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Self Service

Bio Information

First Name * :

Middle Name * :

Last Name * :

Date of Birth * :

Place of Birth :

Gender * :

Marital Status * :

Maiden/Mother's maiden name * :

Spouse Name :

Citizenship * :

Country * :

Phone Number * :

Email :

Address of Customer* :

Nearest Bus-stop * :

State of Origin * :

LGA *:

Contact Address* :

CHN and CSCS A/C No(for existing customers) :

Documents

Passport Photograph * :

Utilty * :

Identification Doc * :

Identification Type * :

Important Information: Please note that we are obliged to comply with the provisions of the Anti-Money Laundering/Combating Finance of Terrorism Act 2011 as amended which include making disclosures regarding your account to relevant regulatory agencies.
I hereby declare, under this sworn statement, that all the information provided is accurate and true and that I will inform KAPITAL CARE TRUST & SECURITIES LIMITED of any changes.
I also declare, under this sworn statement, that the funds I shall operate with are of legal origin and that these funds are not the proceeds of illegal activities conducted by me or third parties.

I agree to Terms & Conditions Above

Summary Application Information

Kapital Care

Date Submitted: {{formDetails.createdOn | date:'dd-MMM-yyyy'}}

Clearing House Number: {{formDetails.clrHouseNumber}}

Bio:

Name of Customer:

Phone Number:

Email:

Date of Birth:

Place of Birth:

Marital Status:

Gender:

Maiden/Mother's maiden name:

Spouse Name:

Citizenship:

Country:

Address:

Nearest Bus stop:

State of origin:

Local Govt:

Bank Details:

Bank Name:

Branch:

Account Name:

Account Number:

Account Open Date:

Bank sort code:

Bank Verification Number (BVN):

Occupation:

Occupation Name:

Employer Name:

Source of Fund:

Estimated Annual Income:

Next of Kin:

Next of Kins Name:

Address of Next Kin:

Nearest Bus stop of Kin:

Relationship:

Next of Kin Phone Number:

Documents:

Passport Photograph:

Authorized Signature:

Utilty:

ID:

Self Service

Bio Information

Occupation Details

Next of Kin

Bank Details

Documents

Summary Application Information Back

Kapital Care

Summary Application Information