Meristem Ethical Earnings Portfolio

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Staff Name *

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Name *

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Date of Birth *

Nationality *

Nigeria
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Means of Identification *

National ID card
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Tax Identification Number(TIN)

Employment Status *

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Employer's Name *

Employer's Address *

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Monthly Regular Income( ₦ )

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Source of Investment fund (other than regular income)

Bank Account Details

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Branch *

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BVN *

Details of Next of Kin

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

Passport Photograph *

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Utility Bill *

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Signature *

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Declaration by applicant

I guarantee that all information herein is complete and correct.
All transactions, benefits and payments are made in Nigerian Naira
That my investment objective is as detailed in my Investment Policy Statement (IPS) , incorporated herein by reference. That the Investment Policy Statement herein details the risk and returns I 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 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 any of its 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/our instructions or that of any person authorized by me/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;
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.