Absa Mauritius Wealth International: Account Opening Form

Confidential
Privacy Notice
The Bank only collects, processes and shares the Customer’s personal data so that the Bank can provide the Customer with the service/product
that the Customer is applying for. The Bank will obtain the Customer’s consent for any other processing that is not related to this purpose. To
read the Bank’s detailed privacy notice, please refer to the terms and conditions and to the detailed privacy statement on the Bank’s website.

*All fields are mandatory unless otherwise stated. Failure to provide information will imply that we will not be able to process your application in
line with our terms and conditions.
Please read the Absa Mauritius Wealth International Terms and Conditions before completing this form.

Section A – General Information

Applicant 1
Personal details
First name(s) Paul Ronal Idawo
Family name Mwandoe Maiden name (if applicable)

Title Mr Gender Male

Memorable name N/A Nationality Kenya
Form of identification (e.g. NIC/passport) CK107951 issued on 16/12/2022, Expires on 15 Dec 2032
Should mandatorily include document number, date of issuance, country of issuance and date of expiry

Country of residence Kenya Dual nationality (Please indicate country) No

Expected transactions to countries/Destination of funds Kenya Condition 3.13

*Are you a US person? Yes No

✔ (Please tick ( ) the correct option)
*The US Sanctions apply to any individual located in the US, and any US citizen or permanent resident alien (green card holder) wherever they are.
A US person is always a US tax resident, even if they are tax resident in another country.

Contact details
Residential address D2A, LORESHO SPRINGS WAIYAKI WAY. NAIROBI, KENYA.
Town/City Nairobi District/Region Waiyaki Way
Telephone (H) Telephone (W) +254 723969604
Mobile +254723969604 Fax - Home/Work

Email [email protected] Alternate email

Country Kenya
Postal address Same as above
Town/City PO Box 31046-00600

District/Region Nairobi Country Kenya

Employment details
Occupation Director Nature of business Software development
Designation Corporate Affairs Director Time with employer 01/05/2024
Annual income USD 180,000.00 Source of other income

Employment type Full-Time Employer’s name MULA Group (Mauritius) Limi

Applicant 2
Personal details
First name(s) N/A
Family name N/A Maiden name (if applicable)

Title N/A Gender N/A

Absa Bank (Mauritius) Limited (registered number C10068913).

Absa Bank (Mauritius) Limited is regulated by the Bank of Mauritius and the Financial Services Commission.
Memorable name Nationality

Form of identification (e.g. NIC/passport)

Should mandatorily include document number, date of issuance, country of issuance and date of expiry

Country of residence Dual nationality (Please indicate country)

Expected transactions to countries/Destination of funds Condition 3.13

Are you a US person? Yes

✔ No
✔ (Please tick ( ) the correct option)
*The US Sanctions apply to any individual located in the US, and any US citizen or permanent resident alien (green card holder) wherever they are.
A US person is always a US tax resident, even if they are tax resident in another country.

Contact details
Residential address

Town/City District/Region

Telephone (H) Telephone (W)

Mobile Fax - Home/Work

Email Alternate email

Country

Postal address

Town/City PO Box

District/Region Country

Employment details
Occupation Nature of business

Designation Time with employer

Annual income Source of other income

Employment type Employer’s name

Section B - Financial details

Guidance notes on Source of income, Source of funds and Source of wealth:
Source of income (SOI) - the origin of your income (primary source of income) and funds you will be using during the relationship with Absa Bank
(Mauritius) Limited.
Source of funds (SOF) -the origin of the particular funds or other assets, which are subject of the relationship (e.g. amounts being invested,
deposited or wired as part of relationship) in different accounts.
Source of wealth (SOW) - the origin of your body of wealth (i.e. total assets). For example, wealth accumulated from a combination of family
inheritance, salary/bonuses from employment, investments, property sale/income. SOW is not limited to the assets placed with Absa Bank
(Mauritius) Limited, but extends to your entire net worth and through the activities the wealth has been derived or generated.

