Company Details
Full Name of Company
Company Short Name
Date of Incorporation/Registration
Place of Incorporation
Rc Number
Business Sector
Tax Identification Number (TIN)
Company Type
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Limited Liability Company
Partnership
Enterprise
Others
Company Address
Mailing Address
Country of Residence
Corporate Email Address
Telephone No(s)
Website Address
Fax
Purpose Of Investment
Average Annual Turn Over(NGN)
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Less than 10m
10-50m
Above 50m
Source of Investment Fund
Bank Account Details (Same as CSCS Account Name)
Bank Name
Branch
Account Name
Account Number
Date of Account Creation
Bank Verification Number
Principal Contact Person
Name
Phone Number
Email Address
Signature & Date
Authorized Signatory (1)
Name
Date of Birth
Place/Country of Birth
Gender
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Female
Male
Nationality
Residential Address
Country of Residence
Phone Number
E-mail Address
ID TYPE
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International Passport
Drivers Licence
PVC
National Id Card
ID Number
Issue Date
Expiry Date
Place and Country of Issue
Place of Issue
Designation
Class of Signatory
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A
B
C
Date
Upload Signature1:
Authorized Signatory (2)
Name
Date of Birth
Place/Country of Birth
Gender
Select
Female
Female
Nationality
Residential Address
Country of Residence
Phone Number
E-mail Address
ID TYPE
Select
International Passport
Drivers Licence
PVC
National Id Card
ID Number
Issue Date
Expiry Date
Place and Country of Issue
Place of Issue
Designation
Class of Signatory
Select
A
B
C
Date
Upload Signature2:
Authorized Signatory (3)
Name
Date of Birth
Place/Country of Birth
Gender
Select
Female
Male
Nationality
Residential Address
Country of Residence
Phone Number
E-mail Address
ID TYPE
Select
International Passport
Drivers Licence
PVC
National Id Card
ID Number
Issue Date
Expiry Date
Place and Country of Issue
Place of Issue
Designation
Class of Signatory
Select
A
B
C
Date
Upload Signature3:
Authorized Signatory (4)
Name
Date of Birth
Place/Country of Birth
Gender
Select
Male
Female
Nationality
Residential Address
Country of Residence
Phone Number
E-mail Address
ID TYPE
Select
International Passport
Drivers Licence
PVC
National Id Card
ID Number
Issue Date
Expiry Date
Place and Country of Issue
Place of Issue
Designation
Class of Signatory
Select
A
B
C
Date
Upload Signature4:
Mandate
Mandate & Signing Instruction
Questionnaire
Please state if any of your Directors, Signatories, or Major Shareholders have held any Political Position
1. Name
Position Held
Date From
Date To
2. Name
Position Held
Date from
Date to
3. Name
Position Held
Date from
Date to
4. Name
Position Held
Date from
Date to
Name
Position Held
Date from
Date to
How did you hear about us?
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Internet
Advert
Staff
Referral
Others
Staff, referrals or others, please specify
Investment and Financial Market Knowledge
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None
Low
Medium
High
Advance
Uploads
Upload Director's Signature (1):
Upload Director's Signature(2):
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