SIGNATURE MANDATE FORM

TO BE COMPLETED IN BLOCK LETTERS

Account Title: ___________________________________________________________________________________________________
Account Number: _______________________________________________________________________________________________
DECLARATION
I/We have read and had the Terms and Conditions explained to me/us. I/We do hereby affix my/our signature(s) as evidence
that I/We understand and undertake to comply, observe, and be bound by the said Terms and Conditions, copies of which
have been availed to me/us. I/We understand that by entering into this banking agreement, I/We give indemnities,
authorization, consents, and waivers and agree to limitations on the Bank’s liabilities. I/We have, in addition, agreed to be
bound by any variations to the Terms and Conditions that may be made by the Bank from time to time, and updated on its
website www.kcbgroup.com

Mode of Signing (if joint) Any  Both  All to sign  Other (specify) ………………………………………………………………………………
1. Applicant(s)/Signatories:
Name: Name:
Identification No. Identification No.
Nationality 1 Nationality 1
Nationality 2 (if dual) Nationality 2 (if dual)
Affix Passport Size Tel. No. Affix Passport Size Tel. No.
Photo or Indicate Email Address Photo or Indicate Email Address
Photo Number PIN
Photo Number PIN
Residential Address Residential Address
Stakeholder type Stakeholder type
Signature Signature

2. Mandate Holder(s):
Name: Name:
Identification No. Identification No.
Nationality 1 Nationality 1
Nationality 2 (if dual) Nationality 2 (if dual)
Affix Passport Size Tel. No. Affix Passport Size Tel. No.
Photo or Indicate Email Address Photo or Indicate Email Address
Photo Number PIN
Photo Number PIN
Residential Address Residential Address
Mandate Instructions Mandate Instructions
Signature Signature

Tools Required
Debit card Mobile banking Internet banking  Register for Simba Loyalty Points

Cheque book. Please supply me/us with…………………number of new cheque book(s) containing 50 100 cheque leaves.

For Diaspora Customers

Signed in the Presence of (Notary Public/Kenya Embassy Staff)

Name……………………………………………………………………………. Signature……………………………………………………Stamp…………………………… …….

Official Use Only:
DSR Code ………………………………………………………………………………Referral Code ………………………………………………………………………………………………………

Signed in the Presence of: Name of Staff................................................................................Signature.................................................

Authorizing Official’s Signature…………………………………………………Signature No………………………………. Branch Stamp…………………………….

Regulated by the Central Bank of Kenya

E-MAIL INSTRUCTIONS AUTHORITY AND INDEMNITY
TO: KCB Bank Kenya Limited
It would be convenient and in my/our interests if I/ We could at any time and from time to time send instructions by means of
electronic mail (meaning the sending of transmissions electronically between computers via the telephone networks) and/or
means of transmissions (meaning the sending of transmissions between machines via the telephone networks) to KCB Bank
Kenya Limited (“KCB”) in relation to any and all my/our existing accounts, facilities and other arrangements with KCB and any
accounts, facilities and other arrangements with KCB and any accounts, facilities which I /we may now or in the future have with
KCB (instructions sent by such transmissions being hereinafter referred to as “E-mail instructions”). In consideration of KCB
agreeing to accept E-mail instructions from me/us as aforesaid, I/We agree: -

1. THAT KCB may act on any E-mail instructions given by me/us from time to time, and I /We voluntarily and with full knowledge
take and assume any and all risks associated therewith.
2. THAT once E-mail instructions have been sent to KCB purported by the person (or by any of the persons if more than one)
specified below, KCB shall have no obligation to check or verify authenticity or accuracy of such E-mail/ instructions purporting
to have been sent by me/us and may act thereon as if the same had been duly given by me/us.
3. THAT in acting on E-mail instructions, KCB shall be deemed to have acted properly and to have fully performed all the
obligations owed to me/us, notwithstanding that such E-mail/ instructions may have been initiated, sent or otherwise
communicated in error or fraudulently, and I/We shall be bound by any E-mail instructions on which KCB may act if KCB has
in good faith acted in the belief that such E-mail instructions were given by me/us;
4. THAT KCB may, in its absolute discretion, decline to act on or in accordance with the whole or any part of an E-mail instruction
pending further enquiry or further confirmation (whether written or otherwise) by me/us, so however that KCB shall not be
under any obligation to so decline in any case, and KCB shall in no event or circumstance be liable for not so declining; and
5. To release from and indemnify against all claims, losses, damages, costs and expenses howsoever arising in consequence of,
or in any way related to KCB having acted in accordance with the whole or any part of any
E-mail instruction exercised (or failed to exercise) the discretion conferred upon KCB in Clause 4 above.

Dated this ___________________ date of ______________________ 20 ____

For a Company;
Signed by the duly Authorized Representative(s):

Director: ___________________________________________

Director/Secretary: ___________________________________

In the presence of:

(Commissioner for Oaths/ Notary Public) ______________________________________

For Individuals;
Name of Individual: ____________________________________________ Signature: ___________________________

Name of Individual (Joint A/C member): ____________________________ Signature: ___________________________

In the presence of: ______________________________________________ (Print Name of Notary Public)

Signature: ____________________________________________________

Account Number: __________________________________ E-mail Address: ____________________________________

Official Use Only:

Authorizing Official’s Signature: ___________________________Signature No: _____________ Branch Stamp: ______________

Regulated by the Central Bank of Kenya