Personal Banking Account Opening Form Personal Account Opening Personal Unsecured Loan Personal Credit Card

Transcription

1 Personal Banking Account Opening Form Personal Account Opening Personal Unsecured Loan Personal Credit Card Checklist I have attached the following documents: Primary identification Identification document (Passport/Driving license/voter s/financial/nssf card) One passport size color photograph Introduction letter from a referee who holds a bank account; or Account holder with CBA for at least the last 6 months or current employment contract from reputable and well known employer; or letter from a practicing Advocate; or 6 months Bank statement. Confirmation of residential address. Any of the following; Utility Bill; or Tenancy Agreement; or Letter from Employer; or Lawyer listed in CBA s panel; or Area chief; or Church / Mosque clergy confirming residential address. Work permit for Foreign Nationals Letter from Embassy or parent firm and Immigration file number for non residents For Credit Card Processing Duly completed Credit Card application form Latest 3 months pay slips Certified copies of bank statements for the last 6 months CBAU is regulated by Bank of Uganda 1 Personal Banking Account Opening form UGX.indd 1

2 2 Personal Banking Account Opening form UGX.indd 2

3 PERSONAL ACCOUNT OPENING FORM Please complete all details in CAPITAL letters. I/We wish to open the following account and undertake to comply, observe and be bound by the attached General Terms and Conditions. ACCOUNT TITLE Indicate type of account required: Account type Current Savings Call deposit Fixed deposit Currency UGX USD GBP EURO Other (specify) Foreign Currency Accounts: Please state the nature and source of the Foreign Currency Account Category Individual Joint For Fixed Deposits Only Period (In Months) PERSONAL DETAILS (FIRST APPLICANT) Title: Mr. Mrs. Ms. Dr. Prof. Hon. Other Name: First Middle Last *Preferred name for the official communication: Date of birth Country of Birth Nationality (DD/MM/YYYY) Marital Status Single Married Divorced Widowed Gender Male Female Identification Doc: Document No. Postal Address Town/ City Country Physical (Residential) Address Plot No. Tel Off. Tel Home Mobile No. (1) Mobile No. (2) (Preferred) (Other) Next of Kin (Name) Relationship Spouse Child Son Parent Daughter Other (Specify) Next of Kin Tel Contacts Postal Address Town/ City Country Physical Address 3 Personal Banking Account Opening form UGX.indd 3

4 EMPLOYER/ BUSINESS DETAILS (FIRST APPLICANT) Employment type: Formal Employment Informal Employment Self Employment Unemployed Occupation Name of Employer Employee Department Employee Position If Self employed, State Nature of Business Gross Income Band (UGX 000) A 0-1,000 B 1,100-5,000 C 5,100-10,000 D 10,100-20,000 E 20,100-40,000 F Above 40,000 Employers Postal Address Town/ City Country Employers / Business Physical Address Plot no. Tel (Off) Mobile No. (Off) Employers / Business Address Other accounts held currently (with CBA or other banks) Bank Name Branch A/C No Bank Name Branch A/C No PERSONAL DETAILS (SECOND APPLICANT) Title: Mr. Mrs. Ms. Dr. Prof. Hon. Other Name: First Middle Last *Preferred name for the official communication: Date of birth TIN No. Nationality (DD/MM/YYYY) Marital Status Single Married Divorced Widowed Gender Male Female Identification Doc: Document No. Postal Address Postal Code Town/ City Country Physical (Residential) Address Plot No. Tel Off. Fax Tel Home Mobile No. (1) Mobile No. (2) (Preferred) (Other) Next of Kin (Name) 4 Personal Banking Account Opening form UGX.indd 4

5 Relationship Spouse Child Son Parent Daughter Other (Specify) Next of Kin Tel Contacts Postal Address Physical Address Postal Code Town/ City Country EMPLOYER/ BUSINESS DETAILS (SECOND APPLICANT) Employment type: Permanent Pensionable Contract Casual Self Employed Other Occupation Name of Employer Employee Department Employee Position If Self employed, State Nature of Business Gross Income Band (UGX 000) A 0-1,000 B 1,100 5,000 C 5,100 10,000 D 10,100-20,000 E 20,100-40,000 F Above 40,000 Employers Postal Address Town/ City Country Employers / Business Physical Address Plot no. Tel (Off) Mobile No. (Off) Employers / Business Address Other accounts held currently (with CBA or other banks) Bank Name Branch A/C No Bank Name Branch A/C No REFEREE DETAILS Name: Bank: Address: Signature: A/C No: Tel. Contacts Cheque Book and Statement Details Please tick as appropriate: Cheque Book Book(s) To be collected from Branch Statement Cycle Monthly Quarterly No Statement Statement delivery Postal Address Please tick if interested in the following products Internet Banking Yes No Mobile Banking Yes No Credit Card Yes No Your preferred mobile number to receive alerts from the Bank Recreation Interests (please tick as appropriate) Golf Art/Antiques Photography Health club/gym Dance/Ballet Foreign travel Tennis/Other Racket sports Music/Theatre Fine foods/wine Athletic/Other Activity sport Equestrian sports Others (please specify) Bicycling/Mountaineering/Hiking Monthly 5 Personal Banking Account Opening form UGX.indd 5

