ACCOUNT OPENING FORM - INDIVIDUAL

(Please indicate the category and type of account to open by ticking the applicable box below) Risk Depth
Category of Account
High
Individual Joint
Medium
Branch Low

Type of Account ( Please indicate the type of account you want to open by ticking in the boxes below)
Others
Individual Current Premier Savings Premier Current Gold Solo Please specify

Purpose of Account (1)

Purpose of Account (2)

ACCOUNT NO (1) GHS € £ $ Y Others

(For official use only) Currency type

ACCOUNT NO (2) GHS € £ $ Y Others

Currency type
(For official use only)
ACCOUNT NO (3) GHS € £ $ Y Others
Currency type
(For official use only)
ACCOUNT NO (4) Currency type GHS € £ $ Y Others
(For official use only)

2. PERSONAL INFORMATION
Title Surname

First Name

Other Names
Maiden Name
(if applicable)
Marital Status
(Please tick) Single Married Others (Specify) Gender M F

Place of Birth Date of Birth D D M M Y Y Y Y

Mother’s Maiden Name

Nationality

Country of Origin Country of Residence

If yes, please Residence
Do you have dual citizenship? Yes No specify Permit No
Permit Issue D D M M Y Y Y Y Permit Expiry D D M M Y Y Y Y Place of
Date Date Issue

Hometown

Profession/ SSNIT No
Occupation
Tax Identification
Number (TIN)
If US Citizen, please provide:
Social Security Employee
Number Identification No.

3. CONTACT DETAILS
Residential Address
in Ghana
City/Town Nearest Landmark

Proof of Address
(Indicate type and Serial Number)
Mobile Number Fixed Tel No.

Metropolitan, Municipal and

District Assembly Area (MMDA)

Email Address

(P. O Box)

1.
 4. VALID MEANS OF IDENTIFICATION
National ID Card National Driver’s License Passport Voter’s ID

Other ID Country
(Please Specify) of Issue

ID No. ID Issue Expiry

Date D D M M Y Y Y Y Date D D M M Y Y Y Y

5. ACCOUNT SERVICE (S) REQUIRED (Please tick applicable option below)

Card Preferences ATM Card Master Card Visa Card Others (Please specify)

Electronic Banking Preferences Internet Banking Mobile Banking Other Internet Products (Specify)

Transaction Alert Services Email Alert SMS Alert

Statement Preference Email Post Collection at Branch

Statement Frequency Monthly Quarterly Semi-Annually Annually

Cheque Book Requisition 25 Leaflets 50 Leaflets 100 Leaflets Opened Cheque Crossed Cheque

6. EMPLOYMENT DETAILS
Employed Self Employed Unemployed Retired Student Others (Please specify)

Salary/Expected Income
Length of period with current Employer (Per Annum)

Monthly Salary Less than GH¢ 1,000 GH¢ 1,001-5,000 GH¢ 5,001-10,000 More than GH¢ 10,000

Employer’s Name

Employer’s Address

Nearest Landmark

City/Town Region

Metropolitan, Municipal and

District Assembly Area (MMDA)
Employer’s
Nature of Business
Email Address
Office Phone No. Mobile Number

7. DETAILS OF NEXT OF KIN (in case of emergency)

Title Surname

Middle Name First Name

Relationship Date of Birth D D M M Y Y Y Y Gender M F

Phone Number (1) Phone Number (2)

Residential Address

Metropolitan, Municipal and

District Assembly Area (MMDA) Region

8. ADDITIONAL DETAILS
Full name of Beneficiary Owner(s)
of the Account (if applicable)

2.
9. EXPECTED ACCOUNT ACTIVITY
Source of funds
to the Account

Level of Deposits Frequency

(Amount) of Deposits
Expected Monthly Income Frequency of
from other sources Withdrawals

Name of Associated
Business (es)

Type of Associated
Business
Associated Business
Address

10. ACCOUNTS HELD WITH OTHER BANKS

SN NAME AND ADDRESS OF BANK/BRANCH ACCOUNT NAME ACCOUNT NUMBER

11. CUSTOMER FEEDBACK

How did you find out about us?

