INDIVIDUAL ACCOUNT OPENING APPLICATION FORM

Please fill in the form in BLOCK letters and tick the appropriate boxes. Please note that all field are mandatory.

PERSONAL DETAILS

Title Mr Mrs Miss Ms Prof Dr Other

First Name Middle Name

Surname Gender Male Female

Maiden Name Date D D M M Y Y Y Y

TPIN

National ID No Country of Birth

Nationality

Citizenship Status Citizen Non Citizen Valid Passport No

Driver’s Licence No D D M M Y Y Y Y Passport Expiry Date D D M M Y Y Y Y

Resident Status Resident Non Resident Passport Country of Issue

CONTACT DETAILS

Home No Work No

Mobile No Fax No

Email

Physical Address

Residential Physical Address Plot/House/Street No Road/Street Name Residential Area

Town City Province

Mailing Address Same as physical address

P.O. Box City/Town

Country Postal Code

African Banking Corporation Zambia Limited T/A Atlas Mara 1 Ver 001/2018
 NEXT OF KIN

First Name Relationship Partner Parent Child

Surname Other (specify)

Home No Work No

Mobile No

Email Fax No

INCOME

Tick applicable

Source of funds Business Rental Salary Other

Currency Initial Deposit Cash

Other Income Total Cheque

Transfer

FOR OFFICIAL USE ONLY

Relationship Manager

Customer Interviewed By
Signature

Verified copies of identification

documents against originals Signature

Date D D M M Y Y Y Y

Comments

Branch Date D D M M Y Y Y Y New Customer

How did you hear about Atlas Mara? Advertising Walk-In Friend Campaign Referral

African Banking Corporation Zambia Limited T/A Atlas Mara 2 Ver 001/2018
 SIGNATURE CARD

Passport Size Photos

A1 A2 A3 A4

Account Name

First Name Surname

Specimen signature(s) to be in black ink (Only one signature required per person)

A1 B2

Signature Signature

Full Name Full Name

A2 B2

Signature Signature

Full Name Full Name

Account Signing Instructions

By ticking this box and signing this agreement the customer is hereby authorising the bank to obtain credit
references, verify sources of income and employment in connection with opening this account with Atlas Mara

Signature of Customer Customer Name

Place

Date D D M M Y Y Y Y

Signature(s) Authentication by

Signature of Bank Official

African Banking Corporation Zambia Limited T/A Atlas Mara 3 Ver 001/2018
 ADDITIONAL SERVICES

Debit Card Prepaid Card E-Tax E-Napsa

SMS NOTIFICATION

This facility notifies you, via SMS, of selected transactions on your account,. if you are notified via SMS of any activity
that has not been authorised by you, let us know immediately. This helps us prevent any fraudulent activity that may
arise.

Atlas Mara SMS notification Yes No

In order for Atlas Mara to communicate transaction alerts and internet banking notifications.
Please provided a valid mobile phone number below.

I, the undersigned:
a) Is responsible for ensuring Atlas Mara has my correct mobile number.
b) Atlas Mara cannot guarantee the accuracy or arrival of an SMS.
c) Agree to the fees as discussed, and such fees may vary on notice.
d) Atlas Mara will accept no liability whatsoever, and I indemnify the bank against any loss, expense, claim or
damage, whether indirect or consequential, arising from the use of this service, or arising from any delay or failure by
Atlas Mara to send an SMS.
e) Atlas Mara makes no representation or warranty, whether express or implied, as to the operation and functionality of
the service.

INTERNET BANKING

Internet Banking Services Yes No

a) Your user ID, initial password and one-time-passwords will be sent to the mobile number via SMS.
b) The Internet Banking facility will be available on all the accounts, whether open now or in the future.

I, the undersigned:
By signing below, I hereby apply for Atlas Mara (Bank) Internet and electronic banking services (collectively “Electronic
Banking Services”) as may be made available to me by the Bank from time to time. Further I acknowledge that my use
of the Electronic Banking Services shall be governed by the Bank’s banking Terms and conditions (copies of which are
available at any of the Bank’s web-site at atlasmarazambia.com and I declare that I have read and fully understood the
said terms and conditions and accept the same. I hereby instruct and authorise the Bank to SMS my Electronic Banking
ID and Electronic Banking Passwords relating to my access to the Electronic Banking Services to my address as per the
Bank’s records and I agree that the risk of non-reciept and / or disclosure of the Security Codes to an unauthorised third
party shall be fully borne by me. I confirm and agree that the Bank shall not be held responsible in any way for any losses
that may be suffered by me as a result of such non receipt or disclosure of the Security Codes to unauthorised third party.
Subject to the Bank’s prevailing terms governing the use of the Services, I hereby authorise and instruct the Bank to act on
any instructions received through the use of my Security Codes, including but not limited to, the transfer funds of funds
(subject to limits as any be imposed by the Bank from time to time) from my account(s) with the Bank (which I am entitled
to operate on a single signing basis) to third party accounts, and to any account which I may designate from time to time
for this purpose under the Bank’s prevailing procedures. I warrant that all the information provided in this application
furnished by me is true, accurate and complete in all respects.

MOBILE BANKING

This facility notifies you, via SMS, of selected transactions on your account,. if you are notified via SMS of any activity
that has not been authorised by you, let us know immediately. This helps us prevent any fraudulent activity that may
arise.

Atlas Mara SMS notification Yes No

In order for Atlas Mara to communicate transaction alerts and internet banking notifications.
Please provided a valid mobile phone number below.

African Banking Corporation Zambia Limited T/A Atlas Mara 4 Ver 001/2018
 DECLARATION AND ACCEPTANCE

I/We understand that Atlas Mara shall use the information provided above solely for evaluation purposes and that it is correct’ We
shall be ready to provide any additional information if and when required.

a) warrant that information furnished is true and correct and undertake to inform Atlas Mara of any changes thereto as well as any facts
or circumstances in future that may impact my legal status as a client of Atlas Mara;
b) indemnify Atlas Mara against any liability for any loss or damage suffered by me/us as a result of inaccurate or incomplete information
contained herein;
c) agree to the terms and conditions governing the account and agree to abide by them and such other rules which may come into
force from time to time.
d) authorise the Bank to make any Independent information verification and generally make whatever enquiries it deems necessary
from any source whatsoever and may supply information regarding my facility and my compliance to otherwise with the terms and
conditions of Atlas Mara, to other banks or any Credit Bureau, subject to any applicable legislation, Code of Conduct or Practice;
e) understand that in the event of any information proving to be inaccurate, the bank reserves the right to decline this application
without disclosing the reasons thereof. I/We agree that the Bank reserves the right to close my/our account compulsorily without
warming if it is conducted unsatisfactorily

Date D D M M Y Y Y Y
Customer’s Signature

Place

FOR OFFICIAL USE ONLY

Date Account Opened D D M M Y Y Y Y CIF Number

Customer Category /
MIS Code
Segment
All data captured and
scanned in the system by
Date D D M M Y Y Y Y
Signature
Filed by

Date D D M M Y Y Y Y
Signature

African Banking Corporation Zambia Limited T/A Atlas Mara 5 Ver 001/2018