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    Additional Applicant Form: Personal Details

    Uploaded by

    Alhassan Emmanuel
    This document is an additional applicant form for GCB Bank PLC. It collects personal details such as name, date of birth, nationality, employment information, contact details, tax compliance information, and a signed declaration from the applicant. The form gathers details to verify the applicant's identity and tax residency status to comply with regulations like FATCA and CRS. It requires the applicant to confirm the accuracy of the information and consent to the bank sharing it with tax authorities as necessary.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Additional Applicant Form: Personal Details

    Uploaded by

    Alhassan Emmanuel
    118 views2 pages
    This document is an additional applicant form for GCB Bank PLC. It collects personal details such as name, date of birth, nationality, employment information, contact details, tax compliance information, and a signed declaration from the applicant. The form gathers details to verify the applicant's identity and tax residency status to comply with regulations like FATCA and CRS. It requires the applicant to confirm the accuracy of the information and consent to the bank sharing it with tax authorities as necessary.

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    This document is an additional applicant form for GCB Bank PLC. It collects personal details such as name, date of birth, nationality, employment information, contact details, tax compliance information, and a signed declaration from the applicant. The form gathers details to verify the applicant's identity and tax residency status to comply with regulations like FATCA and CRS. It requires the applicant to confirm the accuracy of the information and consent to the bank sharing it with tax authorities as necessary.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    118 views2 pages

    Additional Applicant Form: Personal Details

    Uploaded by

    Alhassan Emmanuel
    This document is an additional applicant form for GCB Bank PLC. It collects personal details such as name, date of birth, nationality, employment information, contact details, tax compliance information, and a signed declaration from the applicant. The form gathers details to verify the applicant's identity and tax residency status to comply with regulations like FATCA and CRS. It requires the applicant to confirm the accuracy of the information and consent to the bank sharing it with tax authorities as necessary.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    GCB Bank PLC

    Additional Applicant Form your bank for life

    Personal Details

    Title Dr. Mr. Mrs. Miss Others (specify)

    Name
    Surname First Name Other Name(s)

    Maiden Name (if applicable) Mother’s Maiden Name

    Gender Male Female


    Marital Status Single Married Divorced Separated Widowed
    No. of Dependants Children Other Physically Challenged Status Yes No
    Place of Birth Date of Birth D D M M Y Y Y Y Hometown
    Nationality Country of Origin Country of Residence
    Profession/Occupation Email
    Educational Level Undergraduate Graduate Post Graduate Not literate
    SSNIT Number TIN
    Mobile No.(s) Telephone No.
    Name of Spouse
    Spouse Employment Mobile No.:
    For Foreign Nationals Only
    Y
    Resident/Work Permit No. Permit Issue Date D D M M Y Y Y Y

    Place of Issue Permit Expiry Date D D M M Y Y Y YY

    Employment Details
    Employment Status Employed (Public) Employed (Private) Unemployed Student
    Self Employed Retired Other (specify)

    Number of Years with Mode of Salary payment: Cash Cheque Direct Credit
    Current Employer:
    Monthly Salary/
    Income (GH¢): Less than 2,000 2,000 - 5,000 5,001 - 10,000 More than 10,000
    Employer’s Name
    Nature of Business
    Employer’s Address
    Nearest Landmark
    Region City/Town
    Office Phone No. Mobile No.
    Employer’s Email

    1
    your bank for life

    Valid Means of Identification (Please tick and provide relevant details)


    ID Type ID Number Issue Date Expiry Date
    National ID Y

    Others (specify)

    Contact Details

    Postal Address
    Residential/Permanent Address
    Res. Address Street Name
    Nearest Landmark
    City/Town Digital Address/Pincode
    Metropolitan, Municipal and District Assembly

    Title to Residence Self-owned Mortgaged Rented Family House Other (specify)

    Proof of Address Electricity Bill Water Bill Tenancy Agreement Other (specify)

    Proof of Address Serial Number Issue Date


    Residential Address Abroad (for foreign nationals and Ghanaians living abroad)
    House No. Street Name
    City/Town Suburb
    Post Code Country

    Foreign Account Tax Compliance Act (FATCA) Requirement For US Nationals


    Tax Identification No. Social Security No.

    Common Reporting Standard (CRS) Certification (sign off is mandatory for all Customers)
    Are you a Tax Resident of another Country? Yes No
    Declaration of Tax Residency (other than Ghana)
    I hereby confirm that I am, for tax purposes, resident in the following countries (indicate the tax reference number
    type and number applicable in each country).

    Country/countries of tax residency Tax reference number

    Declaration and Undertakings


    I declare that the information provided in this form is, to the best of my knowledge and belief, accurate and
    complete. I undertake to advise the recipient promptly and provide an updated Self-Certification form within 30
    days where any change in circumstances occurs which causes any of the information contained in this form to be
    inaccurate or incomplete. Where legally obliged to do so, I hereby consent to the recipient sharing this information
    with the relevant tax information authorities.

    I acknowledge that it is an offence to make a self-certification that is false in a material particular.

    Customer Signature: .......................................................................................... Date ..................................


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