Uniform Account Opening Forms

Financial Policy & Re n Department Central Business Distri Garki, Abuja, Te09-46237401: 09-462 37404 E-mail: fprd@cbn.gov.ng FPR/DIR/CIR/GEN/01/034 2nd October, 2012 CIRCULAR TO ALL BANKS AND OTHER FINANCIAL INSTITUTIONS UNIFORM ACCOUNT OPENING FORMS The absence of uniformity in account opening procedure and documentation for prospective customers has continued to hinder the effectiveness of KYC requirements in banks and other financial institutions in Nigeria. The adverse implication of this on the fight against money laundering and the combating of financing of terrorism cannot be overemphasized. The CBN, in conjunction with the Committee of Chief Compliance Officers of Banks in Nigeria (CCCOBIN) has therefore developed draft uniform account opening forms for adoption by banks and other financial institutions in order to: increase the effectiveness of customer due diligence (CDD); i.

ii.

comply with AML/CFT standards; and iii. facilitate quick investigation of financial crimes by relevant agencies.

In line with best practice, you are please requested to make your comments and critique on the draft documents structured as follows: i. FORM A- Account Opening Form for Individuals; ii. FORM B- Account Opening Form for Companies, Partnership & Sole Proprietorship; and iii. FORM C- Account Opening Form for Designated Non-Financial Businesses and Professions (DNFBPs).

Hard copies of your comments and response should be forwarded to the Director, Financial Policy and Regulation Department (FPRD) by 5th November, 2012 while soft copies be mailed to uaobot@cbn.gov.ng and abisah@cbn.gov.ng accordingly.

FOR: DIRECTOR, FINANCIAL POLICY AND REGULATION DEPARTMENT Affix Passport Photograph here

Account Opening Form-Individual

Account type ( Please indicate the type of account you want to open by ticking in the box below & Joint Account Current Account Savings Account Domiciliary Account ACCOUNT No. (for official use only) This form should be completed in CAPTAL LETTERS using ELACK INK. Characters and marks should be similar in style to the Salowing ESSEE I. PERSONAL INFORMATION Title

Surname First Name Middle Name Other (please specify) Married Marital Status (Please tick) Single Gender F M Date of Birth NO i 94 Mether's Maiden Name Nationality (for non Nigerian) Resident permit No.

State of Origin LGA Tax Identification Number (TIN) 2. CONTACT DETAILS Residential Address Street Number Street Name City! Town Landmarks Phone Number (I) Phone Number (2) E-mail Address 3. MEANS OF IDENTIFICATION International Passport National Driver's License · Other (please specify) National ID Card ID Expiry Date ID No.

ID Issue Date In pecular circumstances - Artisans, Petty Traders, Soudents who may not tuve the prescribed ID 's 4. ACCOUNT SERVICE(S) REQUIRED (Please tick eption below) Visa Card Master Card Card Preferences: Verve /ATM Card Biometric ATM Internet Banking Token (Fee applies) Mobile Banking Internet Banking Preferences: Internet Banking SMS Alert (Fee applies) Transaction Alert Preferences: Email Alert (Free) Somi Quarterly Post Frequency: Monthly Quarterly Statement Preferences: Email Crossed Cheque 50 Leaves 100 Leaves Cheque Book Requisition: Opened Cheque Cheque Confirmation Threshold: You will be required to pre confirm any cheque above Nxxx,000.00 if you would like to have a higher threshold for

pre-confirmation, please specify the amount (i.e threshold above Nxxx,000.00) 1 5. EMPLOYMENT DETAILS ACCOUNT No. (for official use only) Unomployed Retired Self Employed Employed Ino Date of Employment (if employed) Student Other (Please specify) Employer's Name Employer's /Employment Address Street Number Street Name City/ Town Nearest Bus Stop Nature of Business/ Occupation Olfice Phone Number Fax Number 6. DETAILS OF NEXT OF KIN Surname Middle Name First Name Relationship E-mail Address: Contact Details Street Number Street Name Mobile Number City/Town Nearest Bus Stop 2

Affix Passport Photograph here Title Surname First Name Middle Name Gender 7b. CONTACT DETAILS: Street Name Student Retired Street Name 7a. PERSONAL INFORMATION FOR SECOND OR JOINT APPLICANT Married Other (please specify) Marital Status (Please tick) Single Date of Birth Mother's Maiden Name Resident permit No.

