INVESTMENT APPLICATION FORM
NOTE: PORTIONS MARKED WITH
*
ARE COMPULSORY
AND MUST BE COMPLETED
PERSONAL INFORMATION
Account
*
Select
Individual
Joint
ITF
Title
*
Select
Mr
Mrs
Ms
Dr
Prof
Surname
*
Firstname
*
Other Names
*
Marital Status
*
Select
Single
Married
Gender
*
Select
Male
Female
Date of Birth
*
Place of Birth
*
Mothers Maiden Name
*
Residential Status
*
Select
Resident Ghanaian
Non-Resident Ghanaian
Resident Foreigner
Non-Resident Foreigner
Country of Origin
*
Country of Residence
*
Occupation
*
Residential Address
*
Digital Address
*
Mobile Number
*
EMERGENCY CONTACT DETAILS
Contact Name
*
Contact Relation
*
Contact Email
*
Contact Number
*
PROOF OF IDENTITY
Identity Type
*
Select
Ghana Card
Passport ID
ID Number
*
Place of Issue
*
Issue Date
*
Expiry Date
*
EMPLOYMENT/ BUSINESS DETAILS
Employment Status
Select
Employed
Self Employed
Unemployed
Retired
Student
Total Monthly Income Range
Select
Below 1000
1,001-5,000
5,000-10,000
Above 10,000
Employer/Business/School Name
Eployer/Business/School Address
Nature of Business
Digital Address
PERSONAL INFORMATION (Party 2)
Account
Select
Individual
Joint
ITF
Title
Select
Mr
Mrs
Ms
Dr
Prof
Surname
Firstname
Othernames
Marital Status
Select
Single
Married
Gender
Select
Male
Female
Date of Birth
Place of Birth
Mothers Maiden Name
Residential Status
Select
Resident Ghanaian
Non-Resident Ghanaian
Resident Foreigner
Non-Resident Foreigner
Country of Origin
Country of Residence
Occupation
Residential Address
Digital Address
Mobile Number
EMERGENCY CONTACT DETAILS (Party 2)
Contact Name
Contact Relation
Contact Email
Contact Number
PROOF OF IDENTITY (Party 2)
Identity Type
Select
Ghana Card
Passport ID
ID Number
Place of Issue
Issue Date
Expiry Date
EMPLOYMENT/ BUSINESS DETAILS (Party 2)
Employment Status
Select
Employed
Self Employed
Unemployed
Retired
Student
Total Monthly Income Range
Select
Below 1000
1,001-5,000
5,000-10,000
Above 10,000
Employer/Business/School Name
Employer/Business/School Address
Nature of Business
Digital Address
IN-TRUST-FOR (ITF)
Name of IN-TRUST-FOR
Date of Birth
Contact
Relationship
Percentage Allocation
GPS Address
Ghana Card No.
Name of IN-TRUST 2
Date of Birth
Contact
Relationship
Percentage Allocation
GPS Address
Ghana Card No.
Name of IN-TRUST 3
Date of Birth
Contact
Relationship
Percentage Allocation
GPS Address
Ghana Card No.
BENEFICIARY INFORMATION
Name of Beneficiary
*
Date of Birth
*
Contact
*
Relationship
*
Percentage Allocation
*
GPS Address
*
Ghana Card No.
*
Name of Beneficiary 2
Date of Birth
Contact
Relationship
Percentage Allocation
GPS Address
Ghana Card No.
Name of Beneficiary 3
Date of Birth
Contact
Relationship
Percentage Allocation
GPS Address
Ghana Card No.
CLIENT INVESTMENT PROFILE
Investment Objective
*
Select
Capital Preservation
Income
Growth
Speculation
Risk Tolerance
*
Select
Low
Medium
High
Investment Horizon
*
Select
Short Term
Medium Term
Long Term
Investment Knowledge
*
Select
Low
Medium
High
EXPECTED ACCOUNT ACTIVITY
Source of Funds
*
Initial Investment Amount
*
UPLOADS
Party 1
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Upload Your Ghana Card:
Upload Signature:
I / we hereby declare that all the information submitted by me or us in this form is correct,true and valid,that by my or our request to open and maintain investment account in my or our name and undertake to notify Ecocapital of any changes my or our particulars or information as may be necessary. I or we also declare that we have read thoroughly and understood the content of this application and have given my or our consent by virtue of my or our signature on this form. I or we consent that investment decisions are my or our prerogative without so realiance on the investment advice received from Ecocapital.I or we also declare that all debit incured on my or investment account by virtue of my or our trade others shall be settle by me or as accordingly.