CLIENT UPDATE FORM

(For clients with existing securities account with Vetiva)

Account No.:
(For official use only)

* Kindly initial at the bottom of each page as well as beside any alterations or additions. Also note that all our
client transactions are subject to the Rules and Regulations of the Securities and Exchange Commission, the
Nigerian Stock Exchange, the Anti-Money Laundering Act of the Federal Republic of Nigeria and other applicable
laws and regulations.
CLIENT NAME

SECTION 1: CHANGE OF PERSONAL DETAILS

A. Change of Name

Mother’s Maiden Name:

New Name

Change is due to (Please check as applicable): Marriage Divorce Separation

Other (Please specify)

Please provide copy of evidence of change of name (original to be presented for sighting)

B. Change of Nationality

New Nationality

Change is due to (Please check as applicable): Marriage Divorce Separation

Other (Please specify)

Please provide copy of international passport and any other supporting evidence (original to be
presented for sighting)

SECTION 2: CHANGE OF CONTACT INFORMATION

A. Change of Residential Address

New Residential Address

Please provide copy of utility bill (not more than 3 months old) for new address (original to be
presented for sighting)

B. Email Address

Please check as applicable: New email address Additional email address

C. Telephone Number

Please check as applicable: New Tel No. Additional Tel. No.

D. Change of Next of Kin

Name Phone Number

Address

Authorised Signatory_____________________ Authorised Signatory____________________

 SECTION 3: CHANGE OF FINANCIAL INFORMATION

Change of Bank Account Details

Bank Name Bank Branch

Bank Account Name

Bank Account Number Bank Sort Code

Bank Verification Number (BVN)

Date of creation of Bank Account Currency

Please check as applicable: New Bank Account Additional Bank Account

Authorised Signatory______________________________ Date: ____________________________

Authorised Signatory______________________________ Date: ____________________________

Affix Company
Seal

Witnessed by Witness Signature

FOR INTERNAL USE ONLY

RELATIONSHIP MANAGER:

Name: _________________________________Signature & Date: ___________________________

CHECKED BY RISK MGT/COMPLIANCE (Signature & Date):__________________________________

Comments/Remarks (if any):_________________________________________________________

_________________________________________________________________________________

Vetiva Securities Limited

c
Plot 266B, Kofo Abayomi Street
Victoria Island
Lagos, Nigeria
Tel: + 234 (1) 4617521-3
Fax: +234 (1) 4617524
Email: info@vetiva.com
Website: www.vetiva.com