*CATEGORY OF INVESTMENT
Investment CategoryIndividualJointITFCISBrokerageCSD NOProduct 1Product 2Product 3
CSD Number (if you have one already)
*PERSONAL INFORMATION 1
TitleMrMrsMsProfDrothers
Surname
First Name
Other Names
Date of Birth
GenderMaleFemale
Marital StatusMarriedSingle
Residential StatusResident GhanaianNon Resident GhanaianResident ForeignerNon Resident Foreigner
If country of origin is not Ghana, please provide the following
Country of Origin
Country of Residence
Resident Permit Number
Place of Issue
Date of Issue
Date of Expiration
ID TypeVotersDrivers LicenseSSNIT Biometric CardNational ID
ID Number
Job Title
Email
Occupation*
Profession
Contact Number 1
Contact Number 2
TIN
*PERSONAL INFORMATION 2
If country of origin is not Ghana, please provide following
Occupation
*CONTACT DETAILS
Contact Name:
Contact Relationship:
Residential Addresss
Postal Addresss
Ghana Post GPS
Nearest Landmark
Mobile Number 1
Mobile Number 2
*IN TRUST FOR
Relationship with Applicant
*BENEFICIARY
*CLIENT INVESTMENT PROFILE
Investment Objective
Risk ToleranceLowMediumHigh
Investment HorizonShort TermMedium TermLong Term
Investment KnowledgeLowMediumHigh
*EXPECTED ACCOUNT ACTIVITY
Source of FundsSalaryProceeds from BusinessInheritance / GiftsPersonal Savingsothers
If Others, Specify
Initial Investment Amount
Anticipated Investment Activity: Top-upsMonthlyQuarterlyBi-AnnualAnnualOthers
WithdrawalsMonthlyQuarterlyBi-AnnualAnnualOthers
Anticipated Investment Amount
Regular Top-up Amount (expected)
Regular Withdrawal Amount (expected)
*BANK ACCOUNT DETAILSBank 1
Bank Name
Bank Branch
Account Name
Account Number
Bank 2
*EMAIL/ PHONE/ FAX INDEMNITY
Email/ Telephone/ Fax Indemnity
Upload all signatory's Files / signature(s)
❌
DeclarationI/we hereby declare that all the information submitted by me/us in this form is correct, true and valid, that by my/our request, to open and maintain securities account(s) in my/our name and undertake to notify (Me and or my Company) of any changes to my/our particulars or information as may be necessary. I/We also declare that we have read thoroughly and understood the contents of this application and have given my/our consent by virtue of my/our signature(s) on this form. I/We consent that investment decisions are my/our prerogative without sole reliance on the investment advice received from (Me and or my Company). (Me and or my Company) accepts no liability for any direct or consequential loss arising from my/our decision. I/We also declare that all debits incurred on my/our securities account(s) by virtue of my/our trade orders shall be settled by me/us accordingly.
