TYPE OF ACCOUNTREGISTRATION FORM Select Type of Account INDIVIDUAL ACCOUNTJOINT ACCOUNTCORPORATE ACCOUNT BackNext PERSONAL DETAILS Surname Others Names ID No/ PP No KRA PIN Nationality (required) —Please choose an option—ArubaAfghanistanAngolaAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntigua and Barbuda AustraliaAustriaAzerbaijanBurundiBelgiumBeninBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaBelarusBelizeBermudaBoliviaBrazilBarbadosBrunei DarussalamBhutanBotswanaCentral African RepublicCanadaSwitzerlandChileChinaCôte d’IvoireCameroonCongo the DemocraticCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaSpainEstoniaEthiopiaFinlandFijiFranceMicronesia, Federated GabonUnited KingdomGeorgiaGhanaGuineaGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGuatemalaGuamGuyanaHong KongHondurasCroatiaHaitiHungaryIndonesiaIndiaIrelandIran, Islamic RepublicIraqIcelandIsraelItalyJamaicaJordanJapanKazakhstanKenyanKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, RepublicKuwaitLao People’s Democratic LebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMoroccoMonacoMoldova, Republic MadagascarMaldivesMexicoMarshall IslandsMacedoniaMaliMaltaMyanmarMontenegroMongoliaMozambiqueMauritaniaMauritiusMalawiMalaysiaNamibiaNigerNigeriaNicaraguaNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People’sPortugalParaguayPalestine, StateQatarRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSerbiaSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSeychellesSyrian Arab RepublicChadTogoThailandTajikistanTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United RepublicUgandaUkraineUruguayUnited StatesUzbekistanSaint Vincent andGrenadinesVenezuela, BolivarianVirgin Islands, U.S.Viet NamVanuatuSamoaYemenSouth AfricaZambiaZimbabwe Date of Birth Marital Status SingleMarriedOther Gender MaleFemaleOther Residential Address Postal Code City Country (required) —Please choose an option—ArubaAfghanistanAngolaAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntigua and Barbuda AustraliaAustriaAzerbaijanBurundiBelgiumBeninBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaBelarusBelizeBermudaBoliviaBrazilBarbadosBrunei DarussalamBhutanBotswanaCentral African RepublicCanadaSwitzerlandChileChinaCôte d’IvoireCameroonCongo the DemocraticCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaSpainEstoniaEthiopiaFinlandFijiFranceMicronesia, Federated GabonUnited KingdomGeorgiaGhanaGuineaGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGuatemalaGuamGuyanaHong KongHondurasCroatiaHaitiHungaryIndonesiaIndiaIrelandIran, Islamic RepublicIraqIcelandIsraelItalyJamaicaJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, RepublicKuwaitLao People’s Democratic LebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMoroccoMonacoMoldova, Republic MadagascarMaldivesMexicoMarshall IslandsMacedoniaMaliMaltaMyanmarMontenegroMongoliaMozambiqueMauritaniaMauritiusMalawiMalaysiaNamibiaNigerNigeriaNicaraguaNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People’sPortugalParaguayPalestine, StateQatarRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSerbiaSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSeychellesSyrian Arab RepublicChadTogoThailandTajikistanTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United RepublicUgandaUkraineUruguayUnited StatesUzbekistanSaint Vincent andGrenadinesVenezuela, BolivarianVirgin Islands, U.S.Viet NamVanuatuSamoaYemenSouth AfricaZambiaZimbabwe Telephone No Email Source of Funds EmployedSelf-EmployedOther Employers Name Nature of Business Monthly Income Next of Kin/Spouse Name Next of Kin Residential Address Next of Kin Telephone Next of Kin Email Upload Your ID/Passport Photo Upload Your Signature copy BANK DETAILS Dividend Disposal Preference Bank Account (details below)Cheque Bank Name Bank Branch Account Name Account Number Declaration By clicking submit, you authorize Faida Investment Bank to open a brokerage account on your behalf. DETAILS Names Telephone Number Email Declaration By clicking submit, you authorize Faida Investment Bank to open a brokerage account on your behalf. DETAILS Names Telephone Number Email Declaration By clicking submit, you authorize Faida Investment Bank to open a brokerage account on your behalf. Δ
