First Name

Surname

Middle Name

Gender GenderMaleFemale

Email Address

Place of Birth

Date of Birth

Residential Address (Not P.O. Box)

Mobile Phone Number

Occupation

Drivers License/Passport No.

Employer's Name

Employer's Address

Local Government of Origin

State of Origin

Citizenship (Not Nigerian)

Next of Kin

Relation of Next of Kin

Address of Next of Kin

Address of Next of Kin

Phone Number of Next of Kin

Name of Bank

Account Name

Account Number

Declaration Declaration I Declare that all the information given for the purpose of opening account with Magnet Capitals Ltd are true and accurate.