Nationality (For non Nigerian) LGA State of Origin Tax Identification Number (TIN) Residential Address Street Number Gryl Town Nearest Bus Stop Phone Number (2) Phone Number (I) E-mail Address 7c. MEANS OF IDENTIFICATION International Passport National Driver's Licenso ID Issue Date in pacular circumstances - Artisans, Perry Traders, Seudenes who may not hive the prescribed ID 's . Other (plasse specify) National ID Card ID Expiry Date ID No 7d. EMPLOYMENT DETAILS: Unemployed Other (Please specify) Self Employed Employed Date of Employment (if employed) Employer's Name Employer's /Employment Address Street Number City/ Town Landmarks Nature of Business/ Occupation Fax Number Offica Phone Number M F . Per 3 rea e 7e. DETAILS OF NEXT OF KIN Surname Middle Name First Name Relationship Mobile Number E-mail Address: Contact Decails Street Number Street Name City/Town Landmarks

8. Particular Of Referees

l.

Surname Middle Name First Name Name of Bank/Branch Banker's Address: 2 Surname Middle Name First Name Name of Bank/Branch Banker's Addross:

9. Additional Details

l Educational Qualification: II Name of Beneficial Owner(s):

Certification Date:

III Spouse's Name: E E IV Spouse Date of Birth: V Sources of Fund to the Account:

VII Name of Children:	DATE OF BIRTH	ADDRESS/E-MAIL
S/N	NAME	(DDMMMM)

VI Sources of Wealth of the Account holder: 4 .

.

VIII Name of Associated Business(es): I.
		2
		3.
IX Type of Business:
x	Business Address:
XI ACCOUNT HELD WITH OTHER BANKS :
S/N	NAME AND ADDRESS OF
BANK/BRANCH	ACCOUNT NAME	ACCOUNT NUMBER	DATE ACCOUNT
OPENED	STATUS: ACTIVE
l.
2
3.
4.

E

Io. Terms And Conditions I I. Account Opening Mandate

Joint a. Type of Account (Please tick os appropriate) | Current Savings Domiciliary b. Name of Organization ............

c. Account No. d. Signatories: i Middle Name First Name Name: Surname Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature Middle Name iii. Name: Surname First Name Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature Middle Name First Name v. Name: Surname Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer

Signature ii. Name: Surname Middle Name First Name Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature iv. Name: Surname First Name Middle Name Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature vi Name: Surname First Name Middle Name Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Signature NOTE: The institution can provide more space if the number of Signatories to the account is more than spaces (6) provided.

6 Name of Officer 12. DECLARATION: I/We hereby apply for the opening of account(s) with ...

. .

the basis for opening such account (s) and I/We therefore warrant that such information is correct.

I/Wa have read the terms and conditions governing the operations of the account(s) which are presented overleaf and agreed to be bound by them.

Signature ACCOUNT No. (for official use only)

Hecklist (For Bank Use Only)

Savings Account
DOCUMENTS REQUIRED	CHECKED	DEFERRED	WAIVED
S/N	Duly completed Account opening form
l.	Specimen signature card duly completed
2
3.	Three (3) recent passport photographs
Proof of Identity: International passport, Driver's license or National ID card
4.	(original must be sighted)
Proof of Address: Utility bill (Certified true copy is acceptable if original is not heid)
5
6.	Letter from Employer / School / NYSC (ior salary account and or Student only)
7.
Current/Domiciliary Account
S/N	DOCUMENTS REQUIRED	CHECKED	DEFERRED	WAIVED
l.	Duly completed Account opening form
2	Specimen signature card duly completed
Three (3) recent passport photographs
3.	Two (2) independent and satisfactory references
4.	Proof of Identity: International passport, Driver's license or National ID card
5.	ust bo sighted
Proof of Address: Utility bill (Certfied true copy is acceptable if original is not held)
6
7.	Letter from employer (for salary account only).
8	Resident permit (for domiciliary account only)
Other Documents Provided
9.

14. Authentication For Financial Inclusion

l.

Is the customer socially or financially disadvantaged? YES ii.

If answer to the question (i) above is yes, state other documents obtained in line with the bank's policy on social/financially disadvantaged customer in compliance with paragraph 2.6.1.5.8 of AML/CFT Regulation, 2009 ...

...

...

.. NO.L ...

iii.

Dove stishe [ toder Risk ti dillig 6 Reskuil hent ?

