Please enable JavaScript in your browser to complete this form.Product DetailsPlease tick as appropriate the fund you would like to invest in Meristem Money Market FundMeristem Equity Market FundAmount (you want to invest)Company Information Ownership *Sole-ProprietorshipJoint-ownershipCompany/Business Name *Certificate of Incorporation Registration No.: *Business Type/Nature *Sector/Industry *Corporate / Operating Address *Contact Telephone number 1: *Contact Telephone number 2: *Preferred mode of communication: *EmailTelephoneLetterVisitTax Identification Number (TIN) *BVN *Average Annual Turnover: *Less than 50M50M – Less than 500M500M – Less than 5BAbove 5B* Special Control Unit Against Money Laundering (Scuml) Reg. No *Bank Account InformationAccount Name *Account Number *Bank Name *INTEREST/DIVIDEND RE-INVESTMENT: *YesNoDetails of Account Signatory1. Title *Mr.Mrs.MissDr.Prof.OtherPlease SpecifyName *FirstLast Date of birth: *Nationality *NigerainOtherPlease specify *Marital statusSingleMarriedWidowedPostal addressResidential address *Applicant’s Email address *Telephone Number Mobile Number *Means of Identification *National ID CardNational Driver’s LicenseInternational PassportINEC Voters CardID Card Number *ID Card Issue Date *ID Card Expiry Date *Tax Identification Number (TIN) *BVN *Date of Employment Employer’s Name *Employer’s/Employment Address *Nature of Business/Occupation *KYC DocumentPassport * Click or drag a file to this area to upload. ID Card * Click or drag a file to this area to upload. Utility bill (not later than 3 months) * Click or drag a file to this area to upload. 2. Title *Mr.Mrs.MissDr.Prof.OtherPlease Specify Name *FirstLast Date of birth: *Nationality (copy) *NigerainOtherPlease specify *Marital status SingleMarriedWidowedPostal address Residential address *Applicant’s Email address *Telephone Number Mobile Number *Means of Identification *National ID CardNational Driver’s LicenseInternational PassportINEC Voters CardID Card Number *ID Card Issue Date *ID Card Expiry Date *Tax Identification Number (TIN) *BVN *Date of EmploymentEmployer’s Name *Employer’s/Employment Address *Nature of Business/Occupation *Details of Next of Kin (Sole-Proprietor)Name *FirstLastRelationship *EmailPhone Number *Contact address *KYC Document Passport * Click or drag a file to this area to upload. ID Card * Click or drag a file to this area to upload. Utility bill (not later than 3 months) * Click or drag a file to this area to upload. Declaration By ApplicantsCheckboxesI/We have attached a cheque, bank draft, or evidence of fund transfer/payment made payable in the name of my chosen fund to Meristem.I/We understand that as with all stock market investment, the prices of Mutual Funds (Meristem Equity Market Fund) invested in quoted securities may go down or up. I understand that past performance is not an indication of future performance.I/We agree to comply with the minimum investment period specified for any of the Mutual Funds, failing which I accept any losses, charges or costs that may arise at the point of redemption of my investment.I/We agree that my e-statement can be sent at my risk to the correspondence address/email address I have provided.I/We hereby authorize the Fund Manager to honour redemption requests and instructions sent by electronic mail in respect of my investment holdings in the FundI/We declare that the above information is trueIndemnity For Redemption Requests/Instructions Sent By Meristem Mutual Fund Clients Through Electronic MailCheckboxesI/We hereby authorize the Fund Manager to honour redemption requests and instructions sent by electronic mail in respect of my investment holdings in the Fund and in this regard confirm the email address captured as designated one for this purpose.Submit
