1.

ACCOUNT INFORMATION

Category of Business:

Business Banking:

Emerging Local Corporate

Institutional Banking:
Professionals / Associations / Clubs

2.

Country of Incorporation /
Registration

Corporate Business
Address/Registered Office
( if different from above )

Special Control Unit against Money

Laundering (SCUML) Reg. No.
( where applicable )

2
 3.

N5 Billion and above

i ?

ii i

4. ( Please tick applicable option(s) below )

:

Debit Card Union Pay

Credit Card

Online Banking Internet Banking USSD Banking ATM/POS Soft Token

Transaction Notification
Threshold:

5. ( )

Cheque Confirmation:

If you would like to have a higher or lower threshold for pre-confirmation, please specify the amount
( Note: Regulatory threshold is N150,000 )

6.

Others :

ID Issue ID Expiry
ID Number
Date Date

Position / Office of the Signatory

3
 (Nigerian)

( For Non-Nigerian )

(where applicable)

Others :

ID Issue ID Expiry
ID Number
Date Date

Position / Office of the Signatory

(Nigerian)

( For Non-Nigerian )

(where applicable)

4
 Others :

ID Issue ID Expiry
ID Number
Date Date

Position / Office of the Signatory

(Nigerian)

( For Non-Nigerian )

(where applicable)

5
7.
ADMINISTRATOR

ID Issue ID Expiry
ID Number
Date Date

Position / Office of the Director

(Nigerian)

( For Non-Nigerian )

(where applicable)

Title Surname

Middle
First Name
Name
:

Contact Details:

House

6
 :

ID Issue ID Expiry
ID Number
Date Date

Position / Office of the Director

(Nigerian)

( For Non-Nigerian )

(where applicable)

Title Surname

First Name Middle

Name
:

Contact Details:

House

7
 :

ID Issue ID Expiry
ID Number
Date Date

Position / Office of the Director

(Nigerian)

( For Non-Nigerian )

(where applicable)

Title Surname

Middle
First Name Name
:

Contact Details:

House

8
 8.

Company

9. ACCOUNT(S)

10.

9
PLEASE READ THIS SECTION CAREFULLY. IT PROVIDES YOU WITH IMPORTANT INFORMATION
ABOUT YOUR PROVIDUSBANK ACCOUNT(S).

The information contained on this page together with any further instructions and conditions that may be prescribed by the bank from time to time
shall constitute the terms of the agreement between the customer and ProvidusBank Plc (”ProvidusBank”). When this application form has been
signed, it will be deemed to have been accepted as binding on the customer and the ProvidusBank representative office or affiliate where the
account is held.

of the
of the

a.

of

b.

Both

If ProvidusBank acts on any Instruction sent by any means requiring manual intervention (such as telephone, telex, telefax, electronic mail or disks
sent by messenger and in compliance with the Procedures, the Customer will be responsible for any loss ProvidusBank may incur in connection
with that Instruction.

10
 ( Continued)

c.

d.

prevailing

e.

W
third party.

f.

11
9.

We hereby apply for the opening of account(s) with ProvidusBank PLC. We understand that the information given herein and the documents
supplied are the basis for opening such account(s) and we therefore affirm that such information is correct.

We further undertake to indemnify the Bank for any loss suffered as a result of any false information or error in the information provided by us
to the Bank.

Signature & Date Signature & Date

10.

11.

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 1.

DEFERRED

(Special Control Unit against Money Laundering)

Proof of address of all beneficial owners

(i.e directors with 5% and above)

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2.

3.

Designation

Designation

4.

Designation

14