Personal Banking Products Application Form

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1 Personal Banking Products Application Form Personal Account Opening Personal Unsecured Loan Personal Credit Card Mandatory Requirements Original ID or passport Original PIN certificate One passport size coloured photograph Copy of utility bill (electricity, telephone, water, cable/internet, tenancy agreement) not more than 3 months old Additional Requirements For Account Opening Introduction letter from a referee who holds a CBA account; or employer; or lawyer listed in CBA s panel; or area chief; or church / mosque clergy Residential permit for Foreign Nationals Letter from Embassy or parent firm and Immigration file number (R. Number) for non residents For Childrens Acccount - Original Birth Certificate Additional Requirements For Personal Credit Card Certified Bank Statements for the last 6 months - (for non-cba customers) Payslips for the last 3 months Additional Requirements For Personal Unsecured Loan Certified Bank statements for the last 6 months - (for non CBA customer) Payslips for the last 3 months (original or copy certified by employer) Letter from employer confirming terms and conditions of employment Copy of work permit (if non-kenyan) CBA is regulated by the Central Bank of Kenya

3 PERSONAL INFORMATION (First Applicant) Title: Mr. Mrs. Ms. Dr. Prof. Hon. Other (Please specify) First Middle Last of birth PIN Nationality (DD/MM/YYYY) Country of Birth Place of birth Child (If Applicable) First Middle Last Marital Status Single Married Divorced Widowed Gender Male Female Identification Document (National ID, Passport, Alien ID, Disciplined forces ID) Document No. Postal Address Postal Code Town/ City Country Physical Address (Residential) Plot No. Length of stay at current residence in years Nearest Landmark Is the property Company House Rented Own House Live with parents Mobile No. (1) Mobile No. (2) (Preferred) (Other) Next of Kin () Relationship Spouse Child Parent Other (Please specify) Next of Kin Tel Contacts Postal Address Postal Code Town/ City Country EMPLOYER/ BUSINESS DETAILS (First Applicant) Employment type: Permanent Pensionable Contract Casual Self Employed Other Occupation of Employer Employee Department Employee Position If Self employed, State Nature of Business Gross Income Band (KES 000) A 0-50 B C D E F Above 500 Employers Postal Address Postal Code Town/ City Country Employers / Business Physical Address Plot No. Tel (Off) Fax Mobile No. (Off) Employers / Business Address Other accounts held currently (with CBA or other banks) Bank Branch A/C No Bank Branch A/C No 1

4 PERSONAL INFORMATION (Second Applicant) Title: Mr. Mrs. Ms. Dr. Prof. Hon. Other (Please specify) First Middle Last of birth PIN Nationality (DD/MM/YYYY) Country of Birth Place of birth Child (If Applicable) First Middle Last Marital Status Single Married Divorced Widowed Gender Male Female Identification Document (National ID, Passport, Alien ID, Disciplined forces ID) Document No. Postal Address Postal Code Town/ City Country Physical Address (Residential) Plot No. Length of stay at current residence in years Nearest Landmark Is the property Company House Rented Own House Live with parents Mobile No. (1) Mobile No. (2) (Preferred) (Other) Next of Kin () Relationship Spouse Child Parent Other (Please specify) Next of Kin Tel Contacts Postal Address Postal Code Town/ City Country EMPLOYER/ BUSINESS DETAILS (Second Applicant) Employment type: Permanent Pensionable Contract Casual Self Employed Other Occupation of Employer Employee Department Employee Position If Self employed, State Nature of Business Gross Income Band (KES 000) A 0-50 B C D E F Above 500 Employers Postal Address Postal Code Town/ City Country Employers / Business Physical Address Plot no. Tel (Off) Fax Mobile No. (Off) Employers / Business Address Other accounts held currently (with CBA or other banks) Bank Branch A/C No Bank Branch A/C No 2

