Apply as Corporate Apply as individual ALGEBRA INCOME TRUST INDIVIDUAL APPLICATION FORM PLEASE COMPLETE ALL SECTIONS IN CAPITAL LETTERS SECTION A. ACCOUNT TYPE IndividualJointITFiTHER SECTION B. PERSONAL DETAILS OF APPLICANT TITLEMr.Mrs.MissMs. SURNAME FIRST NAME OTHER NAME(S) DATE OF BIRTH GENDERMaleFemale Type of id PassportVoter's IDNational IDDriving License ID Number Issue Date Expiry Date Issuing Authority RESIDENTIAL ADDRES H. No. Street Town City Region District POSTAL ADDRESS GPS Address EMAIL ADDRESS MARITAL STATUS SingleMarriedOther Other CONTACT NUMBER(S) Mobile Residence Office Nationality Country of Residence EDUCATIONAL LEVEL BasicSecondaryTertiaryOther Others (Specify) OCCUPATION DATE EMPLOYED NAME OF CURRENT EMPLOYER/BUSINESS POSTAL ADDRESS OF EMPLOYER/BUSINESS PHYSICAL LOCATION TELEPHONE NUMBER(S) NATURE OF EMPLOYMENT SalariedSelf-employedOther Other EMPLOYER TYPE (for salary workers) GovermentLocal FirmMultinational FirmOther Other NATURE OF BUSINESS (For self employed) RetailerWholesalerServiceOther Other MONTHLY INCOME (GHS-Select a range 1-300301-500501-10001001-20002001-30003001-5000>5000 SECURITY QUESTION ANSWERS SECTION C. RISK ASSESSMENT QUESTIONAIRE 1.1 What percentage of your savings is being invested? 1.2 Do you have an emergency fund equal to 6 months of your income? YesNo 1.3 Do you intend to withdraw more than 30% of your investments? YesNo 1.4 If Yes, When? 1.5 On a scale of 1 to 10 how would you evaluate your knowledge of investments 1.6 On scale of 1 to 10 how would you rate your appetite for risk SECTION D. INVESTMENT INSTRUCTIONS INITIAL INVESTMENT DEPOSIT Figures Words FREQUENCY OF DEPOSITSMonthlyQuarterlyAnnualOthers Others MODE OF FUNDINGDirect DebitChequesStanding Orders Expected Amt SECTION E. BENEFICIARY DETAILS FULL NAME RELATIONSHIP TO APPLICANT CONTACT PERCENTAGE 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 H. ILLITERATE / BLIND CUSTOMER RATIFICATION I declare that, I filled the form on behalf of the owner of this account due to his/her literacy/physical status. I completed the forms with only information provided by the individual without any ammendment. By this declaration, I can not be held responsible for any misinformation given by the account owner I consent to the conditions.