6 Electronic Banking (Mobile and Internet Banking) First Applicant Phone Make e.g Nokia, Android, Blackberry Memorable Word* Token Number (For Bank use only) Second Applicant Phone Make e.g Nokia, Android, Blackberry Memorable Word* Token Number (For Bank use only) * The memorable word you specify will be requested when you first log onto the internet to authenticate your identity. Your memorable word will also be requested should you require to reset/unlock your token. (NB: The word must be between 6 and 20 characters) (First Applicant) Beneficiary Bank Branch Code * This register will be accessible through your mobile phone. (First Six Digits) (Last Four Digits) * This information will allow you to access card available balance, amounts due and the due date for payment on Mobile Banking. 6 Personal Banking Account Opening form UGX.indd 6

7 (Second Applicant) Beneficiary Bank Branch Code * This register will be accessible through your mobile phone. (First Six Digits) (Last Four Digits) * This information will allow you to access card available balance, amounts due and the due date for payment on Mobile Banking. I /We have read the conditions necessary to open and operate an account with Commercial Bank of Africa (Uganda) Limited (CBA) and I/we oblige to comply. I /We agree that this account shall be solely at the discretion of CBA and hereby agree to indemnify CBA at my/our cost against any loss or claims arising out of the account being closed by CBA without notice due to unsatisfactory performance. I undertake to inform the bank of any changes of contact or my personal details. I/We confirm that the information given on this form is true and accept that the operations of the account will be subject to the General Terms and Conditions. Name: _ Signature: _ I/D or Passport No: _ Mobile No: Name: _ Signature: _ I/D or Passport No: _ Mobile No: _ Dated This: Day of 20 Authorised Signatories Operating Mandates Sole Either/Or All to sign Other (specify) 7 Personal Banking Account Opening form UGX.indd 7

8 FOR BANK USE ONLY. Customer number A/C number A/C officer A/C opened by Date Signature Authorized by Date Signature Sector Industry Legal Entity T24 Mapping: Token issued by AIDE MEMOIRE CHECKLIST (Please tick requisite documents obtained and attached) Original primary identification Document as applicable. Original and Certified copy of TIN Certificate (1) Passport size colour photograph Work Permit for Foreign Nationals For non residents, Letter from Embassy or Parent firm 8 Personal Banking Account Opening form UGX.indd 8

9 PERSONAL UNSECURED LOAN Credit details I would like to apply for Unsecured Loan Top-up Currency UGX USD EURO Amount Period (months) Purpose of loan School fees Home improvement Medical Plot purchase Other (please specify) Budget planner Please attach original documents to assist in fast processing of your application. Please attach latest 3 months ORIGINAL payslips Monthly Income Salary Commissions Rental /receipts Other income (Specify) Total Income (l) Monthly Expenses Loan payments Mortgage / rent payments Card payments Other expenses Total (E) Surplus (S=I-E) OTHER FINANCIAL DETAILS Other loans/credit NAME OF LENDER MONTHLY PAYMENT CURRENT BALANCE DECLARATION 4. I agree to obtain credit insurance cover for the loan and authorize CBA to deduct premiums payable towards the Cover. Please tick as applicable: In the event that the amount I qualify for is less than the amount requested: I instruct the bank to contact me before crediting my account. I authorize the bank to create a loan account in my name and disburse the approved amount without reference to me. I authorise my employer to channel my monthly salary to CBA account No. Signature of applicant Date (DD/MM/YYYY) Signature of joint applicant Date (DD/MM/YYYY) 9 Personal Banking Account Opening form UGX.indd 9

11 DIRECT DEBIT INSTRUCTIONS (Optional) Please indicate the percentage of the outstanding amount to be debited monthly. (min 20%) Percentage Account Name Account Type Account No. Instructions to the Bank I/We instruct you to pay autocredit payments from my/our account at the request of CBA VISA Card. The amounts are variable and are to be debited on various dates (but not to exceed total amount outstanding on due date). Authorized Signatory Date Authorized Signatory Date DECLARATION Please issue me with a CBA VISA Classic /Gold Card. I warrant that the information given in the application form is true and complete and I authorize you to make any inquiries necessary in connection with this application. I have read, accepted and agree to be bound by the CBA VISA Card General Terms and Conditions of use (as amended from time to time). I agree that I/We are jointly and severally liable for all charges incurred through the use of CBA VISA Card. I/We understand that Commercial Bank of Africa (Uganda) Limited reserves the right to decline the application without giving resons. Name Signature Date 11 Personal Banking Account Opening form UGX.indd 11

12 BANK USE ONLY (Personal Account Opening) Sales Code Customer number A/C number DAO Code A/C opened by Date Signature Authorized by Date Signature Sector Industry Legal Entity Signature Verified Name Signature Date T24 Mapping Customer enabled for Internet Banking by Customer enabled for Mobile Banking by Notifications mapped Accounts mapped Token issued by INITIAL DEPOSIT C ash Amount I n house Cheque Amount L ocal Cheque Amount Bank A/C number I nternal Transfer Amount BANK USE ONLY (Personal Unsecured Loan) Checklist for Branch /Account Relationship Manager Checklist completed6 months statements checked against payslip If foreigner, attach contract and work permit Is application compliant with existing product profile? If No, list the exceptions i) ii) iii) Yes No Recommended by: Account Relationship Manager Signature Date 12 Personal Banking Account Opening form UGX.indd 12

13 DECLARATION Name Name Signature Signature Date Date 13 Personal Banking Account Opening form UGX.indd 13

16 16 CBA/JULY/2015 Personal Banking Account Opening form UGX.indd 16