5 REFREES DETAILS For Account Opening application Account Number For Credit Card application Full Relationship No. of years acquainted Nationality Tel. Home Tel. Work Tel. Mobile Physical address Work/Residence Address Referee 1 Referee 2 (must be a relative) RECREATION INTERESTS (please tick as appropriate) Art/Antiques Athletic/Other Activity sport Art/Antiques Fine foods/wine Foreign travel Photography Tennis/Other Racket sports Bicycling/Mountaineering/Hiking Golf Water sport Dance/Ballet Health club/gym Others (please specify) Equestrian sports Music/Theatre 3

6 PERSONAL ACCOUNT OPENING Please complete all details in CAPITAL letters. I/We wish to open the following account and undertake to comply, observe and be bound by the General Terms and Conditions. ACCOUNT TITLE Indicate type of account required: Account type Current Savings Call deposit Fixed deposit Child Account Currency KES USD GBP EURO Other (specify) Account Category Individual Joint For Fixed Deposits Only Period (In Months) Q. How did you get to know about CBA and our products? TV Advert Radio Advert Print Advert Billboard/Outdoor Letter/ Online Word of mouth Others (please specify) Promotional Campaign (please specify the campaign) CHEQUE BOOK AND STATEMENT DETAILS (please tick as appropriate) Cheque Book To be collected from Book(s) Branch Statement Cycle Monthly Quarterly No Statement Your preferred address to receive statements from the Bank Please tick to sign up for this product Internet Banking Yes No Mobile Banking Yes No Your preferred mobile number to receive alerts from the Bank ELECTRONIC BANKING (Mobile and Internet Banking) Applicant Phone Make e.g Nokia, Android, Blackberry Memorable Word* Token Number (For Bank use only) *The memorable word you specify will be requested when you first log onto the internet to authenticate your identity. Your memorable word will also be requested should you require to reset/unlock your token.(nb: The word must be between 6 and 20 characters) Funds Transfer Beneficiary Maintenance Register* These are accounts that you will regularly make transfers to. Beneficiary Beneficiary Account No. Beneficiary Bank Branch Code *This register will be accessible through your mobile phone. 4

7 CBA CREDIT CARD INFORMATION* (First Six Digits) (Last Four Digits) Card : Card Number: Card : Card Number: Card : Card Number: *This information will allow you to access card available balance, amounts due and the due date for payment on Mobile Banking. I/We have read the General Terms and Conditions necessary to open and operate an account with Commercial Bank of Africa Limited (CBA) and I/we oblige to comply. I/We agree that this account shall be solely at the discretion of CBA and hereby agree to Indemnify CBA at my/our cost against any loss or claims arising out of the account being closed by CBA without notice due to unsatisfactory performance. I/We undertake to inform the bank of any changes of contact or my/our personal details. I/We confirm that the information given on this form is true and accept that the operations of the account will be subject to the General Terms Conditions. : : : : I/D or Passport No: I/D or Passport No: Mobile No: Mobile No: d This: Day of 20 AUTHORISED SIGNATORIES Operating Mandates Sole Either/Or All to sign Other (specify) 5

8 PERSONAL UNSECURED LOAN Credit details I would like to apply for: Unsecured Loan Top-up Currency: KES USD EURO Amount Period (months) Purpose of loan: School fees Home improvement Medical Plot purchase Other (please specify) Budget planner Please attach original documents to assist in fast processing of your application. Please attach latest 3 months ORIGINAL payslips Monthly Income Salary Commissions Rental /receipts Other income (Specify) Total Income (l) Monthly Expenses Loan payments Mortgage / rent payments Card payments Other expenses Total (E) Surplus (S=I-E) OTHER FINANCIAL DETAILS Other loans/credit NAME OF LENDER MONTHLY PAYMENT CURRENT BALANCE DECLARATION 1. I/We certify this information is true and correct and authorize Commercial Bank of Africa (CBA) to contact any source for confirmation. I /We have read the General Terms and Conditions governing this facility and agree to be bound by them. I understand CBA reserves the right to decline this application without giving reasons. 2. I understand that this application will go through a vetting process and should my loan be approved a loan account of the amount requested will be created in my name. 3. I understand that interest of this loan will be applied based on the prevailing variable interest rate currently at p.a for the entire period. I instruct CBA to credit the loan amount approved to my account number with yourselves upon approval of my loan. 3a. My loan will be repaid over months. 3b. Facility fees charged will be % of the loan amount disbursed. 4. I agree to obtain credit insurance cover for the loan and authorize CBA to deduct premiums payable towards the Cover (applicable to customers that obtain cover from Commercial Bank of Africa Insurance Agency) 5. I authorize CBA to deduct the facility fee from the loan granted. 6. I agree to inform CBA should my employment status change and I further confirm that I should NOT change my salary paypoint from CBA until I have paid off the loan in full. 7. I agree to inform CBA should my employment status change thereby affecting the direct salary check-of arrangments with my employer. Please tick as applicable: In the event that the amount I qualify for is less than the amount requested: I instruct the bank to contact me before crediting my account. I authorize the bank to create a loan account in my name and disburse the approved amount without reference to me. I authorize my employer to deduct via direct salary check-off my monthly loan repayment and remit to CBA. I authorise my employer to channel my monthly salary to CBA account No. of applicant (sign in presence of a Bank Official) (DD/MM/YYYY) of joint applicant (DD/MM/YYYY) 6

