Individual Account Opening Form

FIXED DEPOSIT INVESTMENT APPLICATION FORM

(For Individual Investors in Nigeria)

SECTION A: PERSONAL DETAILS

Prefix

Your First Name *

Middle Name *

Your Last Name *

Date of Birth *Please enter your date of birth

Day *

Month *

Year *

Gender *

Your Email Address *

Mother’s Maiden Name *

Marital Status *

Phone Number *0 / 11

Contact & Identity

Please provide accurate contact details and identification.

Residential Address *

Occupation *

Mailing Address (Optional)

State of Origin *

L.G.A *

Nationality *

Bank Details

Bank Account Number *

Bank Account Name *

Bank Name *

BVN *

NIN *

SECTION B: INVESTMENT DETAILS

Deposit Amount (₦) *

NGN

Tenure *

90 Days180 Days365 DaysOther

Interest Payment Mode *MonthlyQuarterlyAt MaturityRoll Over

Interest Payment Account (if different from above)

Account Name

Bank Name

Account Number

Instruction at Maturity *

Reinvest Principal + InterestReinvest Principal OnlyPay Out All

Next of Kin

Prefix

First Name *

Middle Name *

Last Name *

Phone *0 / 11

Email Address *

Residental Address *

City

State/Province

Country

Your relationship with the Next of kin

Document Uploads

Upload files (Valid Means of ID) *

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Upload files (Recent Passport Photo) *

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Upload files (Utility Bill) *Valid Means of ID Passport Photo Utility Bill Signature

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Declaration

(i) I hereby authorize Networth Portfolio & Asset Management (NP&AM) to open an investment account for me using the above information provided by me in this form. (ii) I hereby authorize NP&AM to honor all instructions including but not limited to purchases/sales mandates, e-dividends/e-bonuses mandates, etc. emanating from me in writing or through my e-mail address as given in this form. (iii) I hereby confirm that I shall be solely responsible for all orders / transactions done in my name and on my account. Consequently, NP&AM and its officers, Directors and/or Employees shall have no liability, financial or otherwise, and/or suffer any damages arising from my decision/instruction on this account.
(iv) I agree to be bound by the terms and conditions governing the operation of this account.

Kindly upload your signature here: *

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(I) That, I, (Full Name Below:)

Your full name Here *

hereby authorize Networth Portfolio & Asset Management (NP&AM) to open an Investment Account in my name and form me.
(II) That Networth Portfolio & Asset Management (NP&AM) is hereby requested and authorized to act on my instructions with regard to any transactions on the Investment Account.
(III) That all transactions between Networth Portfolio & Asset Management (NP&AM) and I shall be subject to the articles, rules and regulations of the Nigerian Stock Exchange (NSE), the Securities & Exchange Commission (SEC), the Investments and Securities Act (ISA) of 1999, and all further regulations/directives passed and as amended from time to time to regulate trades between the parties and to regulate broker/dealer activities.
(IV) That my mandates shall be sent through written instruction(s) to APL, and/or via a secured e-mail to info@networthsec.com.
(V) That my mandates will only be executed if delivered to Networth Portfolio & Asset Management (NP&AM) through any of the aforementioned channels by/or before 9:00am on the intended business day of execution.
(VI) That in the event that I submit mandates/amendments/cancellations after the deadline stated above, they may not be executed until the next business day.
(VII) That my buy and sell mandates will only be executed based on the prevailing market prices of stocks on the Nigerian Stock Exchange at the time of execution and not a price range.
(VIII) That my purchase mandates shall not be executed if sufficient funds are not available in my stockbroking account to meet the value of such transaction(s).
(IX) That in the event that purchase mandate was erroneously executed in excess of my account balance, Networth Portfolio & Asset Management (NP&AM) has a duty to notify me with a view of regularizing my account without any loss to me.
(X) That all sales proceeds of stocks shall bee retained in my investment account except if I advise otherwise in writing, provided that such express instruction(s) is/are not in favor of third parties. (XI) That funds deposited in my investment account with Networth Portfolio & Asset Management (NP&AM), including retained sales proceeds, are not interest bearing. The fund will remain in my investment account until I give an express instruction/mandate authorizing its utilization.

Today's Date *

Agreement *I have read and agree to the declaration above. I also confirm that the information provided above is true and correct. I understand the terms and conditions governing this fixed deposit and authorize the institution to act accordingly.

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+234-8035--689215

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