ULTRA PAY MICROFINANCE BANK LIMITED

Application to Open an Entity Account (Incorporated & Non-Incorporated)

CONFIDENTIAL

Email Address (used as form ID)

COMPANY DETAILS (Please complete in BLOCKED LETTERS and tick where necessary)

Branch

Account No. (For official use only)

Customer ID (For official use only)

BVN/RC No.

Business Category

Entity Type

Company/Business Name

Certificate of Incorporation/Registration

Date of Incorporation/Registration

Jurisdiction of Incorporation/Registration

Type/Nature of Business

Sector/Industry

Operating Business Address 1

Operating Business Address 2

Corporate Business Address / Registered Office

Email Address

Phone Number 1

Phone Number 2

Tax Identification Number (TIN)

CBN No/Borrower's Code

SCUML Reg. No.

ANNUAL TURN OVER

Annual Turnover

Is your Company quoted on any Stock Exchange?

Yes