KYC RELATED PARTY INFORMATION: INDIVIDUALS

CB_CI_RP_IND (1111)

Use BLOCK LETTERS when completing

*Please mark your selections with an “X”. Draw diagonal line ( / ) through unused sections.
Title and full names Date
If passport,
ID Type* SA ID Passport ID Number
country of issue
Postal
Residential Address
code
Owner or CEO or Principal Trustee Beneficiary Founder or Authorised Account user/
Relationships*
Co-owner Controller member of trust of trust donor of trust representative signatory
Cell number Work Number I confirm that this information is correct
25% + voting rights in
Fax number Percentage Interest %
the entity

Email address
Signature of Related Party
For office Use: UCN ID scanned date: KYC Codes

Title and full names Date

If passport,
ID Type* SA ID Passport ID Number
country of issue
Postal
Residential Address
code
Owner or CEO or Principal Trustee Beneficiary Founder or Authorised Account user/
Relationships*
Co-owner Controller member of trust of trust donor of trust representative signatory
Cell number Work Number I confirm that this information is correct
25% + voting rights in
Fax number Percentage Interest %
the entity

Email address
Signature of Related Party
For office Use: UCN ID scanned date: KYC Codes

Title and full names Date

If passport,
ID Type* SA ID Passport ID Number
country of issue
Postal
Residential Address
code
Owner or CEO or Principal Trustee Beneficiary Founder or Authorised Account user/
Relationships*
Co-owner Controller member of trust of trust donor of trust representative signatory
Cell number Work Number I confirm that this information is correct
25% + voting rights in
Fax number Percentage Interest %
the entity

Email address
Signature of Related Party
For office Use: UCN ID scanned date: KYC Codes

Title and full names Date

If passport,
ID Type* SA ID Passport ID Number
country of issue
Postal
Residential Address
code
Owner or CEO or Principal Trustee Beneficiary Founder or Authorised Account user/
Relationships*
Co-owner Controller member of trust of trust donor of trust representative signatory
Cell number Work Number I confirm that this information is correct
25% + voting rights in
Fax number Percentage Interest %
the entity

Email address
Signature of Related Party
For office Use: UCN ID scanned date: KYC Codes

Title and full names Date

If passport,
ID Type* SA ID Passport ID Number
country of issue
Postal
Residential Address
code
Owner or CEO or Principal Trustee Beneficiary Founder or Authorised Account user/
Relationships*
Co-owner Controller member of trust of trust donor of trust representative signatory
Cell number Work Number I confirm that this information is correct
25% + voting rights in
Fax number Percentage Interest %
the entity

Email address
Signature of Related Party
For office Use: UCN ID scanned date: KYC Codes

For office use only

Principal Customer UCN Name of the principal client CT Code

First National Bank - a division of FirstRand Bank Limited. An Authorised Financial Services and Credit Provider (NCRCP20). Reg. No. 1929/001225/06.