Account Opening/KYC Form

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Page 1 of 4

SECTION A: PERSONAL INFORMATION

BVN Number

Title

Please selectMr.MrsMissDr.Prof.

Other Name

Marital Status*

Please selectMarriedSingleOthers

Place of Birth*

State of origin*

Home town

Spouse's Name(if aplicable)

Spouse's Occoupation

Bank name*

Bank sort code

Account Type

Please selectC-HomeC-FMBNC-EDLC-Family HomesC-NMRC

First name*

Surname*

Gender*

F

M

Date of Birth*

LGA *

Mother's Maiden Name

Spouse's Date of Birth

Anniversary Date

Bank account number*

Date Opened

Bank address

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SECTION B: CONTACT DETAILS

Street name*

State*

City /town*

Mobile Number*

MEANS OF IDENTIFICATION*

National ID Card

National Driver's license

International passprt

PVC

Others

ID Expiry Date

Nearest bus stop/landmark*

Local Govt.area*

Phone number(2)

Email address*

ID No:*

ID Issue Date

Utility Bill

Please selectNepa BillWater Rates

Full Residential address*

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SECTION C: EMPLOYMENT DETAILS

Employment Status*

Please selectEmployedSelf-EmployedUnemployedRetiredStudentOthers

Business/Employer's Name

Nature of Business/Occupation

Street Name*

Local Govt.area*

Office Phone number

Date of Employment(if employed)

Nearest Bus stop/Landmark

Position held by the applicant at place of work

City/town*

Email address

Employer's/employment address*

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SECTION D: NEXT OF KIN DETAILS

Surname*

Other Name(s)

Date of Birth*

Mobile Number(2)*

Street Name*

City/town *

State*

First Name*

Gender*

Male

Female

Relationship*

Email address

Nearest Bus Stop/Landmark*

Local Govt.Area*

Upload Passport

Upload Other Relevant Document

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