Social Media Facebook Twitter Instagram Access Bank’s Website

Advertisement Radio TV Billboards/Banner Flyer/Poster Newspaper/Magazine

Referrals Staff Family Friend Other (Please Specify)

12. INDIVIDUAL ACCOUNT MANDATE

To Access Bank (Ghana) Plc
I/WE HEREBY REQUEST AND AUTHORIZE YOU TO (g) I/We note that the Bank will accept no liability whatsoever for funds handed to members
of staff outside the Bank’s premises.
1. Open an account in my/our name and at any time subsequently to open further accounts as
(h) That my/our attention has been drawn to the necessity of safeguarding my/our
I/WE may direct
cheque book so that unauthorized persons are unable to gain access to it and to the
2. Honour all cheques or other orders which may be drawn on the said account provided. fact that neglect of this precaution may be ground for any consequential loss being
Such cheques or orders are signed by me/us and to debit such cheques or orders to the said charged to my/our account.
account whether such account be for the time being in credit or overdrawn or may become
(I) That the Bank is under no obligation to honour a cheque(s) drawn on this account
overdrawn in consequence of such debit without prejudice to your right to refuse to allow
unless there are sufficiant funds in the account to cover the value of the said cheque
any overdraft and inconsideration. I/We agree.
and I/We are obliged to me/us unpaid but if paid, I/We are obliged to repay the Bank on
a) To assume full responsibility for the genuineness of correctness and validity of demand.
endorsement appearing on all cheques, orders, bills, notes, negotiable instruments
(j) That any disagreements with entries on my/our Bank Statements will be made by me/
receipts and/or other documents deposited in my/our account.
us within 15days from the dispatch of the Bank Statement. Failing receipt by the Bank
(b) To be responsible for the repayment of any overdraft with interest and to comply and of a notice of disagreement of entries within 15days from the date of dispatch of my/
be bound by the bank’s rules for the conduct of a current account receipt of which I/ our Bank Statement as it shall be rendered correct.
WE hereby acknowledge.
(k) That any sum standing to the debit of the current account shall bear interest charges
(c) To free the bank from any responsibility for any loss or damage to funds deposited at the rate fixed by the Bank from time to time.
with the bank due to any future government order, law, levy, tax, embargo and/or all
The Bank is authorized to debit from the account the banking charges, interest, commissions
other causes beyond the bank’s control
and service charges, interest, commissions and service charge set by the Management from
(d) That all funds standing to my/our credit are payable on the demand only in such local time to time.
currency as may be in circulation.
I/We also agree that in addition to any general lien or similar right to which you as bankers may
(e) To be bound by any notification of change conditions governing the account directed be entitled by law, the bank may at any time without notice to me/us combine or consolidate all
to my/our last known address shall be considered as duly delivered and received by or any of my/your accounts without any liabilities to you and set off my/our accounts without any
me/us at the time it will be delivered in the ordinary course of post. liabilities to you and set off or transfer any sum or sums standing to the credit, be it cheques,
valuables, deposits, securities, negotiable instruments or assets belonging to me/us liabilities
(f) That if a cheque credited to my/our individual current account is returned
to the bank or any other account or in any other respect whether such liabilities be actual or
dishonoured, the same may be transmitted to me/us through my/our last known
contingents, primary or collateral and joint or several
address either by the bearer or by post

13. CHEQUE CONFIRMATION POLICY (For Cheque Bearing Accounts Only)

You will be required to pre-confirm any cheque above GHS 2,000.00
If you would like to have a higher threshold pre-confirmation, please specify the amount (ie. threshold above GHS)
In case you are unavailable to confirm a cheque that meets pre-confirmation threshold, please indicated your preferred action:

Pay Cheque Return Cheque Authorized Signatory

3.
14. DISCLOSURE OF INFORMATION TO IRS (U.S CITIZENS ONLY)
I/We consent to the disclosure of my/our account information to the U.S Internal Revenue Service (IRS) in line with the Bank’s compliance with the
Foreign Account Tax Compliance Act (FATCA)

