Professional Documents
Culture Documents
UBA VISA Prepaid Card Application Form
UBA VISA Prepaid Card Application Form
* Middle Name/Prénom:
Permanent Address: Residential Status: Ow n residence/Pr opr e Maison Tenant/Locat air e P.O BOX ………………..
Adr esse act uelle Résidence Boit e post ale
TelephoneNumber/
NO de T éléphone:
Mobile/Por t able Home /Fixe Office/Bur eau
* Cust om er Signature/Signat ur e du Client * Cust om er Segment/Segm ent du Client * Cust om er ID/N° Client * Cust om er introducer
Name of Relat ion s h ip officer /Nom du Chargé de clientèle elert s Name of BOM/Nom du BOM :
Relationship Officer’s ID /No d’ident ificat ion du Chargé de client ele Business Office/Agence :