9 APPLICATION FOR LOCAL FUND TRASFER DD/MM/YYYY Kindly effect the following payment on my / our behalf as follows EFT RTG s Account of Bank & Branch Salary Account No. (As it is in the Bank Statement) Payment Details Loan proceeds Cheque details Cheque Details (Where applicable) of Beneficiary Amount Preferred Collection Branch In an electronic transfer, it is understood that the same is sent at my/ our risk and that the Bank is not held liable either for any mistake, delay or omission which may happen in the transmission of the message or from its misinterpretation when received. I/ We undertake to pay charges made for repetition of the transfer if this occurs. Mobile No. Mobile No. FOR BANK USE ONLY Amount to be transfered RTG S 1 RTG S 2 Amount OF Cheque CHEQUE 1 BANK CHARGES 7

PERSONAL CREDIT CARD Card preference Classic Card Gold Card KES KES USD OTHER CREDIT CARD DETAILS Issuer (name of bank) Card No.

Credit Limit Held since Credit Limit Held since CBA Credit Card limit requested for: KES USD ADDITIONAL CARD HOLDER Do you wish to have a card issued to another member of your family*?

First Middle Last Title: Mr. /Mrs. / Miss Employer (If applicable) Occupation of birth Country of Birth (DD/MM/YYYY) Tel No. (Off) Place of birth Mobile No. Passport No.

10 PERSONAL CREDIT CARD Card preference Classic Card Gold Card KES KES USD OTHER CREDIT CARD DETAILS Issuer (name of bank) Card No. Issuer (name of bank) Card No. Credit Limit Held since Credit Limit Held since CBA Credit Card limit requested for: KES USD ADDITIONAL CARD HOLDER Do you wish to have a card issued to another member of your family*? If yes, please provide their details and signature below.(must be over 18 years old) Yes No Limit *Please attach one colour photogragh and and original ID/Passport of the additional card holder. First Middle Last Title: Mr. /Mrs. / Miss Employer (If applicable) Occupation of birth Country of Birth (DD/MM/YYYY) Tel No. (Off) Place of birth Mobile No. Passport No. Country of issue Nationality Relationship to principal card holder Mobile No. Address Please issue me with a supplementary card as indicated above. I warrant that the information given in the application form is true and complete and I authorize you to make any inquiries necessary in connection with this application. I have read, accepted and agree to be bound by the CBA VISA Card General Terms and Conditions of use (as amended from time to time). of additional cardholder CARD DELIVERY Please indicate which CBA Branch you wish to collect your card(s) from. Branch/Specify (DD/MM/YYYY) DIRECT DEBIT INSTRUCTIONS (Optional) This facility allows automatic debiting of your CBA Current or Savings Accounts for settlement of your monthly statements. How does it work? Payment is made automatically from your nominated CBA account in accordance with your instructions to settle your CBA Visa Card Account. Safety No payment is made unless you have authorized us to do so. Control You remain in total control. You can cancel the authority simply by informing us in writing. You will be advised in advance on your monthly statements from CBA of the amounts due and when they will be charged to your bank account. Should you have a query about payment, you may contact us for immediate action. 8