15. AUTHENTICATION FOR POLITICALLY EXPOSED PERSONS ls the Applicant a Politically Exposed Person?

YES For Bank Use Only: A. ACCOUNT OPENED BY: Name Date: Name Date: B. DEFERRAL/WAIVER OF DOCUMENT(IF ANY) AUTHORISED BY: Name Date: Name Date: C. ADDRESS VERIFICATION CARRIED OUT BY Name Date: Signature .

Name Date: COMMENT(S): D. ACCOUNT OPENING APPROVED BY: Name Date: Name Date: Signature .

Signature : .

Signature: Signature : cos environ Signature: ...

e management more and the may be and A PRODUCTION PRODUCTION A COLLECTION COLLECTION CONTRACTOR COLLECTION CONTRACTOR THE and and the management of the manage of the work of the world with a would be the world and the many of the may be and Signature: Signature .

8 ACCOUNT OPENING FORM - COMPANIES, PARTNERSHIP & SOLE PROPRIETORSHIP Account Type(please tick) Current Account [ Fixed Deposit Account ] Domiciliary Account [ BRANCH .

ACCOUNT No. (for official use only) I. COMPANY DETAILS ( Please complete in BLOCK LETTERS and tick where necessary) Company Name Certificate of incorporation number Date of Incorporation Type of Business Operating Business Address Corporate Business Address/ Registered office (if different from above) Email address Website (if any) Phone Number (1) Phone Number (2) CRM No/ Borrower's Code Tax Identification Number (TIN) 2. ANNUAL TURNOVER N5 Billion - Above N4,99Billion-N500 Million N499.9Million - N50 Million No N49.9 Million Below Is Your Company Quoted On The Stock Exchange?

Yes 3. ACCOUNT SERVICE(S) REQUIRED (Please tick option below) Verve /ATM Card Card Preferences: Master Card (Cards Are Applicable For Sole Proprietorship Account Only) Visa Carc Internet Banking Preferences: Internet Banking Internet Banking Token (Fee applies) Mobile Banking Biometric AT Transaction Alert Preferences: Email Alert (Free) SMS Alert (Fee applies) Post Frequency: Monthly Statement Preferences: Email Quarterly Somi Quarterly Cheque Book Requisition: Opened Cheque IOO Leaves Crassed Cheque 50 Leaves

4. Cheque Confirmation Threshold

You will be required to pre confirm any cheque above Nxxxx,000.00 If you would like to have a higher threshold for pre-confirmation, please specify the amount (i.e threshold above Nexx,000.00)

5. Key Contact Persons /Principal Officers Details:

5. KEY CONTACT PERSONS /PRINCIPAL OFFICERS DETAILS:
I. Surname
First Name
Middle Name	E	a
Date of Birth	Gender: M	F	Mother's Maiden Name;
	ID Number
Means Of Identification
Occupation
Job Title
Residential Address
Mobile Number	E-mail:
2. Surname
First Name
Middle Name	I MARKET IN
-C	e	Gender: M	F	Mother's Maidon Name:
Date of Birth
Means Of Identification	ID Number
Occupation
Job Ticle
Residential Address
Mobile Number	E-mail:
3. Surname
First Name
Middle Name	ED	DI NAME
Date of Birth	Gender: M	F	Mother's Maiden Name:
	l		ID Number
Means Of Identification
Occupation
Job Title
Residential Address
Mobile Number	E-mal:
4. Surname
First Name
Mickle Name	leg	IDA MARKE &
Date of Birth	Gender: M	E	Mother's Maiden Name:
Means Of Identification	ID Number
Occupation
Job Title
Residential Address
Mobile Number	E-mail:

2

6. Account Signatory'S Details

l Sumame First Name Middle Name E Gender: M F Mother's Maiden Name: Means Of Identification Occupation Job Title Residential Address

ID Number Occupation Job Title Residential Address Mobile Number Class of Signatory (Please indicate class in the box provide) First Name Middle Name EDS E Gender: M F Mother's Maiden Name: Date of Birth Occupation Job Title Residential Address Mobile Number E-mail: Sigancure - Date NISH E os HO Class of Signatory (Plaze indicate class in the box provide) Surname First Name Middle Name Gender: M F Mother's Maiden Name:

ID Number Date of Birth

H Means Of Identification HEAT IN o o Date in

B I Date of Birth Surname 3.

