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REB Customer Information Form

The Customer Information Form is a legal requirement for individuals to provide their current personal details for record updates. It includes sections for personal identification, contact information, occupation, and any prominent public functions held by the individual or their relatives. Additional documentation is required for processing, especially if an agent submits the form on behalf of the client.

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Bimmer Lyfe JA
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14 views2 pages

REB Customer Information Form

The Customer Information Form is a legal requirement for individuals to provide their current personal details for record updates. It includes sections for personal identification, contact information, occupation, and any prominent public functions held by the individual or their relatives. Additional documentation is required for processing, especially if an agent submits the form on behalf of the client.

Uploaded by

Bimmer Lyfe JA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Customer Information Form

Individual

Dear Customer,

We are required by law to collect and maintain your most current information. We
therefore ask that you complete and return this form so that your records can be updated
accordingly.

Surname First Name Middle Name

Other Names (including aliases)

Mother’s Maiden Name

Title
Mr Mrs Miss
Date of Birth Place of Birth Nationality

Home Address Mailing Address (if different from home address)

Telephone Numbers Home Mobile Work

Email Address

Occupation (‘businessman/ businesswoman or self-employed’ is not acceptable)

Nature of Business (if self- employed)

Name of Employer/ Business Address of Employer/Business

Telephone Numbers
Fax: Work:
Identification Type: (DL, PP, Nat ID, Other) ID Number:

Expiration Date:
Source of Funds

Tax Registration Number (if driver’s licence is not being used)

Have you or any relative or close associate been entrusted with prominent public functions
(e.g. Member of Parliament, Senate or Mayor, Senior Government Official, Judiciary, Security
Forces) Yes No

If Yes, state the type of public office:

1
Customer Information Form
Individual

Address:
If Yes to the above give the name and address of spouse and children

Name of Spouse* _____________________ Address of Spouse __________________

Name of Child _______________________ Address of Child ____________________

Name of Child ________________________ Address of Child _____________________

Name of Child ________________________ Address of Child ______________________

*Spouse includes common law husband or wife

Client’s Signature__________________________ Date________________________

**this section is only applicable if an agent is completing the form on behalf of the client
Agent’s Last Name Agent’s First Name Agent’s Middle Name:

Agent’s Address: Date of Birth: Nationality:

Identification Type & Number: (DL, PP, Nat ID, Tax Registration Number:
Other) state

I declare that the information given above is correct to the best of my knowledge and
belief and any misrepresentation can void the application.

Agent’s Signature __________________________ Date:_____________________

I declare that the information given above has been verified by original documents to
ensure the veracity of the information given

_______________________________________ ____________________
Signature of CSR/Compliance Date

NB: The following documents are require for processing of your transaction

 Power of Attorney or a letter duly notarised (where application submitted by an agent).


 Proof of Address
 Picture identification (customer and agent, where applicable)
 TRN (if a driver’s licence is not being used)

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