Personal Banking Account Opening Form
• Personal Account Opening
• Personal Unsecured Loan
• Personal Credit Card
www.cbagroup.com
Checklist
I have attached the following documents:
Primary identification
Identification document
(Passport/Driving license/Voter’s/Financial/NSSF card) One passport size color photograph
Introduction letter from a referee who holds a bank account; or Account holder with CBA for at least the last 6 months or current employment contract from reputable and well known employer; or letter from a practicing Advocate; or 6 months Bank statement.
Confirmation of residential address. Any of the following;
Utility Bill; or Tenancy Agreement; or Letter from Employer; or Lawyer listed in CBA’s panel; or Area chief; or Church / Mosque clergy confirming residential address.
Work permit for Foreign Nationals
Letter from Embassy or parent firm and Immigration file number for non residents
For Credit Card Processing
Duly completed Credit Card application form Latest 3 months pay slips
Certified copies of bank statements for the last 6 months
PERSONAL ACCOUNT OPENING FORM
PERSONAL DETAILS (FIRST APPLICANT)
Please complete all details in CAPITAL letters.
I/We wish to open the following account and undertake to comply, observe and be bound by the attached General Terms and Conditions. ACCOUNT TITLE
Indicate type of account required:
Account type Current Savings Call deposit Fixed deposit
Currency UGX USD GBP EURO Other (specify)
Foreign Currency Accounts: Please state the nature and source of the Foreign Currency
Account Category Individual Joint
For Fixed Deposits Only Period (In Months)
(DD/MM/YYYY)
Title: Mr. Mrs. Ms. Dr. Prof. Hon. Other
Name:
First Middle Last
Date of birth Country of Birth Nationality Marital Status Single Married Divorced Widowed
Gender Male Female
Identification Doc: Document No.
Postal Address Town/ City Country
Physical (Residential) Address Plot No.
Tel Off. Tel Home
Mobile No. (1) Mobile No. (2)
Email (Preferred) Email (Other) Next of Kin (Name)
Relationship Spouse Child Son Parent Daughter Other (Specify)
Next of Kin Tel Contacts Postal Address
Town/ City Country
Physical Address
Title: Mr. Mrs. Ms. Dr. Prof. Hon. Other
Name:
First Middle Last
Date of birth TIN No. Nationality Marital Status Single Married Divorced Widowed
Gender Male Female
Identification Doc: Document No.
Postal Address Postal Code Town/ City Country
Physical (Residential) Address Plot No.
Tel Off. Fax Tel Home
Mobile No. (1) Mobile No. (2)
Email (Preferred) Email (Other) Next of Kin (Name)
PERSONAL DETAILS (SECOND APPLICANT)
EMPLOYER/ BUSINESS DETAILS (FIRST APPLICANT)
Employment type: Formal Employment Informal Employment Self Employment Unemployed
Occupation Name of Employer
Employee Department Employee Position
If Self employed, State Nature of Business
Gross Income Band (UGX ‘000) A 0 - 1,000 B 1,100 - 5,000 C 5,100 - 10,000 D 10,100 - 20,000 E 20,100 - 40,000 F Above 40,000 Employers Postal Address Town/ City Country
Employers / Business Physical Address Plot no.
Tel (Off) Mobile No. (Off)
Employers / Business Email Address
Other accounts held currently (with CBA or other banks)
Bank Name Branch A/C No
Bank Name Branch A/C No
(DD/MM/YYYY)
Relationship Spouse Child Son Parent Daughter Other (Specify)
Next of Kin Tel Contacts Postal Address
Physical Address
Postal Code Town/ City Country
EMPLOYER/ BUSINESS DETAILS (SECOND APPLICANT)
Employment type: Permanent Pensionable Contract Casual Self Employed Other
Occupation Name of Employer
Employee Department Employee Position
If Self employed, State Nature of Business
Gross Income Band (UGX ‘000) A 0 - 1,000 B 1,100 – 5,000 C 5,100 – 10,000 D 10,100 - 20,000 E 20,100 - 40,000 F Above 40,000
Employers Postal Address Town/ City Country
Employers / Business Physical Address Plot no.
Tel (Off) Mobile No. (Off)
Employers / Business Email Address
Other accounts held currently (with CBA or other banks)
Bank Name Branch A/C No
Bank Name Branch A/C No
Please tick as appropriate:
Cheque Book Book(s)
To be collected from Branch
Statement Cycle Monthly Quarterly No Statement Statement delivery Postal Address Email
Please tick if interested in the following products
Internet Banking Yes No
Mobile Banking Yes No Credit Card Yes No Your preferred mobile number to receive alerts from the Bank
Recreation Interests (please tick as appropriate)
Golf Art/Antiques Photography
Health club/gym Dance/Ballet Foreign travel
Tennis/Other Racket sports Music/Theatre Fine foods/Wine
Athletic/Other Activity sport Equestrian sports Others (please specify) Bicycling/Mountaineering/Hiking Monthly
REFEREE DETAILS
Name: Signature:
Bank: A/C No:
Address: Tel. Contacts
Electronic Banking
(Mobile and Internet Banking)
Second Applicant
First Applicant
(First Applicant)
* The memorable word you specify will be requested when you first log onto the internet to authenticate your identity. Your memorable word will also be requested should you require to reset/unlock your token. (NB: The word must be between 6 and 20 characters)
* This register will be accessible through your mobile phone.
Beneficiary Bank Branch Code
* This information will allow you to access card available balance, amounts due and the due date for payment on Mobile Banking.
(First Six Digits) (Last Four Digits) Phone Make
Memorable Word*
e.g Nokia, Android, Blackberry Token Number
(For Bank use only)
Phone Make Memorable Word*
e.g Nokia, Android, Blackberry Token Number
(For Bank use only)
(Second Applicant)
* This register will be accessible through your mobile phone.