E-mail: Siganture - Class of Signatory (Plass indicate class in the box provide) II II no D EN EV EM Date Siganture - E-mail: Means Of Identification ID Number Mobile Number 3 .

7. Director'S Details

I, Sumame Middle Name Date of Birth

CON RANGE IN

F Gender: M Mother's Maiden Name: Means Of Identification

ID Number Residential Address Mobile Number E-mail: Date LAND A Siganture - Date of Birth First Middle Name E PROD MARK I Gender: M F Mother's Maiden Name: Occupation

ID Number Means Of Identification Mobile Number E-mail: Siganture - Date E ea EK 3. Surname First Name Middle Namo Date of Birth Means Of Identification Occupation Job Title Residential Address Mobile Number E-mail: Siganture - Mother's Maiden Name: ID Number Gender: M F Residential Address Job Title Job Title 2. Surname First Name First Name Occupation E ar 4 Date 8, FOR SOLE PROPRIETORSHIP I. PERSONAL INFORMATION Title First Name

Surname Middle Name Gender F Nick Name M 14 Married Marital Status (Please tick) Single Other (please specify) Date of Birth Mother's Maiden Name Resident permic No.

Nationality (for non Nigeriar) LGA Street Number Street Name City/ Town Landmarks Phone Number (2) Phone Number (I) E-mail Address III. MEANS OF IDENTIFICATION National Driver's License International Passport

e ID Issue Date ID No.

· People in pecvlier crounstances - Artisans, Petty Traders, Students who may not have the proscribed ID 's

• Other (please specify) EHS ID Expiry Date National ID Card IV. DETAILS OF NEXT OF KIN First Name Contact Details Street Number Street Name E-mail Address: City/Town Landmarks 5 Surname Mobile Number Relationship II. CONTACT DETAILS Residential Address Middle Name Bla Tax Identification Number (TIN) State of Origin V. DETAILS OF NEXT OF KIN Surname e Middle Name First Name Fielationship E-mail Address: Contact Details Street Number Street Name City/Town Nearest Bus Stop

9. Additional Details:

l. Name of affiliated company/Body: I.

II. PRINCIPAL SHAREHOLDERS (Shareholding of 5% and above) a Surname Middle Name First Name Residential Address:

Percentage holding

Scitus Mobile Number E-mail Address: b. Surname Middle Name First Name Residential Address; Status Moble Number E-mail Address: c Surname Middle Name First Name Residential Address; Scatus Mobile Number E-mail Address: 6 .

Percentage holding

Percentage holding

Mobile Number

IV. DIRECTOR BANK ACCOUNT DETAILS	STATUS:
	NAME AND ADDRESS OF
S/N	ACCOUNT NAME	ACCOUNT NUMBER	DATE ACCOUNT
OPENED	ACTIVE/DORMANT
	BANK/BRANCH
1-
2.
3.
4.

III. DETAILS OF ACCOUNT HELD WITH OTHER BANKS BY THE PROSPECTIVE COMPANY/PARTNERSHIP/SOLE PROPRIETORSHIP
	NAME AND ADDRESS OF	STATUS:
S/N	ACCOUNT NAME	ACCOUNT NUMBER	DATE ACCOUNT
OPENED	ACTIVE/DORMANT
	BANK/BRANCH
l.
2.
3.
4.

Io. Particulars Of Referees

l.

Sumarne Middle Name First Name Name of Bank/Branch Bankar's Address: 2. Surname Middle Name First Name Name of Bank/Branch Banker's Address: 7

Ii. Authority To Debit Account For Search Fee

.................................................................................................... Bank Plc ... ...

Dear Sir, We hereby authorize you to debit our account with the sum of N ....................................................... being the legal cost of search conducted on our account at the Corporate Affairs Commission.

Thank you. Yours faithfully,

12. Letter Of Set-Off

Miss/Mr/Mrs/Chief .

...

...

...

...

l/ We agree that you (in addition to any general lien or similar right to which you as my/our banker may have at any time and without notice to me/us) combine or consolidate all or any of the company's accounts with all liabilities to you and set off or transfer any sum standing to the credit of any such accounts, be it cash, cheques, valuable, deposits, securities, negotiable instruments or other assets belonging to me/us with you in or towards satisfaction of any of my/our liabilities to you or any other account or in any other respect, whether such liabilities be actual or contingent, primary or collateral, several or joint.

