Appendix

ACCESS BANK PLC

Acknowledgment Form (In Duplicate)

NAME IN FULL:...............................................................................................
(SURNAME FIRST, OTHER NAMES LAST)

STAFF NUMBER:..............................................................................................

ADDRESS:............................................................................................................

HOME TOWN:........................................... STATE:.........................................

DATE OF BIRTH:............................PLACE OF BIRTH:..........………………

PLACE OF ENGAGEMENT:............................................…………………..

DATE OF ENGAGEMENT:....................................................………………

NATURE OF EMPLOYMENT:................................................……………..

SIGNATURE & DATE:.......................................................................……….

www.accessbankplc.com