banking transactions with the to pass the card to any other person.
use of a debit or credit card.
29. The Account Holder shall notify the Bank immediately if the
25.8. “ATM Card” means the card used by the Account Holder for
ATM card is lost, mislaid or stolen or if it comes into the hands of
processing transactions through Automated Teller
a third party or if the PIN is unwittingly or otherwise disclosed
Machine.
or made available to a third party. In all circumstances, the Bank
25.9 “Secure Message Facility” means the facility within the e- will not be liable for any damages or loss resulting from loss of
Banking Service that enables the client to send electronic the card. Where oral notice of loss or theft is given, the Account
messages (e-mail, SMS) to the Bank, including without Holder shall ensure that such is communicated in writing to the
limitation, free-format messages, xed format messages, Account Holder's branch of the Bank within 48 hours of the
or instruction to make payments, requests for cheque receipt of oral notice.
books, banker's drafts or the purchase or sale of securities
and interest in mutual fund. 30. The Bank shall debit the Account Holder with the amount of
any withdrawal, transfer, payment for goods and services at
26. The Password/E-mail point of sales (POS) terminals and all such payments as are
(a) The Account Holder understands that his/her effected by the use of the ATM card along with the related bank
password/e-mail is to be used to give instructions to the charges.
Bank and accordingly undertakes:
(i) That under no circumstance shall the password be 31. The Bank reserves the right to limit the total cash withdrawn by
disclosed to or assessed by anybody. the Account Holder and total amount spent on POS terminals
during any 24-hour period. The Bank shall not be responsible
(ii) Not to write the password to avoid third party
for any loss or damage arising directly or indirectly from any
coming across same.
malfunction or failure of the ATM card or the ATM or the
(b) The Account Holder instructs and authorizes the Bank to temporary insufficiency of funds in such machine.
comply with any instruction given to the Bank through
the use of the service. 32. The Account Holder's Responsibility:
(c) Once the Bank is instructed by means of the Account (a) The Account Holder undertakes to be absolutely
Holder's PIN the Bank is entitled to assume that those are responsible for safeguarding his/her username,
the instructions given by the Account Holder and to rely password and PIN. Under no circumstance shall the
on same. Account Holder disclose any of all of these to any person.
(d) The Account Holder's password/PIN access code must be (b) The Account Holder undertakes to ensure the secrecy of
changed immediately it becomes known to someone his/her password/PIN by not reproducing same in any
else. manner whatsoever either in writing or otherwise
capable of making it known to persons other than the
(e) The Bank is exempted from any form of liability
Account Holder.
whatsoever for complying with any or all instruction(s)
given by means of the Account Holder's password/PIN if (c) The Bank is expressly exempted from any liability arising
by any means: the password/PlN becomes known to a from unauthorized access to the Account Holder's
third party or otherwise becomes compromised; account and/or data as contained in the Bank's records
via its services, which arises as a result of inability and/or
(f ) Where an Account Holder noti es the Bank through e-
otherwise of the Account Holder to safeguard his/her
mail of his/her intention to change his/her password/PIN
PIN, password and/or failure to log out of the system