15. ELECTRONIC BANKING AGREEMENT

1. Introduction 5.3 Neither the customer nor Access Bank Ghana Plc. will be responsible for any failure of
obligations under the Agreement if such performance would result in it being breach of
1.1 This Agreement is a service agreement, which applies to Communication (defined below) any government or other authority in accordance with which it is required to act or if its
performance is prevented, hindered or delayed by a Force Majeure Event; in such case its
1.2 The Customer will provide to Access Bank Ghana Plc. documents and other information obligations shall be suspended for so long as the Force Event continues.
reasonably required by it in connection with this Agreement. “Force Majeure Event” means any event due to any cause beyond the reasonable control
of the relevant party, such restrictions on convertibility or transferability, requisitions,
2. Authority involuntary transfers, unavailability of any system, sabotage, fire, flood, explosion, acts of
God, civil commotion, strikes or industrial action of any, riots, insurrection, war or acts of
2.1 Access Bank Ghana may rely on the authority of each person designed (in a form acceptable government.
to Access Bank Ghana) by the Customer to end Communications or by written notice
or other notice acceptable to it of any change. 6. Customer Information

3 Communications 6.1 Access Bank will treat information relating to the customer, as confidential but (unless
consent is prohibited by law) the Customer consents to the transfer and disclosure by
3.1 Each of the Customer and Access Bank Ghana Plc. will comply with certain agrees security Access Bank Ghana Plc. of any information relating to the customer to and between the
procedures (the Procedures) designed to verify the origination of communications branches, subsidiaries, representatives offices, affiliates and agents of Access Bank Ghana
between them such as enquiries. Advices and instructions (each a communication) Plc. and any branch, subsidiary, representative offices, affiliate agent or third party may
transfer and disclose any such information as required by any law, court, regulator or legal
3.2 Access Bank Ghana Plc. is not obliged to do anything other than what is contained in the
producers to establish communication. Access Bank Ghana Plc. is not responsible for 7. Termination process.
errors or omissions made by the Customers or duplication of any Communication by the
reference to an account number only, even if an account name is not provided. Access 7.1 The customer or Access Bank Ghana Plc. may terminate this agreement on reasonable
Bank Ghana Plc. may act on a communication if it reasonably believes it contains sufficient notice (taking into account any communication and any service).
information.
8. General
3.3 Access Bank Ghana Plc. may decide not to act on a communication, where it reasonably
8.1 Neither the Customer nor Access Bank Ghana Plc. may assign or transfer any of its rights
doubts its contents, authorizat ion, or igination or compliance with the procedures and will
or obligations under this agreement without the others written with consent which will
promptly notify the customer (by the telephone if appropriate) of its decision.
not be unreasonably withheld or delayed provided that Access Bank Ghana Plc. may make
such an assignment or transfer to a branch, subsidiary affiliate if it does not materially
3.4 If the customer informs Access Bank Ghana Plc. that it wishes to recall, cancel or amend
affect the provision of services to the customer
a communication, Access Bank Ghana Plc. will use its reasonable efforts to comply

3.5 If Access Bank Ghana Plc. acts on any communication sent by any means requiring manual 8.2 If any provision of this Agreement is or become illegal. invalid or unenforceable under any
intervention (such as telephone, telex, electronic mail or disks) sent by Procedures, the applicable law, the remaining of this Aggreement will remain in full force and effect (as will
customer will be responsible for any loss Access Bank Ghana Plc. may incur in connection that provision under any other law).
with that communication
8.3 No failure or delay of the Customer or Access Bank Ghana Plc. in exercising any right or
4. Statement remedy under this Agreement will constitute a waiver of that right. Any waiver of any right
will be limited to the specific instance
4.1 The customer will notify Access Bank Ghana Plc. in writing of anything incorrect in a
statement promptly and in any case within thirty (30) days from the date on which the 8.4 The Customer and Access Bank Ghana Plc. consent to telephonic or electronic monitoring
statement or advice is sent to the customer or recording for security and quality of service purposes and agree that either may produce
telephonic or electronic recordings or computer records as evidence in any proceedings
5. Performance brought in connection with this agreement.

5.1 Access Bank Ghana Plc. will act in good faith and reasonable care, as determined in 8.5 Written notice shall be effective if delivered to either parties address specified below
accordance with the standards and practices of the banking industry , and cheque may use (or at any address it may provide by written notice for purpose). Notices shall be in English
any communications, clearing or payment system, intermediary bank or other entity (each unless otherwise agreed
“system”) It reasonably selects; Access Bank Ghana Plc. performance is subjected to the
rules and regulations at any time of any system. CAUTION: ACCESS BANK GHANA PLC SHALL NOT BE LEGALLY OR OTHERWISE
RESPONSIBLE WHERE CUSTOMER’S USERNAME AND PASSWORD KNOWN ONLY TO
5.2 Neither the customer nor Access Bank Ghana Plc. shall have liability for any indirect, THE CUSTOMER IS ACCURATE PROVIDED BY ANY OTHER PERSON APART FROM THE
incidental or consequential loss or damages (including loss profit), even if advised of the CUSTOMER FOR ANY TRANSACTIONS COMMUNICATION WHERE IT REASONABLE
possibility of such loss or damages. CONTAINS SUFFICIENT INFORMATION BELIEVED TO HAVE EMANATED FROM THE
CUSTOMER.

