FOREIGN CURRENCY DOMICILIARY ACCOUNT OPENING FORM - INDIVIDUAL

GTBank
Guaranty Trust Bank plc RC 152321

Name / Company: Address:

Reg No (if Applicable)

Occupation/Profession / Business: Nationality/Residence: Passport No:

(If Applicable)

Residence Permit No:

(If Applicable)

Anticipated Sources of Foreign Exchange: (Please Be Explicit) Current Account No: (with Guaranty Trust) Date Opened: DD MM YY

Type Of Domiciliary Account (Please tick as appropriate) Us Dollars Pound Sterling Euro CFA Others

The undersigned hereby request(s) you to establish a domiciliary account in the chosen currency and agree(s) that: 1. Cash withdrawals from my / our Account shall be subject to availability. 2. The Bank shall have no responsibility / liability for the following: (i) Any diminution due to taxes, charges or depreciation in the value of funds credited to the account which funds may be deposited by you in your name and subject to your name and subject to your control. (ii) The unavailability of such funds due to restrictions on convertibility, requisitions, involuntary transfers, distrains of any character, exercise of military, or usurped power or other similar causes beyond your control. 3. The operation of this account is subject to the laws and regulations at any time existing in the Federal Republic of Nigeria. Authorised Signatories: Name: Signature: Name: Signature:

FOR OFFICIAL USE ONLY Account officer:

Name Signature & Date

Relationship Manager:
Name Signature & Date Signature & Date

Group Head: CSU Head:

Head - CIS

CIS Officer - Name

CIS Officer - Signature

1 Completed Signature Card.

1 Passport Photograph

Identification

SPECIMEN SIGNATURES (INDIVIDUAL)

Account No:

GTBank
Guaranty Trust Bank plc RC 152321

Account Name: Address:

Tel No: (Mobile)

Tel No: (office/home) Photograph

Title: (Mr, Mrs etc) Name:

Signature:

Authorised Combination:

(For Joint Account Holders)

Title (Mr, Mrs etc)

Name

Photograph

Signature

Title (Mr, Mrs etc)

Name

Photograph

Signature