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