CSCS Form.

ACCOUNT TYPE

PERSONALCORPORATE(Please Tick appropriately)

NAME OF CLIENT (surname first) OR COMPANY’S NAME:

PASSPORT PHOTOGRAPH

DATE OF BIRTH/CAC NO:

MOTHER’S MAIDEN NAME (where applicable)

ADDRESS

CSCS ACCOUNT NUMBER

CLEARING HOUSE NUMBER

TEL. NUMBER: (1)

TEL. NUMBER: (2)

E-MAIL ADDRESS: (1)

E-MAIL ADDRESS: (2)

DO YOU OPT FOR DIRECT SETTLEMENT INTO YOUR BANK ACCOUNT?

YESNO

SIGNATURE: (1)

SIGNATURE: (2)

(For Corporate accounts, two authorized signatories must sign with their passports photographs affixed and company’s Seal appended on this form).

BANK NAME

BANK BRANCH

BANK ACCOUNT NUMBER

BANK VERIFICATION NUMBER (BVN)

TYPE OF ACCOUNT (Please tick the type of account)

CurrentSavings

MEMBER CODE

STOCKBROKING FIRM NAME

AUTHORIZED SIGNATORY

AUTHORIZED SIGNATORY 2