GCB Bank PLC

Customer Update Form - Entities your bank for life

General Account Information (Complete in block letters and tick where applicable)
Transaction Branch Date D D M M Y Y Y Y
Account Number
Account Name
Tick all the applicable information to be updated
Directors/Shareholders Signatory & Mandate Business Detail
Expected Account Activity Address and Contact Details Others (specify)
Business Details
Business Name:
Certificate of Inc. No.: Date of Inc. D D M M Y Y Y Y
Certificate of
Registration No.: Date of Issue D D M M Y Y Y Y
Regulator’s Certificate/ Date of Issue D D M M Y Y Y Y
Licence No.:
Jurisdiction of Inc./
Registration: TIN:
Parent Company’s Digital
Country of Inc.: Address
Type/Nature of
Business:
Sector/Industry: Product/
Service Traded
Operating Business
Address:
Business Address/
Registered Office: If different from the above indicate
Location of Office: Landmark
Metropolitan, Municipal and District Assembly (MMDA):
Mobile No.: Telephone No.:
Email Address: Website (if any):
Number of Directors: No. of Employees
Mode of Salary payment: Cash Cheque Direct Credit

Account Services Subscription

Have you subscribed to any of our E-Banking products? Yes No

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)
Entity Self Certification

Is the Entity a Tax Resident of another Country? Yes No

If Yes, complete an additional CRS Form. If No, kindly sign the declaration below.

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Declaration of Tax Residency (other than Ghana)

Please indicate the Entity’s place of tax residence (if resident in more than one jurisdiction please detail all jurisdictions and
associated tax reference number type and number).
If an entity has no residence for tax purposes please indicate the jurisdiction in which its place of effective management is
situated. Please indicate not applicable if jurisdiction does not issue or you are unable to procure a tax reference number or
functional equivalent and indicate the reason below.

Country/Countries of tax residency Tax reference number

If applicable, please specify the reason for non-availability of a tax reference number:

..............................................................................................................................................................................................................

Entity Declaration and Undertakings

I/We declare (as an authorised signatory of the Entity) that the information provided in this form is, to the best of my/our
knowledge and belief, accurate and complete. I/We 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/we hereby consent to the recipient sharing this
information with the relevant tax information authorities.
I/we acknowledge that it is an offence to make a self-certification that is false in a material particular.

Authorised Signature: __________________________________ Authorised Signature: __________________________________

Position/Title: _________________________________________ Position/Title: _________________________________________

Date (dd/mm/yyyy): ___________________________________ Date (dd/mm/yyyy): ____________________________________

Key Contact Person / Principal Officer's Details

Name
Surname First Name Other Name(s)
Date of Birth D D M M Y Y Y Y Gender Male Female
Mother’s Maiden name

Country of Residence Nationality

ID. Type ID. No.
ID. Expiry Date D D M M Y Y Y Y ID. Issue Date D D M M Y Y Y Y
Resident/Work Permit No. TIN
Job Title %Shareholding Occupation

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

Tax Identification No. Social Security No.

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Account Signatories Details (1)

Name
Surname First Name Other Name(s)
Date of Birth D D M M Y Y Y Y Gender Male Female
Mother’s Maiden name
Country of Residence Nationality
ID Type ID No.
ID. Expiry Date D D M M Y Y Y Y ID. Issue Date D D M M Y Y Y Y
Resident/Work Permit No. TIN
Job Title %Shareholding Occupation
Residential/Permanent Address
Residential Address Street Name
City/Town Digital Address/
Pin Code
MMDA Suburb/Landmark
Region Mobile No.
Email Telephone No.

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

Tax Identification No. Social Security No.

Account Signatories Details (2)

Name
Surname First Name Other Name(s)
Date of Birth D D M M Y Y Y Y Gender Male Female
Mother’s Maiden name
Country of Residence Nationality
ID Type ID No.
ID. Expiry Date D D M M Y Y Y Y ID. Issue Date D D M M Y Y Y Y
Resident/Work Permit No. TIN
Job Title %Shareholding Occupation
Residential/Permanent Address
Residential Address Street Name
City/Town Digital Address/
Pin Code
MMDA Suburb/Landmark
Region Mobile No.
Email Telephone No.

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

Tax Identification No. Social Security No.