Financial activity
Purpose of the account Personal Use
Source of Income (SoI) Through employment Others (Please specify)

Source of ongoing funds (SoF) Employment Others (Please specify)

Source of initial funds deposited (SoF) Employment Others (Please specify)

Amount of initial deposit USD 50,000

Net worth details

Source of wealth

Bank deposit: Absa (local currency) Bank deposit other than Absa (local currency)

Type of assets that customer has Total estimated value of assets

Type of liabilities that customer has Total estimated liabilities

Expected yearly transaction behavior

Deposit type Deposit volume Deposit count Transaction description
Cheque deposit N/A
International transfers 1-5 15,000 - 20,000 salary, Dividends
Withdrawal type Withdrawal volume Withdrawal count Transaction description
Cheque deposit
International transfers
Section C – Account opening
Mode of operation (for multiple account holders)
All to sign ✔ Any to sign Both to sign Either to sign

Transactional/current account

Currency Any other currency Currency and amount of initial deposit

Savings account ✔
Currency USD Any other currency Currency and amount of initial deposit 20,000
Fixed deposit account

Currency Any other currency Currency and amount of initial deposit

Start date of deposit (ddmmyyyy)

Term of deposit Month(s) Year(s)

Foreign currency deposits 1 3 6 12 1 2 3
Interest payment details
Frequency of interest payment at Maturity
Settlement instructions - disposal account for maturity proceeds and interest payments
Please credit my Absa: Savings Current

Section D – Debit card

New ✔ Renewal Replacement Faulty/lost/stolen

Name to be embossed (Family last name) Mwandoe

Currency: USD ✔ GBP EUR

Please indicate which account(s) you want to access using this card: Savings account ✔ Current account

Section E – Internet banking registration

E-statement registration
I wish to subscribe to the e-statement service for all my accounts held with Absa Bank (Mauritius) Limited ✔

SMS registration
I wish to subscribe to the SMS service for all my accounts held with Absa Bank (Mauritius) Limited

Section F – Tax self-certification and declaration

Applicant 1
Part 1 – Tax residency information
Are you a tax resident of Mauritius only? Yes No
✔
If you indicated “Yes”, Part 2 is not required.

Part 2 – Tax residency information

Please list all details below for each country where you are a tax resident.
Country of Tax residency Taxpayer Identification/Account Number (TIN/TAN)
Kenya A003678677u

If you indicate that you are a tax resident in a country other than Mauritius, you must provide a TIN/TAN unless one of the reasons below applies. If
you have not provided a TIN/TAN in the table above, please tick the relevant box below to indicate the reason for not having done so.
A TIN/TAN is not issued by the relevant tax authority in the Country of Tax Residency

The domestic law of the Country of Tax Residency does not require the collection of TIN/TAN

Please list all details below for each country you are a passport holder:
Passport country Passport number
Kenya CK107951
Applicant 2
Part 1 – Tax residency information
Are you a tax resident of Mauritius only? Yes No
If you indicated “Yes”, Part 2 is not required.

Part 2 – Tax residency information

Please list all details below for each country where you are a tax resident.
Country of Tax residency Taxpayer Identification/Account Number (TIN/TAN)

If you indicate that you are a tax resident in a country other than Mauritius, you must provide a TIN/TAN unless one of the reasons below applies. If
you have not provided a TIN/TAN in the table above, please tick the relevant box below to indicate the reason for not having done so.
A TIN/TAN is not issued by the relevant tax authority in the Country of Tax Residency

The domestic law of the Country of Tax Residency does not require the collection of TIN/TAN

Please list all details below for each country you are a passport holder:
Passport country Passport number

Section G - Instructions
Instructions via e-mail Condition 10
The instructions shall be sent from the following e-mail address(es)

Call back Condition 10.18

Account number(s) 1

Call back contact number(s)

For Joint Account

Full name of customer

Call back contact number(s)

No call back
Account number(s) 1

Section H - Miscellaneous
Where applicant is an existing customer
I confirm that there is no change in the information previously provided to Absa Bank (Mauritius) Limited by me. ✔
There are changes in the information previously provided to Absa Bank (Mauritius) Limited by me.