8

13. Account Opening Mandate

a. Type of Account ( b. Name of Organization .

c. Account No.

d. Signatories: i Name: Surname First Name Middle Name Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY

Signature Name of Officer Middle Name iii Name: Surname First Name Identification Type: PHOTO ldentification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature

Middle Name First Name Name: Surname Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer it Name: Surname Middle Ham First Name Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature Name: First Name Aliddle Name Surasma Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature vi Name: Surname First Name Middle Name Identification Type: PHOTO Identification No: Signature & Date FOR BANK USE ONLY Name of Officer Signature NOTE: The institution can provide more space if the number of Signatories to the account is more than spaces (5) provided.

: 9 Signature

14. Terms And Condition

tha

15. Mandate & Resolution

CUSTOMER INFORMATION I/ We hereby apply for the opening of any occount or accounts with opening such account(s) and hereby warrant that such information is carrect.

I/We agree to use the account for only transactions permitted by law and to be bound by the terms and condifions governing the operation of the account(s).

Authorized Signature of the Customer /Representative & Date Authorized Signature of the Customer /Representative & Dote 16. SIGNED, SEALED & DELIVERED BY THE WITHIN NAMED PERSON Name Status Date Signature --------- Name Date Signature .

Name Address Occupation Signature wom edda and and in the see a see a see a more of the mail of IN CONSULTION COLLECTION Date 10 Company Seal here

17. In The Presence Of:

Status

For Bank Use Only

18. REQUIREMENTS CHECKLIST	CHECKED	DEFERRED	WAIVED	N/A
S/N	DOCUMENTS REQUIRED
l.	Account opening form duly completed
	Specimen signature card duly completed
2
3.	Copy of certificate of incorporation
	Board Resolution
4.	Copy of Memorandum and Article of Association
(cortified as true copy by the Registrar of Company)
5	(a)Form C07 Particulars of Directors
6.
7.	(b)Form C02 Allotment of Shares
	Partnership Deed
8.	Approval Letter ( for Government Agency)
9.
IO.	Gazette( for Government Agency)
	Two(2) passport sized photographs of each signatory to the account with
=	name written on the reverse Side
	Introduction letter with two (2) passport sized photographs of contact
12	persons or authorized agent
13.	Status report from Banker ( where Applicable)
	Resident Permit ( for non Nigerians)
14	Evidence of Registration with NIPC
15
16	Search Report
17.	Power of Attorney
18	Letter of indemnity
19.	Proof of Company address
	Business Premises visitation certificate
20.
21.	Proof of identity of all Signatories and Directors
	Proof of Address all Signatories and Directors: Utility bill
22	(Certified true copy is acceptable if original is not held)
	Other (please specify)

11 For Bank Use Only: A. ACCOUNT OPENED BY: Name Date: Name Date: B. DEFERRAL/WAIVER OF DOCUMENT(IF ANY) AUTHORISED BY: Name Dato: Signature : Name Dato: C. ADDRESS VERIFICATION CARRIED OUT BY: Name H Date: Name Date: Signature . COMMENT(S): D. ACCOUNT OPENING APPROVED BY.

Name Dste: Signature .........................

Name Date: Signature : . Signature .

Signature . Signature .

i continued and

Signature .

12 ACCOUNT OPENING FORM - DESIGNATED NON-FINANCIAL INSTITUTIONS (DNFIS) Charity Account Religious Organisation Societies & Clubs Account Others Occupation Pension Scheme Account Account type ( Please indicate the type of account you want to open by ticking in the box below Current Account [] Fixed Deposit Account [ Domiciliary Account [ This lover cloudd to corrplaned in CAPTAL LETTERS wing BLACK INK. Characters and marks should be similar in spja zo the following (EEED ACCOUNT No. (for official use only) BRANCH I. ACCOUNT DETAILS ( Please complete in BLOCK LETTERS and tick where necessary) Name of Organisation: Certificate of Registration Number Date of Registration Registered Address Mailing/Correspondence Address State (For Public Org.) L.G.A(For Public Org.) Email address Website (if any) Phone Number (I) Phone Number (2) Tax Identification Number (TIN)

2. Account Service(S) Required (Please Tick Option Below)

Mobile Banking Blometric ATM Internet Banking Token (Fee applies) Internet Banking Preferences: Internet Banking Transaction Alert Preferences: Email Alert (Free) SMS Alert (Fee applies) Quarterly Semi Quarterly Frequency: Monthly Statement Preferences: Email Post Cheque Book Requisition: Opened Cheque Crossed Cheque 100 Leaves 50 Leaves