Beneficiary Bank Branch Code
* This information will allow you to access card available balance, amounts due and the due date for payment on Mobile Banking.
Electronic Banking
(Mobile and Internet Banking)
Second Applicant
First Applicant
(First Applicant)
* The memorable word you specify will be requested when you first log onto the internet to authenticate your identity. Your memorable word will also be requested should you require to reset/unlock your token. (NB: The word must be between 6 and 20 characters)
* This register will be accessible through your mobile phone.
Beneficiary Bank Branch Code
* This information will allow you to access card available balance, amounts due and the due date for payment on Mobile Banking.
(First Six Digits) (Last Four Digits) Phone Make
Memorable Word*
e.g Nokia, Android, Blackberry Token Number
(For Bank use only)
Phone Make Memorable Word*
e.g Nokia, Android, Blackberry Token Number
(For Bank use only)
(Second Applicant)
* This register will be accessible through your mobile phone.
Beneficiary Bank Branch Code
* This information will allow you to access card available balance, amounts due and the due date for payment on Mobile Banking.
(First Six Digits) (Last Four Digits)
Name:
Signature:
I/D or Passport No:
Mobile No:
Name:
Signature:
I/D or Passport No:
Mobile No:
Authorised Signatories
Dated This: Day of 20
Operating Mandates Sole Either/Or All to sign Other (specify)
I /We have read the conditions necessary to open and operate an account with Commercial Bank of Africa (Uganda) Limited (CBA) and I/we oblige to comply. I /We agree that this account shall be solely at the discretion of CBA and hereby agree to indemnify CBA at my/our cost against any loss or claims arising out of the account being closed by CBA without notice due to unsatisfactory performance.
I undertake to inform the bank of any changes of contact or my personal details.
Customer number _____________________________ A/C number ____________________________ A/C officer _____________________________________________ A/C opened by ________________________________ Date ___________________________________ Signature ______________________________________________ Authorized by _________________________________ Date ___________________________________ Signature ______________________________________________ Sector ________________________________________ Industry ________________________________ Legal Entity ___________________________________________
(Please tick requisite documents obtained and attached)
Original primary identification Document as applicable. Original and Certified copy of TIN Certificate
(1) Passport size colour photograph Work Permit for Foreign Nationals
For non residents, Letter from Embassy or Parent firm
FOR BANK USE ONLY.
AIDE MEMOIRE CHECKLIST
T24 Mapping:
DECLARATION
Signature of applicant Date
Signature of joint applicant Date
(DD/MM/YYYY) (DD/MM/YYYY)
I instruct the bank to contact me before crediting my account.
4. I agree to obtain credit insurance cover for the loan and authorize CBA to deduct premiums payable towards the Cover.
I authorize the bank to create a loan account in my name and disburse the approved amount without reference to me.
I authorise my employer to channel my monthly salary to CBA account No. Please tick as applicable:
In the event that the amount I qualify for is less than the amount requested:
Please attach original documents to assist in fast processing of your application. Please attach latest 3 months ORIGINAL payslips Budget planner Monthly Income Monthly Expenses Commissions Salary Total Income (l) Card payments Surplus (S=I-E) Rental /receipts Other income (Specify)
Mortgage / rent payments Loan payments
Total (E) Other expenses
Credit details
Unsecured Loan Top-up
UGX USD EURO
Period (months)
School fees Home improvement Medical
Plot purchase Other (please specify) Purpose of loan
Amount Currency
I would like to apply for
PERSONAL UNSECURED LOAN
Other loans/Credit
NAME OF LENDER MONTHLY PAYMENT CURRENT BALANCE 1.
2. 3.
Please indicate the percentage of the outstanding amount to be debited monthly. (min 20%) Percentage Account Name Account Type Account No.
Instructions to the Bank
I/We instruct you to pay autocredit payments from my/our account at the request of CBA VISA Card.
The amounts are variable and are to be debited on various dates (but not to exceed total amount outstanding on due date).
Authorized Signatory Date
Authorized Signatory Date
Name
Signature
Date
DECLARATION
DIRECT DEBIT INSTRUCTIONS
(Optional)Please issue me with a CBA VISA Classic /Gold Card. I warrant that the information given in the application form is true and complete and I authorize you to make any inquiries necessary in connection with this application. I have read, accepted and agree to be bound by the CBA VISA Card General Terms and Conditions of use (as amended from time to time). I agree that I/We are jointly and severally liable for all charges incurred through the use of CBA VISA Card. I/We understand that Commercial Bank of Africa (Uganda) Limited reserves the right to decline the application without giving resons.
Customer number _____________________________ A/C number ____________________________ DAO Code A/C opened by ________________________________ Date ___________________________________ Signature Authorized by _________________________________ Date ___________________________________ Signature Sector ________________________________________ Industry ________________________________ Legal Entity
Sales Code
INITIAL DEPOSIT
Cash Amount
I n house Cheque Amount
Local Cheque Amount Bank A/C number
I nternal Transfer Amount
Signature Verified Name Signature Date
T24 Mapping
Customer enabled for Internet Banking by Customer enabled for Mobile Banking by Notifications mapped
Accounts mapped Token issued by
Checklist for Branch /Account Relationship Manager
Checklist completed6 months statements checked against payslip If foreigner, attach contract and work permit
BANK USE ONLY (Personal Unsecured Loan)
Recommended by: Account Relationship Manager
Signature Date
Is application compliant with existing product profile? If No, list the exceptions
i) ii) iii)
Yes No
Name Signature Date Name Signature Date 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.