Fixtip Please enable JavaScript in your browser to complete this form.How did you hear about us *Choose any of...Referral/Word of mouthGoogle SearchTwitterInstagramFacebookStaff PresentationReferred By *Staff Name *Existing ClientChoice 1YesNoMeristem 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 InformationTitle *MrMrsMissMasterDrProfChief/SirSurname *First Name *Other NamesJoint ApplicantsNoYesTitle_2 *MrMrsMissMasterDrProfChief/SirSurname_2First Name_2Other Names_2 IF APPLICANT IS A MINOR, PLEASE WRITE NAME OF SPONSOR BELOWIs Applicant a Minor?NoYesTitle *MrMrsMissMasterDrProfChief/SirSurnameFirst NameOther NamesResidential Address *State *Country *Mobile Number *Email *Date of Birth *Occupation *Religion *Mother's Maiden Name *Type Of ID *International PassportDriver's License issued by the Federal Road Safety Commission (FRSC)Inland Revenue Tax Clearance CertificateNational Identity CardPermanent Voter's Registration card issued by the Independent National Electoral Commission (INEC)ID Number *Issue Date *Expiry Date *Next Of Kin *Next of Kin's AddressNext of Kin's Phone No *Next of Kin's Email *Relationship *Preferred Mode of Communication *EmailTelephoneBank Account InformationAccount Name *Account Number *Bank NameBVN *Interest/Dividend Re-InvestmentYesNo Dividends/Redemption payments will only be made to the bank account details stated above.NationalityNigerianNon-NigerianIf not Nigerian, please state Nationality 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 * Click or drag a file to this area to upload. 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 * Click or drag a file to this area to upload. DeclarationTerms and ConditionsI guarantee that all information herein is complete and correct.If this investment is cancelled by me, MWML will have the right to refund the principal amount up to the date of cancellation plus the residue of accrued interest after a penalty charge as MWML may prescribe on the accrued interest.All amounts relating to this investment in particular payments and benefits will be expressed, calculated and paid in Nigerian currency. Payment will be made in Nigeria.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.AuthorizationI hereby authorize MWML to:act in accordance with our 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 sufficient amounts from our chosen investment for the purposes of transaction charges or its fees; provide our details and details in respect of this investment to companies with whom it has business arrangements or MWML’s regulatorsto retain interest pro rata across the selected Fixed Term Investments in order to collect charges, including reduction charges.NameSubmit