3. Cheque Confirmation Threshold

You will be required to pre confirm any cheque above Nxxx,000.00 if you would like to have a higher threshold for pre-confirmazion, please specify the amount (i.e threshold above Nox,000.00)

4 . PARTICULARS OF KEY CONTACT PERSONS	e stage
I Surname
First Name
Middle Name	HO	8	H	E
Date of Birth	Gender: M	f	Mother's Maiden Name:
	l	ID Number
Means Of Identification
Occupation
Job Title
Residential Address
Mobile Number	E-mail:
2. Surname
First Name
Middle Name	D TO LEAD A	Gender: M	F	Mother's Maiden Name:
Date of Birth	ID Number
Means Of Identification
Occupation
Job Title
Residential Address
Mobile Number	E-mail:
3. Surname
First Name
Middle Name	on a see in	E
Date of Birth	Gender: M	F	Mother's Maiden Name:
		ID Number
Means Of Identification
Occupation
Job Title
Residential Address
Mobile Number	E-mail:
4. Surname
First Name
Middle Name	R	and a minister
Date of Birth	Gender: M	F	Mother's Maiden Name:
	ID Number
Means Of Identification
Occupation
Job Title
Residential Address	E-mail:
Mobile Number

: I Surname 2. Surname 3. Surname 4. Surname 2

5. Account Signatory'S Details

First Name Middle Name

IO	B	MARKET IN

Gender: M F Mother's Maiden Name: Means Of Identification ID Number Occupation Job Title Residential Address Mobile Number E-mail: Class of Signatory (Please indcate class in the box provide) Siganture .

Date R 04 w 2 First Name Middle Name

ao 8 ISMB and

F

Gandor: M ID Number Means Of Identification Occupation Job Tirle Residential Address E-mail: Siganture - Date ERING & T a Class of Signatory (Piease indicate class in the box provide) Mobile Number Gender: M Mother's Maiden Name: Means Of Identification Occupation Job Title Residential Address Mobile Number E-mail: Siganture - Date e IM E Class of Signatory (Please inticate class in the box provide) 3 i.

Surname Surrame Mother's Maiden Name: RM

rr

ID Number Date of Birth Date of Birth First Name Middle Name N - RED THE REAL IN THE Surname 3.

Date of Birth

6. Particular Of Trustees/Promoters

I. Surname First Name Middle Name Date of Birth IT IN REALER Gender: M F ID Number Mobile Number E-mail.

a B R BE Date 2. Surname First Name Middle Name B

B Date of Birth Gender: M F Mother's Maiden Name:

ID Number Mobile Number E-mail: Siganture - Date B 8 IM NEW First Name Middle Name E Gender: M F Mother's Maiden Name: Means Of Identification Occupation Job Title Residential Address Mobile Number Siganture - s Means Of Identification Occupation Job Title Residential Address Means Of Identification Residential Address 3. Sumame

ID Number Mother's Maiden Name: Occupation Job Title Siganture - NH

• Date 4 E-mail: E WI EX E Date of Birth i s

7. Additional Details:

I. Name of affiliated company/Body: I.

II. Sources of Fund to the Account: III. Name of Beneficial Owner(s); IV. DETAILS OF ACCOUNT HELD WITH OTHER BANKS BY THE PROSPECTIVE DNFIS

	STATUS:
	NAME AND ADDRESS OF	DATE ACCOUNT
OPENED
S/N	ACCOUNT NAME	ACCOUNT NUMBER
	BANK/BRANCH	ACTIVE/DORMANT
l.
2
3.
4,

	STATUS:
	NAME AND ADDRESS OF	ACCOUNT NUMBER	DATE ACCOUNT
S/N	ACCOUNT NAME	ACTIVE/DORMANT
	BANK/BRANCH
I.
2.
3.
4.

V. DETAILS OF ACCOUNT OF TRUSTEES/PROMOTERS

8. Particulars Of Referees

l Surname Middle Name First Name Name of Bank/Branch Banker's Address: 2.

Surname Middle Name First Name Name of Bank/Branch Banker's Address: 5 9. AUTHORITY TO DEBIT ACCOUNT FOR SEARCH FEE AUTHORITY TO DEBIT OUR CURRENT ACCOUNT FOR SEARCH FEE

Io. Letter Of Set-Off

V-20.

