APPLICATION FOR OPENING ACCOUNT OF A COMPANY/SOCIETY/CLUB Branch I/We wish to open the following account(s) with I&M Bank Limited as per the following details: Company/Organisation Name Mailing Postal Address Post Code Town Other Number Physical Address Primary Contact* of Incorporation/Registration D D M M Y Y Y Y PIN Number Other Number Registration Certificate Number Hold Mail Y( ) N( ) Preferred Branch (If yes for hold mail) Type of business ( where applicable) Sole Proprietorship Partnership Society/Association/Club Limited Company Others (Specify) Description of business activity Number of Employees Less than 100 100 or more Annual Turnover Less than KShs 500 million KShs 500 million and above Balance Sheet Size (Total Assets) Less than KShs 500 million KShs 500 million and above Purpose of Account Other Accounts held with I&M Bank or other banks Bank Name Branch Account Number First Signatory Gender F( ) M( ) PIN of Birth D D M M Y Y Y Y
Second Signatory Gender F( ) M( ) PIN of Birth D D M M Y Y Y Y Third Signatory Gender F( ) M( ) PIN of Birth D D M M Y Y Y Y Fourth Signatory Gender F( ) M( ) PIN of Birth D D M M Y Y Y Y Account Type ( where applicable) Sapphire Biashara Foreign Currency Transactional Sapphire Others (Specify) Business Transactional Alpha Savannah Noble Others Term Deposit Call Deposit
Currency ( where applicable) KShs USD GBP Euro Other (Name) Initial Deposit Details Period (in case of Term Deposit) Purpose of Account Account Facilities Cheque Book Agent Authority (Fill in Agent Mandate Form) Debit Card (Applicable for Sole Proprietors only) Request for Next Generation Facility ( as needed)* - (Primary contact will be used for the below facilities) I&M Corporate Internet Banking (I-Click) I&M Mobile Banking I&M PesaLink (KITS) Notify me by SMS (chargeable) for transactions of the following amount and above (in Kshs) minimum KShs 5,000 *Service only available if registered for I&M Mobile Banking Debit (KShs) Credit (KShs) Request for emailed statements in lieu of physical statement (optional): Frequency (only one option)* Daily Weekly Monthly Quarterly Annually PEP Declarations for Directors Is any of the Directors entrusted with a prominent public office locally or in a foreign country, including any member of your immediate family or close associates? Yes No If yes, kindly ask for a detailed questionnaire and complete it. FATCA DECLARATION (Foreign Account Tax Compliance Act) On an annual basis, the Bank will report information on financial accounts held directly or indirectly by U.S Persons. In certain circumstances and where customers fail to provide the appropriate documentation, the Bank may be required to apply 30% US withholding tax on certain types of US income paid to such customers. Do you have a US Postal Address? Y( ) N( ) Do you have subsidiaries in the US? Y( ) N( ) Do you have a US Telephone Number? Y( ) N( ) Is the entity registered in the US? Y( ) N( ) Do you have any income from the US? Y( ) N( ) Does the entity have US Partners/ Signatories/Directors? Y( ) N( ) Introducer Name Address I&M Bank A/C No Certificate by Introducer I confirm that I have known the above account applicant for years and the physical location and address indicated herein is correct. I also confirm that I consider the new account holder to be respectable and trustworthy to operate the Bank Account. Signature Documents required Introduction Reference ID/Passport Copy/PIN Card Copy of all Authorised Signatories (of all applicants) Certified Copy of Latest Annual Returns or Letter from Auditor/Co. Secretary Certifying names of Existing Directors Copy of PIN Card of Company/Organisation Recent Colour Passport Photographs of all Authorised Signatories Memorandum & Articles of Association of Company/ by-laws or Constitution of Organisation (certified copy) Copy of Certificate of Incorporation/Registration Board resolution/extracts of Committee Meeting Signed by Chairman and Secretary/Partner s Resolution Signed by all Partners
I/We the undersigned request you to open an account or accounts as detailed above and at any time subsequently to open such further account(s) of whatever nature as I/We may direct. I/We confirm that all of the above details are correct and that I/We have read, understood and agree to the I&M Bank Limited General Terms and Conditions, the Terms and Conditions Governing the Use of I&M Next Generation Banking Facility, the Terms and Conditions Governing the Use of I&M Internet Banking and the Terms and Conditions of Use of the I&M Bank Limited Debit Card. Account Mandate Singly Jointly All Jointly Any Special Mandate (Specify) Other Signing Instructions Name of 1 st Signatory 1 ST SIGNATORY Signature of 1 st Signatory Name of 2 nd Signatory 2 ND SIGNATORY Signature of 2 nd Signatory Name of 3 rd Signatory 3 RD SIGNATORY Signature of 3 rd Signatory Name of 4 th Signatory 4 TH SIGNATORY Signature of 4 th Signatory
FOR OFFICIAL USE ONLY Information Data Input Scheme Code Bank Director related (Y/N) PEP (Y/N) Sector Code Sub Sector Code Economic Sector Code Profit Centre Business Line Detailed Economic Sector Code Branch Check List Initials Initials Valid Identification Documents Obtained & Authenticated Reference Confirmed Manager s Approval Exception (Give reasons) Account Opened by (Name & Initials) Authorised by (Name & Initials) Exception Approved by STAFF DETAILS Name of Sales Staff/Agent Staff ID Branch Name