Central Securities Depository (GH) Ltd.

Affix
Central Securities 4th Floor Cedi House
CT 465 Cantonments, Accra, Ghana
Depository (Gh) Ltd.
Tel: (233-0302) 689313/4 Passport
Fax: (233-0302) 689315
Email: [email protected]
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You Invest, We Protect

SECURITY ACCOUNT OPENING FORM (CSD FORM 1)

NAME OF DEPOSITOR PARTICIPANT: DEPOSITORY PARTICIPANT NO.

Applicant

Title: Mr / Mrs / Miss / Master / Dr / ................................................................................................................................................................................

Surname / Company Name: ..............................................................................................................................................................................................

Other Names: ....................................................................................................................................................................................................................

Address: ............................................................................................................................................................................................................................

Residential address: ..........................................................................................................................................................................................................

Residential Status: { } Resident Ghanaian { } Resident Foreigner { } Non Resident Ghanaian { } Non Resident Foreigner

Tel. No.: (Home) ....................................... Office: ....................................... Fax. No.: ....................................... Email: ......................................

Date of Birth / Incorporation of Business: (DD/MM/YY)………………………………………………………………………………………………………........

Occupation: ......................................................................................................

Nationality: .......................................................................................................
ID (Tick one) ( ) National ID ( ) Passport ( ) Birth certificate ( ) NHIS ( ) Voter’s Card ( ) certificate of Incorporation ( ) Birth Certificate ( ) Driver’s License ( ) SSNIT ( ) Other Specify …………

ID No. Place of Issue: ............................................. Expiry Date: .........................................

Have you bought a security such as Treasury bill, bond, shares etc. before? Yes ( ) No ( )

Existing CSD Client ID (if

applicable)

Bank Information of the Investor for Dividend, Interest and maturity Disposal Instructions (for equity or shares the Bank information is optional)

Bank Name:

Branch Name:

Account No.:

DECLARATION

I hereby:
(i) request to open and maintain a Security Account in my/our name
(ii) affirm that all information in the form are correct
(iii) undertake to notify this Depository Participant of any change of particulars or information provided by me in this form

Name: Signature/Thumbprint:

(Security Account Holder / Authorised Signatory / Guardian) Date:

For Depository Participant Use Only

Tick where applicable Local Individual (LI) Local Company (LC) Pension Fund (FU)
Foreign Individual (FI) Foreign Company (FC) Foreign Junior (FJ)
Resident Foreigner (FR) Local Junior (LJ)

Verified by:
(Name of Depository Participant Officer) (Signature)

Date: Stamp:

Client CSD Securities Account

Number