Letter Of Set-Off

l/We agree that you (in addition to any general lien or similar right to which you as my/our banker may have at any time and without notice to me/us) combine or consolidate all or any of the company's accounts with all liabilities to you and set off or transfer any sum standing to the credit of any such accounts, be it cash, cheques, valuable, deposits, securities, negotiable instruments or other assets belonging to me/us with you in or towards satisfaction of any of my/our liabilities to you or any other account or in any other respect, whether such liabilities be actual or contingent, primary or collateral, several or joint.

6

Ii. Account Opening Mandate

a. Type of Account ( b. Name of Organization .

c. Account No.

d. Signatories: Middle Name First Name Name: Surname Name; Surname Fird Name Middle Ham Identification Type: Identification Type: PHOTO PHOTO Identification No: Identification No: Signature & Date Signature & Date FOR BANK USE ONLY FOR BANK USE ONLY Name of Officer Name of Officer III Name: Surname Middle Name First Name Fires Mar Identification Type: Identification Type: PHOTO PHOTO Identification No: ldentification No: Signature & Date Signature & Date FOR BANK USE ONLY FOR BANK USE ONLY Name of Officer Name of Officer First Name Middle Name Name: Surname SH41 Name Identification Type: Identification Type: PHOTO PHOTO Identification No: Identification No: Signature & Date Signature & Date FOR BANK USE ONLY FOR BANK USE ONLY Name of Officer NOTE: The institution can provide more space if the number of Signatories to the account is more than spaces (6) provided.

i i Signature Signature ix Name: Surname Aiddle 4 Signature Signature xi Name: Surname Middle Na

Signature Name of Officer 7

Signature

12. Terms And Condition 13. Mandate & Resolution

CUSTOMER INFORMATION I/We hereby apply for the opening of any occount or accounts with . opening such account(s) and hereby warrant that such information is correct.

I/We agree to use the account for only transactions permitted by law and to be bound by the terms and conditions governing the operation of the account(s).

Authorized Signature of the Customer /Representative & Date Authorized Signature of the Customer /Representative & Date

I4. Signed, Sealed & Delivered By The Within Named Person

Name Status Date Signature . Name Status Signature ---- Date Company Seal here

15. In The Presence Of:

Name Address

Date Occupation Signature ...

8

For Bank Use Only

16. REQUIREMENTS CHECKLIST
	DOCUMENTS REQUIRED	CHECKED	DEFERRED	WAIVED	N/A
S/N	Account opaning form duly completed
I.	Specimen signature card duly completed
2.	Copy of certificate of Registration
3.	Board/Executive Council Resolution
4
5.	Copy of Memorandum and Article of Association
(certified as true copy by the Registrar of Company)
	(a)Form C07 Particulars of Directors/Trustees/Promoters
6.	Copy Financial
7.	Two(2) passport sized photographs of each signatory to the account with
8.	name written on the reverse Side
	Introduction letter with two (2) passport sized photographs of contact
9.	persons or authorized agent
10.	Status report from Banker ( where Applicable)
11.	Resident Permit ( for non-Nigerians)
12.	Evidence of Registration with SCUML
13.	Search Report
	Power of Attorney
14.
15.	Letter of indemnity.
16.	Proof of Organisation address
17.	Registered Address visitation certificate
I 8.	Proof of Identity of all Signatories and Trustees/Promoters
	Proof of Address all Signatories and Trustees/Promoters: Utility bill
19.	(Certified true copy is acceptable if original is not held)
20.	Other (please specify)

a 17. ForBank Use Only: ACCOUNT OPENED BY: Name Date: Signature : ... ..................

Name Date: Signature: ... B. DEFERRAL/WAIVER OF DOCUMENT(IF ANY) AUTHORISED BY: Name Date: Name Date: C. ADDRESS VERIFICATION CARRIED OUT BY: Name Date: Signature : ..........

Name Date: Signature :.......................

COMMENT(S): D. ACCOUNT OPENING APPROVED BY: Name Date: Signature :... Name Date: A Signature . Signature: ..........

.....

least works and the station in the state of the manufaction STATUS AND IN COLLECTION COLLECTION COLLECTION THE SECTION THE COLLECTION OF

THE CONSULTION COLLECT COLLECT THE BELLER THE PERSONAL PRODUC .........

Signature : ... .

10