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Foreign

How did you hear about us *

Referred By *

Staff Name *

Meristem strictly prohibits payment of CASH by existing and prospective clients to any representative of the Company, for any reason whatsoever. All payments to the Company shall be by way of cheques or bank drafts issued in the name of the Fund or by direct bank transfers or cash payments to the Company's designated Bank Accounts. The Company shall not be liable for any direct or indirect loss or damage which may arise from failure of the client to adhere to this directive. If you do not receive any investment notification 48 hours after making payment for your investment, please contact our representatives via [email protected]

Customer Information

Title *

Surname

First Name

Other Names

Joint Applicants

Title_2 *

Surname_2

First Name_2

Other Names_2

IF APPLICANT IS A MINOR, PLEASE WRITE NAME OF SPONSOR BELOW

Is Applicant a Minor?

Title *

Surname

First Name

Other Names

Residential Address *

State *

Country *

Mobile Number *

Email *

Date of Birth *

Occupation *

Religion *

Mother's Maiden Name *

Type Of ID *

ID Number *

Issue Date *

Expiry Date *

Next Of Kin *

Next of Kin's Address

Next of Kin's Phone No *

Next of Kin's Email *

Relationship *

Preferred Mode of Communication *

Bank Account Information

Account Name *

Account Number *

Bank Name

BVN *

Interest/Dividend Re-Investment

Dividends/Redemption payments will only be made to the bank account details stated above.

Nationality

If not Nigerian, please state Nationality

If you have residence in a jurisdiction other than Nigeria, please state the jurisdiction

If you are a US citizen or US tax resident, please provide your US Tax Identification Number

KYC Documents (kindly upload files max. 1MB in size)

Passport *

Click or drag a file to this area to upload.

Utility Bill *

Click or drag a file to this area to upload.

Form of Identification *

Click or drag a file to this area to upload.

Unit Holder's Signature *

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Passport_2 *

Click or drag a file to this area to upload.

Utility Bill_2 *

Click or drag a file to this area to upload.

Form of Identification_2 *

Click or drag a file to this area to upload.

Unit Holder's Signature_2 *

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Declaration

I guarantee that all information herein is complete and correct.

All transactions, benefits and payments are made in foreign currency of investment

That my/ our investment objective is as detailed in my/our Investment Policy Statement (IPS), incorporated herein by reference. That my/our Investment Policy Statement herein details the risk and returns I/We hereby acknowledge for this investment

I accept full responsibility for informing MWML of any changes in current identification information provided (e.g. address change, surname change, contact details, etc.). If any details change, I will provide MWML with new certified proof of identity and a utility bill, not older than 3 months.

In terms of the Anti-money Laundering (Prohibition) Act (2011), I confirm that the funds with which any payment is or will be made to MWML, in terms of this investment, are derived from a lawful source. In addition, I am willing to answer any questions with regard to the origin of such funds and to provide additional information as and when it may be required by MWML or other Regulatory Agencies.

I understand that information in this application may be recorded electronically with MWML in addition to physical records. Such records will form the record of this investment for all purposes and may be used as evidence at any proceedings.

Authorization

I hereby authorize MWML to:

act in accordance with my instructions or that of any person authorized by us in respect of this investment (including those transmitted and received by telephone, fax, electronic mail or the internet), and to do all things necessary to give effect thereto;
deduct as applicable, specified amounts/percentage from my investment portfolio for the purposes of transaction charges or its fees;
provide my/our details and details in respect of this investment to companies with whom it has business arrangements or MWML’s regulators.
I warrant that all statements given in this application form are true and accurate in every respect, I understand that the completeness and correctness thereof is my responsibility and agree that such statements shall form the basis of contracts which are to be entered into with the parties providing the relevant investment media. I declare that am aware of and accept the risks inherent in the investments, knowing that the realization of those risks may cause me to suffer financial loss.
I warrant that I am authorized and legally competent to enter into and conclude this transaction.

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