PERSONAL ACCOUNT APPLICATION
Full Name: (the “account holder”) Occupation: Mailing Address: Contact person: Contacts:
Phone:
Fax:
Email:
Signature of Account Holder: Date: Please note: For such period as the account holder is a resident of the Cook Islands, the account holder’s account shall be with Capital Security Bank Cook Islands Limited, and all references in this account opening documentation to “Capital Security Bank Limited” and the “Bank” shall be deemed to refer to “Capital Security Bank Cook Islands Limited.”
ACCOUNT SIGNATORY RECORD Name of Account Holder: The persons whose names and signatures appear below are, subject to the conditions set out below, authorized to conduct transactions on the account. 1 Full name:
Specimen signature:
2 Full name:
Specimen signature:
3 Full name:
Specimen signature:
4 Full name:
Specimen signature:
Restrictions:
If no restrictions (such as joint signature being required) are inserted, each of the above signatories are authorized to sign individually. Signature of Account Holder: Date:
CAPITAL SECURITY BANK LIMITED 1
CORRESPONDENCE AND STATEMENTS REGARDING THE ACCOUNT Bank statements by default will be available by registering for online banking, all other general correspondence will be issued to the contact persons email address stated on page one of this application form. OR To make alternate arrangements please contact one of our Banking Officers on info@csb.co.ck or 00 682 22505 to discuss your requirements Place: Date: Signature of Account Holder:
KNOW YOUR CUSTOMER (KYC) Purpose of opening account and intended use of account (please be specific)
Expected geographical sphere of account activity (Please enter the countries expected to be associated with incoming and outgoing funds)
Transaction Profile (Please indicate the anticipated volume and value of transactions for this account per annum) Transaction Volume
Average Transaction Size
Source of Funds (Funds to be deposited originate from? Please state bank / financial institution and address or If from a third party please provide remitter details and reason for the payment).
Place:
Date:
Signature of Account Holder:
ACCEPTED AND AGREED Signature of Account Holder by its authorized signatory: Date: By signing this document you are agreeing to and confirm you have read Capital Security Banks Terms and Conditions our Terms and Conditions can be viewed at www.capitalsecuritybank.com/terms-and-conditions
CAPITAL SECURITY BANK LIMITED 2