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(1) Details of the Director / Executive / Trustee /Promoter /Executor / Administrator, etc

Name
Surname First Name Other Name(s)
Date of Birth D D M M Y Y Y Y Gender Male Female

Mother’s Maiden name

Country of Residence Nationality
ID Type ID No.
ID. Expiry Date D D M M Y Y Y Y ID. Issue Date D D M M Y Y Y Y

Resident/Work Permit No. TIN

Job Title %Shareholding Occupation
Status as a Director (Please tick as appropriate)
Chairman Managing Director/CEO Executive Director Non-Executive Director
Chief Finance Officer Others (specify)
Date of Appointment as Director D D M M Y Y Y Y
Do you hold any directorship position in any other company? Yes No
Company Name (If yes)

Residential/Permanent Address
Residential Address Street Name
City/Town Digital Address/
Pin Code
MMDA Suburb/Landmark
Region Mobile No.
Email Telephone No.

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

Tax Identification No. Social Security No.

(2) Details of the Director / Executive / Trustee /Promoter /Executor / Administrator, etc

Name
Surname First Name Other Name(s)
Date of Birth D D M M Y Y Y Y Gender Male Female

Mother’s Maiden name

Country of Residence Nationality
ID Type ID No.

ID. Expiry Date D D M M Y Y Y Y ID. Issue Date D D M M Y Y Y Y

Resident/Work Permit No. TIN
Job Title %Shareholding Occupation

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Status as a Director (Please tick as appropriate)

Chairman Managing Director/CEO Executive Director Non-Executive Director

Chief Finance Officer Others (specify)

Date of Appointment as Director D D M M Y Y Y Y

Do you hold any directorship position in any other company? Yes No
Company Name (If yes)
Residential/Permanent Address
Residential Address Street Name
City/Town Digital Address/
Pin Code
MMDA Suburb/Landmark
Region Mobile No.
Email Telephone No.

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

Tax Identification No. Social Security No.

Principal Shareholders (Shareholding of 10% and above )

Shareholder (1) Shareholder (2)
Full Name Full Name

Designation Designation
% Shareholding % Shareholding
Nationality Nationality
Address Address
Mobile No. Mobile No.
Email Email
TIN TIN
If a Corporate Shareholder If a Corporate Shareholder
Name of Beneficial Name of Beneficial
Owner(s) if any Owner(s) if any

Expected Account Activity

Transaction Type Expected No. of Transactions Per Month Expected Amount Per Month
Deposits (Funds inflow)
Account (1) 1-20 21-60 61 - Above 1-200,000 200,001-500,000 500,001 plus
Account (2) 1-20 21-60 61 - Above 1-200,000 200,001-500,000 500,001 plus
Withdrawals (Funds outflow)
Account (1) 1-20 21-60 61 - Above 1-200,000 200,001-500,000 500,001 plus

Account (2) 1-20 21-60 61 - Above 1-200,000 200,001-500,000 500,001 plus

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Declaration

I/We hereby apply for update of account(s) with GCB Bank PLC ..................................................... branch. I/ We
understand that the information given herein and the documents supplied are the basis for updating such
account(s) and I/We therefore warrant that such information is correct.

Name: ....................................................................................... Signature ..................................... Date ...................................

Name: ....................................................................................... Signature ..................................... Date ...................................

Name: ....................................................................................... Signature ..................................... Date ...................................

Account Opening Mandate

Please specify new signing instructions:

Date Name Class of Signatory Affix Photo Specimen Signature

(if Applicable)

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FOR BANK USE ONLY

1. KYC/Risk Profile:
Please tick appropriate Risk Profile Low Risk Medium Risk High Risk

2. PEP status : Indicate which Signatory, Director, Executive, Trustee, Promoter, Executor or Administrator is a PEP

Name ........................................................................................ Position .................................................................................

Source of Wealth .......................................................................................................................................................................

Name ........................................................................................ Position .................................................................................

Source of Wealth .......................................................................................................................................................................

MIS Details
Classification MIS Code MIS Description
Industry Sector
Market Segment

3. Data Input By :

Name ..................................................................................... Signature......................................... Date ..............................

4. Document Verification Carried Out By :

Name ..................................................................................... Signature......................................... Date .............................

Comments .......................................................................................................................................................................................
5. Update Authorized/Approved By :

Name ..................................................................................... Signature......................................... Date .............................

6. For PEP and Other High Risk Customers, Refer to the Managing Director /Head of Business Unit for Approval

Name .................................................................................. Designation ................................................................................

Signature .................................................................................. Date ..............................................................................