UMB Stockbrokers | Know Your Client Corporate Form

Account Information

Form Code

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Category Of Investment

CSD No:

Category Of Business

Category Of Investment

CSD No:

Company/Business Name:

Certificate of Incorporation Number:

Date of Incorporation / Registration:

License Number:

Jurisdiction of Incorporation / Registration:

Parent Company’s Country of Incorporation (if any):

Type / Nature of Business:

Sector / Industry:

Principal Place of Business:

Company Postal Address:

Digital Address (GhanaPost GPS):

Email Address:

Website Address (if any):

TIN:

Contact Number 1:

Contact Number 2:

Account Signatory Details 1

Name:

Date of Birth:

Gender:

Residential Status:

If country of origin is not Ghana, please provide the following:

Resident Permit Number:

Place of Issue:

Permit Issue Date:

Permit Expiry Date:

ID Type:

Job Title:

Email Address:

Contact Number 1:

Contact Number 2:

Account Signatory Details 2

Name:

Date of Birth:

Gender:

Residential Status:

If country of origin is not Ghana, please provide the following:

Resident Permit Number:

Place of Issue:

Permit Issue Date:

Permit Expiry Date:

ID Type:

Job Title:

Email Address:

Contact Number 1:

Contact Number 2:

Account Signatory Details 3

Name:

Date of Birth:

Gender:

Residential Status:

If country of origin is not Ghana, please provide the following:

Resident Permit Number:

Place of Issue:

Permit Issue Date:

Permit Expiry Date:

ID Type:

Job Title:

Email Address:

Contact Number 1:

Contact Number 2:

Directors / Executive / Trustee / Admin

Name:

ID Type:

ID Number:

Status:

Contact Number:

Beneficial Owner 1

*Name:

ID Type:

ID Number:

Pep Status:

Contact Number:

Home Address:

Date of Birth:

Ownership %:

Beneficial Owner 1

*Name:

ID Type:

ID Number:

Pep Status:

Contact Number:

Home Address:

Date of Birth:

Ownership %:

Director 1

*Name:

ID Type:

ID Number:

Pep Status:

Contact Number:

Home Address:

Date of Birth:

Ownership %:

Director 2

*Name:

ID Type:

ID Number:

Pep Status:

Contact Number:

Home Address:

Date of Birth:

Ownership %:

Account Holder

If a part of a group, kindly state all entities within the group structure:

Key Contact Person

Name:

Date of Birth:

Gender:

Residential Status:

If country of origin is not Ghana, please provide the following:

Resident Permit Number:

Place of Issue:

Permit Issue Date:

Permit Expiry Date:

ID Type:

Job Title:

Email Address:

Contact Number 1:

Contact Number 2:

Bank Account Details

Bank Name:

Account Name:

Account Number:

Bank Branch:

Turnover

Monthly Turnover(GHs):

Annual Turnover(GHs):

Statement Services

Mode of Statement Delivery:

Statement Frequency:

Specify any other additional statement frequency:

Dividend

Investment Objective:

Risk Tolerance:

Investment Horizon:

Investment Knowledge:

Expected Account Activity

Source of Funds:

If other, please specify:

Initial Investment Amount:

Anticipated Investment Activity:

Top-ups:

Withdrawals:

Anticipated Investment Amount:

Regular Top-up Amount (Expected):

Regular Withdrawal Amount (Expected):

Declaration

I declare that the information provided is true and accurate. I authorize UMB Stockbrokers Ltd to use my personal information to evaluate my financial need(s) and comply with the Securities Industry Law, as amended. This information may be provided to other members of the Universal Merchant Bank Group.

Account Mandate

Signatures:

A.

B.

C.

Name(S)

Date

Signing instructions:

If other, please specify:

Client Additional Information (1)

NB: THE FOLLOWING QUESTIONS ARE DESIGNED TO ENABLE THE INSTITUTION DETERMINE WHETHER THE CLIENT IS A POLITICALLY EXPOSED PERSON (PEP)
Do you, your spouse, or any other immediate family member, including parents, in-laws, siblings and dependants fall under the following:

A head of state/government, politician, senior public official, senior military offical, senior public corporation officer, high rank political party official in Ghana

If yes to any above, please specify name (if not the applicant) and nature of the position:

A head of state/government, politician, senior public official, senior military offical, senior public corporation officer, high rank political party official outside Ghana

If yes to any above, please specify name (if not the applicant) and nature of the position:

Client Additional Information (2)

For Depository Participant Use Only

Tick where applicable:

Verified by CSD Officer:

Signature:

Date:

Stamp:

Client SCD Securities Account Number:

Know Your Client Corporate Form

Know Your Client Corporate Form

Account Information

Business Details

Account Signatory Details

Directors / Executive / Trustee / Admin

Beneficial Ownership

Details of Directors

Affiliations

Key Contact Person

Account Details

Client Investment Profile

Declaration

Account Mandate

Client Additional Information