Marketing communications
Please tick ( ) this box if you do not wish to receive marketing communications from us and/or other members of Absa Group.
Section I - Data Protection
The Bank is a bank duly licensed under the laws of Mauritius (business registration number 68913) with its registered address at Sir William
Newton Street, Port Louis, Mauritius and is a data controller for the purposes of the Data Protection Act 2017. The Bank is committed to
maintaining the privacy and security of the Customer’s personal data collected by it, whether in hard copy or electronic form.
Personal data is any information that allows the Bank to identify the Customer as a unique individual or entity, such as the Customer’s name/s
and surname, home or registered office address, any contact details such as an email address, a passport or identification number. The Bank
is collecting this data to assess the Customer’s application and, if successful, to provide the Customer with the products and/or services as
described in this form.
• Unless otherwise specified, the Customer needs to provide all of the personal data requested on this form. If the Customer does not provide
the Bank with the required information, the Bank will have to suspend the Customer’s access to the product and/or service for a period of
time, or even terminate its relationship with the Customer.
• The Bank may carry out further processing on the Customer’s personal data for historical, research and statistical purposes or to comply with
its legal obligations. The Bank will not engage the Customer in any direct marketing, unless the Customer has given the relevant consent.
• The Bank may also use the Customer’s personal data for carrying out automated decisions that may impact the Customer. If the latter is
unhappy about the outcome of the decision, the Customer Contact Centre may be contacted.
• Where necessary, the Bank may share the Customer’s personal data within the Absa Group and with other third-party service providers,
including credit bureaus that process the Customer’s personal data in conjunction with the Bank or on its behalf. These third-party providers,
whether local or trans-border, are contractually obligated to process the Customer’s personal data in line with its privacy and security policies.
The Bank’s third parties may be located within the Customer’s country of residence or in another country. When appropriate, the Bank may
also share the Customer’s personal data with regulators or other crime-fighting agencies.
• The Bank will keep the Customer’s personal data only for as long as the Bank has to in terms of applicable laws and regulations. After this
time, the Customer’s personal data will be securely destroyed or de-identified.
• To the extent that local legislation permits or if the Customer is a resident of the European Union or United Kingdom, the Customer has the
following rights regarding his/its personal information:
• To access his/its personal information that the Bank has on record.
• To ask the Bank to correct any incorrect personal information. These requests must be sent to the Bank in writing.
• To ask the Bank to delete or destroy his/its personal information. The Customer can also object to the Bank processing
his/its personal information. These requests must be sent to the Bank in writing. However, if the Customer asks the Bank to do this, the Absa
Group may have to suspend the provision of products and/or services for a period of time, or even terminate its relationship with the
Customer. The Absa Group’s records are subject to regulatory retention periods, which means the Bank may not be able to delete or
destroy the Customer’s personal information immediately upon request.
• The Customer may also ask the Absa Group to port his/its personal information to another party in terms of applicable European Union and
United Kingdom data privacy legislation.
• If the Customer has a complaint relating to the protection of his/its personal data, including the way in which it has been collected or
processed by the Bank, the Bank’s Data Privacy Officer may be contacted on (+230) 404 1124 or email [email protected]. If the Customer has
not had his/its complaint dealt with satisfactorily, he/it may lodge a complaint with the Data Protection Office at
http://dataprotection.govmu.org in terms of applicable privacy and confidentiality laws.
• By agreeing to the terms and conditions, the Customer agrees that the personal information he/it provided is accurate and complete to the
best of his/its knowledge and he/it consents to the Absa Group processing his/its personal data for this purpose.
• These terms and conditions must be read in conjunction with the Bank’s detailed privacy statement, which may be found at
https://www.absabank.mu/en/privacy-policy/.

Direct Marketing – To format below as required

Marketing opt-out ( Yes – No direct marketing; No – Direct marketing accepted)

Section J - Customer declaration
1. You confirm that you have read, understood and agree to be bound by terms and conditions contained in the Absa Bank Mauritius x
Wealth International Terms and Conditions, including Conditions 4.9 (Liability and indemnity), 5.6 (Liability and indemnity), 10.18.3,
10.19.4, 10.20 (Authority and indemnity for instructions), 12 (Indemnity) and 34 (Declaration and acknowledgement).
2. You confirm that you have read, understood and agreed to be bound by the terms and conditions contained in our Internet Privacy x
Policy and the Absa Bank Mauritius Wealth International Customer Charter.
3. I/We confirm that I/we are the ultimate beneficial owner of the account. x
-
Note:
As per section 17C of the Financial Intelligence And Anti-Money Laundering Act 2002 (FIAMLA), any person who knowingly provides any false or
misleading information to financial institutions in connection with customer due diligence (CDD) requirements under this Act or any guidelines
issued under this Act shall commit an offence and shall, on conviction, be liable to a fine not exceeding 500,000 rupees and to imprisonment for
a term not exceeding 5 years.

“Read and Approved” (in Customer’s handwriting before signing)

Date (ddmmyyyy)
Customer’s signature

Date (ddmmyyyy)
Customer’s signature

Employee’s signature

This section is for bank use only

Good for processing Name Code Signature
Maker (LG/RM/customer advisor) SSD
Checker (authoriser) SSW

Relationship approval
Name Code Signature
RM (Name and refer code)
Branch employee
Branch signatory

Customer KYC compliant? Yes No

CID Authorised by