Please staple your recent
passport photograph
ANCHORIA INVESTMENT
& SECURITIES LTD
(Member of the
Nigerian Stock Exchange)
112,
Tel: 234-1-8925899,
234-1-7406428
Email:
info@anchoriaonline.com
Personal Data
Name of Individual/(Organisation):
..
(if individual, state surname first and title)
Postal Address:
..
.
Office/Home
Address
..
Phone
No. Office/Fax:
..Home:
Business/Profession:
E-mail:
..Nationality:
..
.
Intl Passport/DL No/RC
No
Date of Birth
..
.
Initial Deposit:
..
..Annual Income(Estimate)
.
Next of kin: (1) Name
..
.Relationship
..
(2) Name
..
.Relationship
..
(3) Any
special instruction
...
Name
of Banker(s) Branch Acct.
Name & Number
(1)
.
(2)
.
Authorized signatories
1 Name
.. Designation:
..Sign
2 Name
.. Designation:
..Sign
DECLARATION (Please
read carefully before signing)
·
I
agree that in compliance with the anti-money laundry legislation, transaction
above N1million and N5 million for individual and corporate organization
respectively, will be reported to Securities and Exchange Commission (SEC) or
the Central Bank of Nigeria (CBN)
·
I
confirm that the information given on this forms is true
·
That
accounts are to be adequately funded and debit balances, if any, must be
cleared within 3 days of its occurrence
·
That
debit balances not cleared within 3 days will attract interest, at two and half
times over the treasury bill rate prevailing at the beginning of the month in
question or 22% whichever is higher and
·
That
the company reserves the right to sell from the portfolio of the defaulter to
clear the debit balance and the accrued interest if the balance is cleared
after 14 days.
I
..
..hereby declare that
I understand the conditions stated above and that I agree to abide with the
said conditions.
Signature(s) Date
FOR OFFICE USE ONLY
Introduced by:
.. Date:
Application received by:
.. Date:
Relationship Officer:
..
.. Date:
Approved by:
..
.. Date:
.