16. ATM CARD AGREEMENT

1. DEFINITIONS 2.3 Withdrawal of funds with the Card from any ATM is only allowable against the credit balance
In this Agreement: on the relevant account of the Cardholder.

“Account” means any account held by the Cardholder in the Bank from which the 2.4 The Card may be used at all ATMs of other participating banks on the Visa network.
Cardholder can carry on transaction with the Card.
3. USE OF THE CARD AND PIN
“Account holder” means a customer of the Bank who has an account with the Bank.
3.1. The Cardholder shall exercise all possible care to ensure the safety of the Card in his/her
“Card or accesscard” means the debit card, including any renewal, replacement or possession at all times.
Additional card(s) issued by the Bank to the Cardholder.
3.2 The Cardholder shall be responsible for formulation and imputation of his/her PIN which
“Cardholder” means the person to whom the Bank issues one or more of the card. shall at all times be known only and be used solely by the Cardholder.
“Hotlist” means the list containing information on missing, lost, stolen, invalid, and 3.3 The PIN shall not under any circumstances be disclosed to any third party and if written on
cancelled cards. Cardholder to keep such material entirely secured at all times.
“Participating bank” means any bank other than the Bank participating in the Visa 3.4 Use of the Card shall not be allowed after the validity period stated on the Card, after same
Payment System. has been placed on the hotlist, or after any notification to the Cardholder by the Bank or
any of its officers or agents of the cancellation or withdrawal of the card.
“PIN” means the personal identification Number imputed and personally known to the
Cardholder for use with a card. 3.5 It shall be the responsibility of the Cardholder to notify the Bank immediately in respect
of any change in his/her name, business or residential change address or telephone
“Point of sale Machine POS” means the machine used by the retailers and suppliers of numbers(s)
goods and services exclusively for transferring and updating units of electronic value.
3.8 The Cardholder shall be exclusively responsible for any losses to the Bank arising from the
2. ISSUE OF CARDS want or exercise of care in keeping the Card or the secrecy of the PIN or the use of the Card
2.1 The Card is a debit card available only to Account holders of the Bank. by any person whatsoever other than the Cardholder
2.2 The Card shall only be used by the Cardholder and in accordance with the terms and 3.9 The Cardholder shall assit the Bank and/or its officers or agents in the investigation of any
conditions herein stated. loss, theft or possible misuse of the the Card and in the recovery of any such Card.

4.
4. TRANSACTION LIMIT 9. BANKRUPTCY, INSOLVENCY AND RECEIVERSHIP

Withdrawal per transaction from any ATM and the daily withdrawal limit will be received In the event of the dissolution, death, bankruptcy, or liquidation of the Cardholder, the Bank
from time to time. shall at its absolute discretion terminate this agreement and disable the Card, or in the
absence of any court order to the contrary, for a fee and within two weeks of notification
5. FEES of any of the events aforesaid, issue a new card in favour of the receiver, receiver/manager,
liquidator, trustee-inbankruptcy, executor or administrator of the Cardholder.
All fees and charges applicable for the issuance and use of the Card shall be as may be
determined from time to time by the bank. 10. DISCLOSURE OF INFORMATION

6. REPRESENTATION AND WARRANTORS OF THE BANK (I) Access Bank may hold and process by computer or any other means, information obtained
about the Cardholder in consequence of this agreement.
The Bank represents and warrants as follows:
(ii) Access Bank may disclose information on the cardholder to:
6.1 The Bank is a member of the Visa payment systems.
(a) Any person (including the police) for purpose of investigation of a fraud or any related
6.2 The Card may be used in all ATMs BEARING THE Visa Payment Logos irrespective of the matter
Bank of ownership.
(b) Any relevant party involved in processing Access card transactions.
Provided that;
(c) Any person who may assume Access Bank’s right under this agreement.
6.2.1 The Card is valid, and authorized in accordance with agreed security measures.
6.2.2 The Cardholder pays any fees including cash withdrawal fees charged by the Bank or the (d) Any party, if permitted or compelled to do so by the provision of any enactment, order of a
participating bank court of law or of any regulatory institution.

