InvestCorp Corporate

Signatory 1

Title

TIN

Surname

First Name & Other Names

Date Of Birth

Maiden Name

Place Of Birth

Marital Status

Gender

Male

Female

Name Of Spouse If Married

Mothers Maiden Name

Contact Number

Residential Status

Country of Origin

Country of Residence

If country of origin is not Ghana, please provide the following :

Residence Permit Number

Place of Issue

Permit Issue Date

Permit Expiry Date

Type Of ID

ID Number

Place Of Issue

Date Of Issue

Date Of Expiration

Job Title

Email Address

Residential Address

Signatory 2

Title

TIN

Surname

First Name & Other Names

Date Of Birth

Maiden Name

Place Of Birth

Marital Status

Gender

Male

Female

Name Of Spouse If Married

Mothers Maiden Name

Contact Number

Residential Status

Country of Origin

Country of Residence

If country of origin is not Ghana, please provide the following :

Residence Permit Number

Place of Issue

Permit Issue Date

Permit Expiry Date

Type Of ID

ID Number

Place Of Issue

Date Of Issue

Date Of Expiration

Job Title

Email Address

Residential Address

Signatory 3

Title

TIN

Surname

First Name & Other Names

Date Of Birth

Maiden Name

Place Of Birth

Marital Status

Gender

Male

Female

Name Of Spouse If Married

Mothers Maiden Name

Contact Number

Residential Status

Country of Origin

Country of Residence

If country of origin is not Ghana, please provide the following :

Residence Permit Number

Place of Issue

Permit Issue Date

Permit Expiry Date

Type Of ID

ID Number

Place Of Issue

Date Of Issue

Date Of Expiration

Job Title

Email Address

Residential Address

Monthly Turnover (GHS)

Annual Turnover (GHS)

BANK ACCOUNT DETAILS

Bank Name

Account Name

Account Number

Bank Branch

Directors / Executive / Trustee / Admin

Surname

First Name & Other Names

Type of ID/ Number:

PPE Status

Contact Number

Surname

First Name & Other Names

Type of ID/ Number:

PPE Status

Contact Number

Surname

First Name & Other Names

Type of ID/ Number:

PPE Status

Contact Number

Beneficial Ownership

Beneficial Owner 1

Surname

First Name & Other Names

PPE Status

Ownership

Date Of Birth

Residential Address

Place of Birth:

Country of Origin:

Country of Residence:

Type of ID/ Number:

Contact Number

Beneficial Owner 2

Surname

First Name & Other Names

PPE Status

Ownership

Date Of Birth

Residential Address

Place of Birth:

Country of Origin:

Country of Residence:

Type of ID/ Number:

Contact Number

Beneficial Owner (Sole Proprietor & Others)

Surname

First Name & Other Names

PPE Status

Ownership

Date Of Birth

Residential Address

Place of Birth:

Country of Origin:

Country of Residence:

Type of ID/ Number:

Contact Number

CHECK AND SIGN APPROPRIATE DISCLOSURE

PRODUCT AGREEMENT - INVESTCORP ACTIVE EQUITY FUND:

A low risk product investing in high quality Treasury securities

• Minimum lump sum investment of GH¢ 1,000.00 or minimum opening balance of GH¢ 100 for direct debits

• Unrestricted entry and exit with five (5) working days’ notice required for redemptions

• Competitive management and expense fees

PRODUCT AGREEMENT - INVESTCORP MONEY MARKET FUND:

A low risk product investing in high quality short-term securities including treasury bills, commercial paper and CDs

• Unrestricted entry and exit, with just a working days’ notice required for redemptions

• Competitive management and expense fees

• Minimum lump sum investment of GH¢ 1,000 or minimum opening balance of GH¢100 for direct debit clients

PRODUCT AGREEMENT - INVESTCORP MID-TIER FUND:

A unique high yielding debt and preferred equity fund that combines the features of a traditional asset management product with advisory services

• Competitive management and expense fees

• Redemptions are paid within five (5) business days

• Minimum lump sum investment of GH¢ 5,000 or minimum opening balance of GH¢ 100 for direct debit clients

PRODUCT AGREEMENT - INVESTCORP WELFARE / BENEFITS FUND:

Managed investment schemes for employees, groups and associations

PRODUCT AGREEMENT - INSTITUTIONAL FUND MANAGEMENT:

An investment portfolio that is managed according to an agreed mandate

PRODUCT AGREEMENT - INVESTCORP ACTIVE EQUITY FUND:

A Fund that tracks the performance of a model portfolio that is constructed based on carefully selected stocks that trade on the Ghana Stock Exchange (GSE)

• Minimum lump sum investment of GH¢ 1,000 or minimum opening balance of GH¢200 for direct debit clients

• Unrestricted entry and exit with five (5) working days notice required for redemptions

• Competitive management and expense fees

MISC

Statement Services

Mode Of Statement Delivery

Statement Frequency: Sent Quarterly (default)

Expected Account Activity

Source Of Funds

If Other, please specify:

Initial Investment Amount:

Anticipated Investment Activity

Top-ups:

Others

Withdrawals:

Others

Anticipated Investment Amount: Regular Top-up Amount (Expected):

Regular Withdrawal Amount (Expected)

Mandate To Operate Account

Account Holder(s) Authorization/ Signature(s):

Name of Signatory 1

Name of Signatory 2

Name of Signatory 3

Approvals

Relationship Manager

Processed by

Position

Reviewed and Approved by

High Risk Account Authorized / Approved by Executive / CEO

Name

Comments

For Official Use Only

Does the shareholders, directors, executives, senior management, administrators, trustees and signatories fall under the following:

A head of state/government, politician, senior public official, senior military official, senior public corporation officer, high rank political party official in Ghana

If yes to any above, please specify name (if not the applicant) and nature of the position:

A head of state/government, politician, senior public official, senior military official, senior public corporation officer, high rank political party official outside Ghana

If yes to any above, please specify name (if not the applicant) and nature of the position:

Have you bought a security such as Treasury bill, bond shares etc before?

Please all fields are required