A. PERSONAL DATA
(Options marked * are compulsory)
Title*
Select Title*
Mr
Miss
Mrs
Dr
Prof
Sir
Surname*
Firstname*
Others
Gender*
Select Gender*
Male
Female
Date of Birth*
Marital Status*
Marital Status*
Single
Married
Divorced
Seperated
Mother's Maiden Name*
Custodian Name(for Minor Only)
Occupation*
Residential Address*
Nationality*
Resident Indicator*
Resident Indicator
Resident
Non-Resident
Phone Number*
Personal Email Address*
ID Type*
Select Identification Type*
International Passport
Driver's License
National ID Card
Voter's Card
ID Number*
Politically Exposed Person (PEP)*
Are you a Politically Exposed Person (PEP)?*
Yes
No
Please provide details if yes
B. JOINT ACCOUNT HOLDERS (partners should provide the following details)
Name(s) of Partner(s) to the account
Partner(s) Annual income
Select Partner(s) Annual income
Below N3m
N3m - N10m
N10m - N50m
N50m and Above
Source of Investment Fund
Select Source of Investment Fund
Employment
Business
Others
C. EMPLOYMENT DETAILS AND PURPOSE OF INVESTMENT (partners should provide the following details)
Employment Status*
Select Employment Status*
Full Time
Self Employed
Retired
Others
Company Name*
Company Office Address*
Annual Income*
Select Annual Income*
Below N3m
N3m - N10m
N10m - N50m
N50m and Above
Source of Investment Fund*
Select Source of Investment Fund*
Employment
Business
Others
Self Employed
Business Name
Business Address
Annual Turnover
Nature of Business
RC or Business Registration No. and Date of Incorporation/Registration
D. PRODUCTS/SERVICES REQUIRED
Securities
Securities*
Stock Broking Account*
Others
E. BANK ACCOUNT DETAILS
Bank Name*
Account Name*
Account Number*
Bank Verification Number (BVN)*
Bank Branch and date the account was opened
F. NEXT OF KIN DETAILS
Name*
Phone Number*
Address*
Gender*
Please select gender*
Male
Female
Date of Birth*
H. EMAIL INDEMNITY
Name*
I. CSCS DIRECT SETTLEMENT FORM - FOR SECURITIES BUSINESS UNIT ONLY
Account Type*
Select Account Type*
Personal
Corporate
Client Details
Name of Client (Surname first) Company*
Date of Birth/CAC No*
Mother's Maiden Name (where applicable)
Address*
CSCS Account Number
Clearing House Number
Telephone Number*
Email Address*
Do you opt for direct settlement into your bank account?*
Do you opt for direct settlement into your bank account?*
Yes
No
Client's Bank Details (Settlement Banks Only)
Bank Name
Bank Branch
Account Number
Bank Verification Number (BVN)
Type of Account
Type of Account
Current
Savings
Stockbroking Firm Details
Member Code
Stockbroking Firm
Self-Certification for Individual Tax Residency
Are you tax resident in Nigeria?*
Are you tax resident in Nigeria?*
Yes
No
Do you have a Tax Identification Number?*
Do you have a Tax Identification Number?*
Yes
No
If yes, please provide TIN
If no, please state reason
Referring Relationship Manager
Client's Name*
Date*
Upload your documents below:
Passport Photo (Accepted formats - jpg, jpeg, png, pdf). Not more than 5mb.
Passport Photo*
Upload Signature(Accepted formats - jpg, jpeg, png, pdf). Not more than 5mb.
Upload Signature*
Utility Bill (Accepted formats - jpg, jpeg, png, pdf). Not more than 5mb.
Utility Bill*
ID Card (Accepted format - jpg, jpeg, png, pdf). Not more than 5mb.
ID Card*