6.2.3 The Card is not on the hotlist and 11 TERMINATION OF THIS AGREEMENT

6.2.4 The transaction meets the condition set by the participating bank. 11.1 Either party may terminate this agreement with seven days written notice to the other
party. PROVIDED HOWEVER, THAT the Bank may terminate this agreement with or
7. CONVENIENCE OF THE CARDS without notice if the circumstances so warrant

The Cardholder hereby convents and undertakes that the Cardholder shall comply with the 12. GENERAL PROVISIONS
terms of this Agreement and all other rules and regulations relating to the issuance and use
of the Card. 12.1 The Bank reserves the right at all times to supplement, amend or vary this agreement as a
result of a requirement of law or product development or such other reason communicated
8. LOST AND STOLEN CARDS to the cardholder at the time of notification of the change. Any such change will be effective
upon notice to the cardholder and notice shall be by any means the Bank thinks fit. On receipt
If a card is lost, missing or stolen or if the PIN becomes known to any other person or if the of such notification, the cardholder may by his/her discretion terminate this
PIN is likely misused, the Cardholder must, as soon as possible notify the Bank Loss Centre agreement in accordance with the conditions of this agreement.
at East Cantonments Branch or the nearest branch of the Bank.
12.2 On termination, bankruptcy, dissolution, insolvency, liquidation or death, the
Individual Account Opening Form 11 cardholder’s obligations will continue until all cards issued in respect of the account are
returned and all outstanding indebtedness owed to the bank by the Cardholder is fully
8.2 Where such notification is made orally, it shall not take effect until the Bank receives repaid.
effective notification in writing and the cardholder shall be reliable in respect of any use
of the card within seven days after the receipt of such written notifications. 12.3 The waiver by the bank of any breach of any term of this agreement will not prevent the
subsequent enforcement of that term and will not be deemed a waiver of any subsequent
8.3 Upon receipt of such Notice as contemplated above, the Bank shall at the cost of the breach.
Cardholder issue a replacement card to the Cardholder.

8.4 It shall be the responsibility of the Cardholder to change the PIN as soon as a replacement
Card is issued.

8.5 Any card that is reported as lost, stolen or missing and is found or recovered thereafter
must be returned to the Bank immediately upon being found or recovered

I/WE APPLY FOR THE OPENING OF AN ACCOUNT OR ACCOUNTS WITH ACCESS BANK (GHANA) LIMITED. I/WE UNDERSTAND THAT
THE INFORMATION GIVEN HEREIN IS THE BASIS FOR OPENING SUCH ACCOUNT(S) AND HEREBY WARRANT THAT SUCH INFORMATION
IS CORRECT.

I/WE HEREBY CONFIRM THAT I HAVE READ THE ABOVE TERMS AND CONDITIONS AND AFFIRM THAT I TRULY UNDERSTAND AND ACCEPT
SAME AS BINDING ON ME/US

Authorized Signatory Authorized Signatory

Name/Signature or Thumb print Name/Signature or Thumb print

SIGNED, SEALED AND DELIVERED

by the within named person

In presence of:

Name:

Occupation:

Address:

Signature

5.
 17. ACCOUNT OPENING MANDATE
Mandate authorisation Sole Signatory Either to Sign Both to Sign
(Please tick as appropriate)

Surname First Name Other Names

Class of Signatory Identification Type Identification No.

Telephone Number

SIGNATORY

Affix
Passport
Name Photograph
Here

Signature Date D D M M Y Y Y Y

In case of joint a/c, 2nd applicant is required to complete Simplified Account Opening Forms

18. DECLARATION
I/we hereby apply for the opening of account(s) with Access Bank (Ghana) Plc. I/we understand that the information given herein and the documents
supplied are the basis for opening such account(s) and I/We therefore warrant that such information is correct.
I/we further undertake to indemnify the Bank for any loss suffered as a result of any error in the information provided to the Bank.

