Apply as CorporateApply as individual ALGEBRA INCOME TRUST CORPORATE APPLICATION FORM PLEASE COMPLETE ALL SECTIONS IN CAPITAL LETTERS SECTION A. CATEGORY OF BUSINESS Sole ProprietorshipPartnershipAssociationsCharities / NGOsOtherLimited Liability Company Other(Please Specify) SECTION B. BUSINESS DETAILS COMPANY / BUSINESS NAME CERT OF INCORPORATION NUMBER I DATE OF INCORPORATION/REGISTRATION License Number JURISIDICTION OF INCORPORATION I Parent Company's Country of Incorporation (if any) TYPE / NATURE OF BUSINESS Sector / Industry PRINCIPAL BUSINESS ADDRESS H. No. Street Region Town City District POSTAL ADDRESS GPS Address EMAIL ADDRESS TIN WEBSITE ADDRESS CONTACT NUMBER 1: CONTACT NUMBER 2: SECTION C. TURNOVER MONTHLY TURNOVER (GHS): Below 10,00010,000-100,000Above 100,000Above 10 million ANNUAL TURNOVER (GHS): Below 10,00010,000-100,000Above 100,000Above 10 million SECTION D. STATEMENT SERVICES MODE OF STATEMENT DELIVERY E MaillBy PostSMS STATEMENT FREQUENCY QuarterlyOther Other(Please Specify) SECTION E. CLIENT INVESTMENT PROFILE INVESTMENT OBJECTIVE RISK TOLERANCE LowMEDIUMHicH INVESTMENT HORIZON SHORTTERMMEDIUM TERMLONG TERM INVESTMENT KNOWLEDGE LowMEDIUMHiGH SECTION F. EXPECTED ACCOUNT ACTIVITY SOURCE OF FUNDS Proceeds from businesOther Other(Please Specify) INITIAL INVESTMENT AMOUNT ANTICIPATED INVESTMENT ACTIVITY TOP UPS MONTHLYQUARTERLYSEMI-ANNUALANNUAL WITHDRAWALS MONTHLYQUARTERLYSEMI-ANNUALANNUAL REGULARTOP UPAMOUNT REGULAR WITHDRAWAL AMOUNT SECTION G. KEY CONTACT PERSON SURNAME FIRST NAME OTHER NAME(S) DATE OF BIRTH GENDERMaleFemale RESIDENTIAL STATUS Resident GhanaianResident ForeignerNon-Resident GhanaianNon-Resident Foreigner IF COUNTRY OF ORIGIN IS NOT GHANA, PLEASE PROVIDE THE FOLLOWING REISDENT PERMIT NUMBER PLACE OF ISSUE PERMIT ISSUE DATE PERMIT EXPIRY DATE Type of id PassportVoter's IDNational IDDriving License ID Number job title email Contact Number 1: Contact Number 2: SECTION H. ACCOUNT SIGNATORY DETAILS 1 SURNAME FIRST NAME OTHER NAME(S) DATE OF BIRTH GENDERMaleFemale RESIDENTIAL STATUS Resident GhanaianResident ForeignerNon-Resident GhanaianNon-Resident Foreigner IF COUNTRY OF ORIGIN IS NOT GHANA, PLEASE PROVIDE THE FOLLOWING RESIDENT PERMIT NUMBER PLACE OF ISSUE PERMIT ISSUE DATE PERMIT EXPIRY DATE Type of id PassportVoter's IDNational IDDriving License ID Number job title email Contact Number 1: Contact Number 2: SECTION I. ACCOUNT SIGNATORY DETAILS 2 SURNAME FIRST NAME OTHER NAME(S) DATE OF BIRTH GENDERMaleFemale RESIDENTIAL STATUS Resident GhanaianResident ForeignerNon-Resident GhanaianNon-Resident Foreigner IF COUNTRY OF ORIGIN IS NOT GHANA, PLEASE PROVIDE THE FOLLOWING REISDENT PERMIT NUMBER PLACE OF ISSUE PERMIT ISSUE DATE PERMIT EXPIRY DATE Type of id PassportVoter's IDNational IDDriving License ID Number job title email Contact Number 1: Contact Number 2: SECTION J. ACCOUNT SIGNATORY DETAILS 3 SURNAME FIRST NAME OTHER NAME(S) DATE OF BIRTH GENDERMaleFemale RESIDENTIAL STATUS Resident GhanaianResident ForeignerNon-Resident GhanaianNon-Resident Foreigner IF COUNTRY OF ORIGIN IS NOT GHANA, PLEASE PROVIDE THE FOLLOWING REISDENT PERMIT NUMBER PLACE OF ISSUE PERMIT ISSUE DATE PERMIT EXPIRY DATE Type of id PassportVoter's IDNational IDDriving License ID Number job title email Contact Number 1: Contact Number 2: SECTION K. EXECUTIVE/TRUSTEE/ADMIN surname OTHER NAMES ID TYPE / ID NUMBER STATUS CONTACT NUMBER SECTION L. DIRECTORS/BENEFICIAL OWNERSHIP FULL NAME PEP / STATUS DATE OF BIRTH ID TYPE / NUMBER HOME ADDRESS OWNERSHIP(%) CONTACT NUMBER IF A PART OF A GROUP, KINDLY STATE ALL ENTITIES WITHIN THE GROUP STRUCTURE SECTION M. BANK ACCOUNT DETAILS BANK NAME ACCOUNT NAME ACCOUNT NUMBER BANK BRANCH SECTION N. DECLARATION AND CONFIRMATION I/We hereby declare that I/we fully comply with all the relevant laws in Ghana and that all information provided is true and complete. I/We agree to inform ALGEBRA Capital Management Limited immediately of any change of particulars or information to me/us. I/We also pledge to provide ALGEBRA with the relevant information necessary to satisfy ALGEBRA Know Your Client (KYC) requirements whenever it is required. I'm filling on someone behalfI'm filling for myself SECTION O. ILLITERATE / BLIND CUSTOMER RATIFICATION I declare that, I filled the form on behalf of the owner/owners of this account due to his/her/their literacy/physical status. I completed the forms with only information provided by the individual/individuals without any ammendment. By this declaration, I can not be held responsible for any misinformation given by the account owner/owners. I consent to the conditions.
