NB-form

KNOW YOUR CUSTOMER (KYC) DETAIL UPDATE FORM

SERVICE CENTER

ACCOUNT INFORMATION

#	Account Number	Account Name
1

SIGNATORY DETAILS

First Name

Last Name

Date of Birth

Nationality

ID Type

ID Number

ID Expiry Date

Marital Status

Gender:

Male

Female

Tel/Cell Phone Number

Email Address/Fax

Home Village

Postal Address

Residential Address

NEXT OF KIN

Full Name:

Relationship(e.g Father, Mother):

NBM Account (if available)

Phone Number:

SOURCE OF INCOME

Occupation/Job Title (Specify)

Employers Name

Employer Business

Employer Address

Employment Start Date

Monthly Income

Business Type

Business Physical Address

Business Reg No (if Registered)

Other Income i.e. Upkeep /Pocket Money

Specify Source of Funds

UTILITY BILL ACCOUNT NUMBERS

ESCOM

Water Board

Other (specify)