11 DIRECT DEBIT INSTRUCTIONS (Optional) Please indicate the percentage of the outstanding amount to be debited monthly. (min 20%) Percentage Account Account Type Account No. Instructions to the Bank I/We instruct you to pay autocredit payments from my/our account at the request of CBA VISA Card. The amounts are variable and are to be debited on various dates (but not to exceed total amount outstanding on due date). Authorized Signatory Authorized Signatory DECLARATION Please issue me with a CBA VISA Classic /Gold Card. I warrant that the information given in the application form is true and complete and I authorize you to make any inquiries necessary in connection with this application. I have read, accepted and agree to be bound by the CBA VISA Card General Terms and Conditions of use (as amended from time to time). I agree that I/We are jointly and severally liable for all charges incurred through the use of CBA VISA Card. I/We understand that Commercial Bank of Africa Limited reserves the right to decline the application without giving resons. 9

12 BANK USE ONLY (Personal Account Opening) Sales Code Customer number A/C number DAO Code A/C opened by Authorized by Sector Industry Legal Entity Verified T24 Mapping Customer enabled for Internet Banking by Customer enabled for Mobile Banking by Notifications mapped Accounts mapped Token issued by INITIAL DEPOSIT Cash Amount In house Cheque Amount Local Cheque Amount Bank A/C number Internal Transfer Amount BANK USE ONLY (Personal Unsecured Loan) Checklist for Branch /Account Relationship Manager Checklist completed 6 months statements checked against payslip If foreigner, attach contract and work permit Is application compliant with existing product profile? If No, list the exceptions i) ii) iii) Yes No Recommended by: Account Relationship Manager 10

13 DECLARATION 1. I have read and understood or have been explained to (in a language I understand) the General Terms and Conditions referred to herein and which form part of this Application Form and which are also available in all CBA branches or website and I agree to be bound by them. I acknowledge that I am bound by any variation the Bank makes to these documents. 2. I confirm and warrant that all information (including any documents) I have given to the Bank in connection with this application is correct, complete and not misleading. If any of the information provided is incorrect or misleading I will be personally liable for the same. I undertake to promptly notify the Bank if I become aware that any information I have given changes, is incorrect or misleading. 3. I agree that the Bank will send all correspondences in electronic form using or any other electronic media. However, the Bank reserves the right to send paper correspondences to me at my last known address as per the Bank s records. 4. I represent and warrant that I have all the necessary power and authorisations to own assets, carry on business, enter into each of the banking agreements and any other arrangement with the Bank to ensure compliance with my obligations under this Agreement 5. I authorise the Bank to disclose to, and verify any of the information I have given to the Bank or my credit standing from anyone the Bank may consider appropriate (such as an authority or credit reference agency). 6. I confirm that the personal information provided in this application form and that of my joint account holder (if any) or authorised person (if any) will apply to the account(s) I hold with the Bank unless I expressly tell you otherwise. 7. I consent to the Bank contacting me at the address, address and phone numbers I have provided to them, to give you information on other products and services that the Bank, or its strategic partners, may offer. 8. I agree and acknowledge that If I am applying for a bundled product that the Bank may vary or terminate the package offers or change the terms of the package by giving me notice. 9. I also understand that should I wish to terminate one of the bundled products, I agree that the Bank may charge me an additional fee for the remaining product(s). 10. I agree that the Bank has the right to set off the amount held in lien against which a cash secured facility(ies) has been granted to me by the Bank, in the event of default. I authorise the Bank to purchase such foreign currency with the monies standing to the credit of my account(s) as may be necessary, to effect the set off and settle any outstanding on the loan facility where necessary to facilitate the offsetting of the facility in default. I agree that the lien will only be lifted upon full repayment of the facility(ies). I further agree that I shall lay no claim whatsoever to the funds under lien until such time the facility is repaid in full. 11

16 CBA/MAR/2015

Individual Clients Banking Products and Services Application Form

Individual Clients Banking Products and Services Application Form Individual Clients Banking Products and Services Application Form Before you sign this application form, please read our Client Terms and