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ALGEBRA INCOME TRUST
CORPORATE APPLICATION FORM

PLEASE COMPLETE ALL SECTIONS IN CAPITAL LETTERS
SECTION A. CATEGORY OF BUSINESS
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):
ANNUAL TURNOVER (GHS):
SECTION D. STATEMENT SERVICES
MODE OF STATEMENT DELIVERY
E MaillBy PostSMS
STATEMENT FREQUENCY
Other(Please Specify)
SECTION E. CLIENT INVESTMENT PROFILE
INVESTMENT OBJECTIVE
RISK TOLERANCE
INVESTMENT HORIZON
INVESTMENT KNOWLEDGE
SECTION F. EXPECTED ACCOUNT ACTIVITY
SOURCE OF FUNDS
Other(Please Specify)
INITIAL INVESTMENT AMOUNT
ANTICIPATED INVESTMENT ACTIVITY
TOP UPS
WITHDRAWALS

REGULARTOP UPAMOUNT
REGULAR WITHDRAWAL AMOUNT
SECTION G. KEY CONTACT PERSON
SURNAME
FIRST NAME
OTHER NAME(S)
DATE OF BIRTH
GENDER
RESIDENTIAL STATUS
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
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
GENDER
RESIDENTIAL STATUS
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
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
GENDER
RESIDENTIAL STATUS
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
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
GENDER
RESIDENTIAL STATUS
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
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.