Individual Account Opening Form - Dunbell Securities Limited

PLEASE COMPLETE THE FORM ACCURATELY

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 *Surname *First Name *Middle NameMother's Maiden Name (if any)Address *Nearest B/StopCity *State *Your Email Address *Date of Birth *

2.) Form of Identification & Source of Funding

Kindly indicate the form of identification provided below and email a photocopy of the supporting documents to info@dunbellsecuritieslimited.com. Please note that due to Anti-money Laundering Legislation, the account may not be opened until the required documents are verified.

National Identity CardDriver's LicenseInternational PassportStudent Identity Card (if a student)Corporate Identity Card (if employed)3 months receipts from public utilities / voters CardBusiness/Employer's Name (Educational Institution, if currently a student)Business/Employer or School's Full AddressCityStatePhoneFaxObjectives for opening the account *Sources of wealth or income *

3.) Next of Kin

Title *First Name *Last Name *Middle Name (if any)Mother's Maiden Name (if any)Street Address *City *State *Postal AddressCityStateDaytime Phone Number *Evening Phone Number

4.) Referee

Title *First Name *Last Name *Mother's Maiden Name (if any)Street Address *City *State *Postal AddressDaytime Phone Number *

5.) Bank Details

Bank Name *Bank Account Number *Bank Account Name *Bank Sort Code/Bank Verification Number *Date Account OpenedState *LGA *

Declaration *

Please be informed that in compliance with the anti-money laundry legislation, transactions 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). We confirm that the information given on this account opening form is true; That accounts are to be adequately funded and debited balances, if any, must be cleared within 3 days of its occurrence; We Hereby declare that we understand the conditions stated above and agree to comply with the said conditions.

AgreeDisagree

Please upload a recent Passport Photograph *