DISCLOSURE TO CREDIT REFERENCE BUREAUS

The Bank will obtain information about you from the credit reference bureaus to check your credit status and identity. The bureaus will record our
enquiries which may be seen by other institutions that make their own credit enquiries about you.

The Bank shall also disclose your credit transactions to credit reference bureaus in accordance with the Credit Reporting Act, 2007 (Act 726).

Name Signature Date D D M M Y Y Y Y

19. (THIS SHOULD BE ADOPTED WHERE THE APPLICANT

IS NOT LITERATE OR IS BLIND AND THE
FORM IS READ TO HIM OR HER BY A THIRD PARTY)

I agree to abide by the content of this agreement and acknowledge that it has been truly and audibly read over and explained to me by an interpreter.

Mark of Customer/ Mark of Customer/

Date D D M M Y Y Y Y
Thumbprint/Signature Thumbprint/Signature

Name and address of Interpreter

Language of interpretation

6.
 FOR BANK USE ONLY
1. REQUIREMENTS CHECKLIST
S/N DOCUMENT REQUIRED CHECKED DEFERRED WAIVED N/A

1 Duly completed Account opening form

2 Specimen signature card duly completed

3 Recent Passport Photograph

4 Proof of Identity: International passport, Driver’s License or National ID

Valid Ghanaian Voters ID Card (original must be sighted)

5 Residence Permit (for Non-Ghanaian)

6 Proof of Address:Utility bills, Visitation Report etc. (certified true copy is

acceptable if original is not held)

7 Letter from Employer/School (for salaried account and or student only)

8 Reference Letter (Others)

9 Proof of sanction screening of all signatories

10 Risk Assessment and Classification

11 EDD on All high risk accounts and Management approval for PEP, NGO
and FEP.

12 Tagging of risk classification in the system

13 FATCA Declaration (Completed W9 and FATCA Indemnity)

2. SANCTION SCREENING
Name

Result

Name

Result

Name

Result

Account Officer Relationship Officer

7.
 3. ANTI-MONEY LAUNDERING RISK MANAGEMENT WORKSHEET
1. Is the customer’s core business activity one of the defined “High Risk Business” and if so which?
Yes. Management concurs with “High Risk” assessment and
No
opening the account subject to High Risk Account Monitoring

Yes. Management judge mentally assesses

account as “Low Risk” (Provide justification below)

2. Is the customer located in a “High Risk” geography and/or does the customer deal principally with customer or suppliers who are located in such geographies?

No
Yes
3. Is the customer :
Expected to handle business Expected to use
A Public Figure activity on the account High Risk Products?
If any 1-3 is Yes “High Risk”. If judgementally classified “Low Risk”, then Explain
JUSTICATION / COMMENTS

Is the applicant a Politically Exposed Person (PEP)? Yes No

CLASSIFICATION High Risk Medium Risk Low Risk

Account Officer Relationship Officer

A. ACCOUNT OPENED BY:

Name (Staff ID)

Team MIS Code Signature Date D D M M Y Y Y Y

Name of Account
Officer

MIS Code Signature Date D D M M Y Y Y Y

Name of Relationship
Manager

MIS Code Signature Date D D M M Y Y Y Y

B. DEFERRAL/WAIVER OF DOCUMENTS (IF ANY) AUTHORISED BY:

Name

Signature Date D D M M Y Y Y Y

C. DOCUMENT VERIFICATION CARRIED OUT BY (CCO)

Customer IDs of Signatures
1 2 3

Name

Date D D M M Y Y Y Y
Signature
COMMENT(S): (Address
Description and Results Findings)

D. ACCOUNT OPENING VERIFIED/APPROVED BY (SUPERVISOR)

Name

Signature Date D D M M Y Y Y Y

For higher risk category, (Head Risk/Compliance; Head Operations; MD/CEO may sign)

Designation Signature Date D D M M Y Y Y Y

8.
LETTER OF REFERENCE
FROM: (Referee)

Name

Address

TO:

The Manager

Access Bank (Ghana) Plc

Dear Sir/Madam

Account Name

The above individual(s) wish(es) to open an Account with you. He/She (they) is/are well known to me and I consider him/her (them) as suitable to
maintain the said account with you.

Our/My Bankers are

Name of Bank Branch

Account No. Signature of Referee(s)