Central Securities Depository Company of Botswana Limited
Securities Account Opening/Update Form (CSDB 1) - Individuals
To be completed in BLOCK LETTERS Applicant Title: Forenames*: Surname*: Date of Birth*: Gender: National ID/Passport No*: Nationality*: Postal Address Line1*: Postal Address Line2: Physical Address Line3: Postal Code: Tax Code: Village/Town/City*: Country*: Resident in*: Telephone*: Fax: e-mail:
1st Joint Applicant
Title: Forenames*: Surname*: Date of Birth*: Gender: National ID/Passport No*: Nationality*: 2nd Joint Applicant Title: Forenames*: Surname*: Date of Birth*: Gender: National ID/Passport No*: Nationality*: N.B. * denotes required/mandatory fields. Completed forms must be accompanied by certified copy of ID document.
Dividend Disposal Instruction Cash or Bank
Bank Name: Branch: Account no.:
DECLARATION i. I hereby request you to open and maintain a Securities Account in the CSDB in our name(s). ii. I hereby represent and warrant that we have good title to such securities that may be held in our Securities Account from time to time. iii. I affirm that the funds to be used for the purchase of Securities through my / our Securities Account will not be funds derived from any money laundering activity or funds generated from terrorist or any other illegal activity. iv. I hereby confirm that the undersigned Participant has full authority to intermediate and or conduct business on with the Depository on our behalf in keeping with CSDB rules and procedures that may be in force from time to time. v. I agree to be bound by the CSDB rules. vi. I undertake to notify the under mentioned Participant of any change of particulars or information provided by me/us in this form.
Declaration: Approved Declined We, the undersigned undertake that we have checked the accuracy of the documents submitted with this application. Signature:…………………………………………. Checked and Verified by (Name in full):
Securities Account Number: CSDB Date stamp
Accompanying certified copy National ID or Passport Details page
