Regulatory Alerts2020-04-06
Investor’s Data and Consent Form
This form requires individual and corporate investors to provide detailed personal, professional, and financial identification data for regulatory and transaction processing purposes. It includes specific sections for next-of-kin details, business ownership structures, and capital market operator information. By signing the document, the investor grants authorization for their data to be shared among various securities entities and mandates that all investment proceeds and returns be paid into the disclosed bank account.
Investor’s Data and Consent Form
INSTRUCTION
Please complete in capital letters.
SECTION A – INVESTOR’S DATA (PERSONAL)
Title Surname First Name Other Names
Maiden Name (if any): NIN: TIN:
Current Address:
City: State:
Post Code: Country:
Previous Address (if any):
City: State:
Post Code: Country:
Nationality: Gender: Male: [ ] Female: [ ] Date of Birth: DD/MM/YYYY
Phone Number 1: Phone Number 2:
E-mail Address:
Alternate E-mail Address:
Bank Verification Number (BVN):
Bank Name: Bank Branch:
Bank Account Number: Bank Account Opening Date: DD/MM/YYYY
SECTION B: NEXT OF KIN
Next of Kin Name:
Next of Kin Address:
City: State: Country:
Phone Number 1: Phone Number 2:
E-mail Address:
Alternate E-mail Address:
SECTION C – INVESTOR’S DATA (COMPANY/ FIRM) (Please tick appropriately)
Company’s Name:
RC Number: CAC Registration Date: DD/MM/YYYY TIN:
Current Address:
City: State:
Post Code: Country:
Previous Address (if any):
City: State:
Post Code: Country:
Phone Number 1: Phone Number 2:
E-mail Address:
Alternate E-mail Address:
Bank Name: Bank Branch:
Bank Account Number: Bank Account Opening Date: DD/MM/YYYY
Nature of Business:
Beneficial Ownership:
| S/N | Name | Full Address |
|---|---|---|
| 1. | ||
| 2. | ||
| 3. | ||
| 4. |
Source of Funds:
Directors/ Partners
| S/N | Name | Address | BVN | NIN |
|---|---|---|---|---|
| 1. | ||||
| 2. | ||||
| 3. | ||||
| 4. | ||||
| 5. | ||||
| 6. | ||||
| 7. | ||||
| 8. | ||||
| 9. | ||||
| 10. |
SECTION D – CAPITAL MARKET OPERATOR (CMO) DETAILS
Name of CMO:
Function(s):
Stockbroker’s Code (If any): Registrars’ ID No (If any):
CONSENT CLAUSE
I/We ___________________________ hereby give consent that my/our data may be processed by authorized entities such as Broker/Dealers, Fund/Portfolio Managers, Clearing Houses, Depositories, Registrars, Banks, Custodians, Nominees, Exchanges, Securities & Exchange Commission(SEC) and other authorized entities approved by SEC for the purpose of my/ our transactions in securities and other purposes directly related to it. I/ we further consent that my/our data can be shared between these entities for the purpose of performing the service. The proceeds of sale of my/ our investments and return on investments including dividend, interest, lease rentals and any other form of return on investments should be paid to the bank account disclosed in this form.