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ACCOUNT OPENING / MEMBERSHIP FORM

Microfinance Multipurpose Coop. Soc. Ltd


Account Information

Date Branch

Joint Account Fixed Investment Account


Account Type: (Tick as appr
appropriate)

Curr
Current Account Fixed Deposit Account Savings Account
Product Name (Please specif
specify)

Do you have an existing account with us? No


Branch

BIOMETRIC VERIFICA
VERIFICATION (For official use)
NUMBER (BVN)

Title Mrs. Other


Others (Specif
(Specify) Gender: Male Female
Surname Fir
First Name

Other Name

Date of Bir
Bir th Place of Bir
Bir th
Mother'
Mother's Maiden Name Nationality
Religion (Optional)

L.G.A. Occupation
Marital Status (Please tick) Single Married Other
Others (Specif
(Specify)

2. Contact Details

Residential Addr
Address

one no. (1) Phone no. (2)


Identity Type: Driver'
Driver's license Int'l Passpor
asspor t National ID car
card INEC Voter
oters car
card
ID NUMBER
* have the prescribed Ids.

FOR CUSTOMER

Name_________________________________________

Signature_______________________________________

FOR OFFICIAL USE ONLY (PRESIDENT) FOR OFFICIAL USE ONLY (SECRETARY)

Name_________________________________________ Name_________________________________________

Signature_______________________________________ Signature_______________________________________

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Account Opening Agreement