DECLARATION OF ULTIMATE BENEFICIAL OWNERSHIP

In line with NMB Bank Limited Anti-Money Laundering and Countering the Financing of Terrorism (AML/CFT) Policy, reasonable steps must be taken in
order to verify and identify the ownership structure of true and legal persons.
The shareholding section must be completed by Ultimate Beneficiary Owners with 10% shareholding and above.
Name of Registered Entity…………………………………………………………………………………………………………………………………………...
Registration Number of Entity…………………………………………………………………………............................................................................................
Account Number of Registered Entity…………………………………………………………………............................................................................................
Names of Listed Directors…………………………………………………………………………………………………………………………………………...
Names of Listed Shareholders……………………………………………………………………………………………………………………………………...
Country of registration……………………………………………………………………………………………………………………………………………….
Ownership type (Government/Private Owned)……………………………………………………………………………………………………………………...
Is the company listed on any Stock exchange……………………………………………………………………………………………………………………..
Name of Stock exchange listed on…………………………………………………………………………………………………………………………………...

 Please attach to this form your;

 Detailed shareholding structure
 Memorandum and articles of association
 Company profile
 Copy of passport/id’s for all listed directors
 Three months bank statements from previous bankers
Declaration of Information By Directors
Title First Surname Identification Passport Date of Nationality Place of Business Contact Ownership Email
Name Number Number Birth Residence Address Numbers Percentage
(IF
Applicable)

Declaration of Information By Shareholders (Beneficiary Owner)

Title First Surname Former Identification Passport Date of Nationality Place of Business Ownership Direct or Contact Email
Name Names (If Number Number Birth Residence Address Percentage Indirect Numbers
Applicable) Ownership
I/We acknowledge that the information provided is correct to the best of our knowledge. I/We undertake to keep NMB Bank Limited informed in writing
about any changes to the above information in future and any other information as may be requested.

Name………………………………………………………Capacity/Title………………………………………………….……………………………………..
Date Completed…………………………………………….Signature….………………………………………………………………………………………….