7
 GENERAL TERMS AND CONDITIONS (Contd.) Bank's hotline: +234 (1) 6370000, or send email to
customercare@greenwichbankgroup.com and notify the Bank
completely by allowing on screen display of his/her in writing within 24 hours of the loss/theft of device or
account information. computer and or email/password compromise.
(d) The Bank is further relieved of any liability as regards
breach of duty of secrecy arising out of the Account 39. The Bank in its absolute discretion and without prior notice can
Holder's inability/failure to scrupulously observe and temporarily suspend any, or all of the services or terminate
implement the provisions of the above clauses. them completely.
(e) The Account Holder's access code and password must be
changed immediately it becomes known to anyone else. E-mail Indemnity
The Account Holder is therefore under a duty to notify The Account Holder hereby requests the Bank to act in accordance
the Bank by contacting the Bank's customer care centre with any instructions, information or other communications
by telephone and in writing whenever his/her access furnished to the Bank, which reasonably appear to have been
code and/or password is suspected to be or has become furnished by the Account Holder on his/her behalf by email. This
known to another person. a p p l i e s w h e t h e r t h e y a re t ra n s m i t te d d i re c t l y f ro m a
computer/device owned by him/her or otherwise. This applies at any
(f ) The Account Holder shall be responsible for any fraud, time, and in relation to any business or transactions, which he/she
loss and/or liability to the Bank or third party arising from may have with the Bank, or in which the Bank may be acting on
usage of the Account Holder's access code, password his/her behalf or in accordance with his/her instructions.
and/or PIN by either a third party or through other
unauthorised access. Accordingly, the Bank shall not be The Account Holder acknowledges receipt of the following
responsible for any fraud that arises from usage of the warning:- The Bank cannot detect from inspection of e-mails
Account Holder's access code, password and/or PIN. whether the original document from text or other content of any
(g) The Account Holder undertakes to ensure that his/her email (or any document or other le attached to an email) was
PIN is not one that can be easily guessed by anyone forged, unauthorized, wrongfully altered, misused or whether any of
including but not limited to addresses, telephone the transmission details included in a received email such as the
numbers, anniversaries, birthdays, simple sequence sender's name, the sender's email address, the date or time of
numbers, etc. sending, server details or the route through which the email
travelled are false.
33. Upon enrolling an Account Holder for the service, the Account
Holder may be charged the applicable monthly fee and/or Because of this, the Account Holder realises that the Bank cannot
usage fee whether or not the Account Holder makes use of the accept any liability for loss or damage to him/her resulting from
service during the period in question. failure to detect such matters in any document or email furnished or
appearing to have been furnished by him/her. The Bank requires the
34. Under no circumstances will the Bank be liable for any following indemnity before agreeing to the Account Holder's
damages including without limitation, direct or indirect, request.
special, incidental or consequential damages, losses or
expenses arising in connection with this service or use thereof The Account Holder acknowledges the Bank's warning and
or inability to use by any party, or in connection with any failure indemni es the Bank against any actions, damages, costs, claims,
of performance, error, omission, interruption, defect, delay in demands or losses arising from the Bank acting in accordance with
operation, transmission, computer virus or line or system any document or email which appears to have been furnished by the
failure, even if the Bank or its representatives thereof are Account Holder or on his/her behalf. This Indemnity applies even if
advised of the possibility of such damage or losses. any such document or email was produced by or contains or has
attached any forgery, lack of authority, wrongful alteration or other
35. The Account Holder acknowledges that the alert and other misuse of a document, text or le or any transmission details or
information sent to him/her or accessed by him/her contain information appearing on it are not genuine. This indemnity applies
con dential information and should such information be sent even if any such document or email was not in fact issued by the
to a third party through no fault of Greenwich Merchant Bank Account Holder or with his/her authority.
Limited, the Bank shall not be held liable.
Declaration
36. The Bank will not be liable for non-delivery or delayed delivery I hereby authorise and grant consent to the Bank to carry out the
of alerts or emails, or for errors, losses or distortions in necessary checks on me at the various bureaus and reference
transmission of alerts and emails to the Account Holder. The agencies and share my information with such agencies. The Bank is
Bank shall not be liable for non-receipt of alerts due to technical discharged from any form of liability or damages made against the
defects on the Account Holder's device or computer or any Bank by virtue of my granting this consent.
damage or loss incurred by the Account Holder as a result of
causes not directly attributable to the Bank. Authority To Open an Account
I hereby apply to open an account with Greenwich Merchant Bank
37. The Bank shall not be liable to the Account Holder, or to any Limited. I understand that the information and the documents
third party for any drawing, transfer, remittance, disclosure, or supplied herein are the basis for the account opening. I therefore
any activity, or incidence on the Account Holder's account, attest that such information is correct.
whether authorized by the Account Holder or not, provided
that such drawing, transfer, remittance, disclosure, or any I have read and understood all the Terms and Conditions governing
activity or incidence was the Account Holder authorized or the account and I agree to be bound by same.
made possible by the fact of the knowledge and/or use or
manipulation of the Account Holder's password or otherwise
by the Account Holder's negligence. The Account Holder _______________________________
hereby acknowledges that his password shall be known only to Account Holder's Name
him and kept secret at all times.

38. In the event of loss or theft of the device or compromise of the _______________________________
security of the email account, the Account Holder shall call the Account Holder's Signature and Date

8
 FOR OFFICIAL USE ONLY

S/N REQUIREMENTS CHECKED DEFERRED WAIVED N/A

A Duly completed and signed specimen signature card

B Clear passport-size photograph with the Account Holder’s Name and Signature
on the reverse side

C Means of Identi cation of the Account Holder

D Proof of Residential Address

E Valid Residence Permit (for Non-Nigerians only)

F Power of attorney (where applicable)

G Two (2) independent and satisfactory references.

AUTHENTICATION FOR POLITICALLY EXPOSED PERSONS

Is the applicant a politically exposed person? Yes No

Is the applicant related to a politically exposed person? Yes No

If yes, state relationship

ADDRESS VERIFICATION CARRIED OUT BY

Staff ID Comment(s)
Surname

First Name

D D M M Y Y Y Y

Signature Date

ACCOUNT OPENED BY DEFERRAL /WAIVER OF DOCUMENTS (IF ANY) AUTHORISED BY

Staff ID Staff ID

Surname Surname

First Name First Name

D D M M Y Y Y Y D D M M Y Y Y Y

Signature Date Signature Date

ACCOUNT OPENING AUTHORISED/APPROVED BY

Staff ID

Surname First Name

D D M M Y Y Y Y

Signature Date

ACCOUNT DETAILS

BRANCH BRANCH ACCOUNT

CODE NUMBER