PERSONAL ACCOUNTS Application Form

PERSONAL ACCOUNTS Application Form

PERSONAL ACCOUNT Application Form I/We hereby apply to open the following account and undertake to read, comply, observe and be bound by the terms and conditions that have been displayed at any of First Community Bank s banking halls and at the First Community Bank s official website http://www.firstcommunitybank.co.ke or upon request of a copy of the terms and conditions for my/our records. Branch: Date: D D M M Y Y Y Y SECTION A PERSONAL DETAILS (Please Tick appropriate box) Status: Single Joint Minor National ID/Passport No. Visa Expiry Date: D D M M Y Y Y Y Title: Mr. Mrs Ms: Other First Name: Middle Name: Surname Other P.O. Box Code PIN (specify) Nationality /City/County Country Date of birth D D M M Y Y Y Y Home Tel Mobile Place of residence Country of residence Place of birth Gender Male Female Education Level Post Graduate Graduate Diploma Marital Status: Single Married Other Certificate High School Other No. Of Children 5-18yrs Above 18 0-4 yrs Are you an American citizen? Next of Kin Relationship Yes No Account Signatory Yes No 1. Bank, Branch 2. Bank, Branch SOURCE OF INCOME a) Employed Date of Employment Gross Monthly Salary Occupation/Profession Designation/Position Nature of Employer(Sector) b) Self-Employed Nature of Business Employers Name Employers Address Office email Monthly Income/Turnover Business Location Version: 2019 Page 1 of 6 First Community Bank is regulated by the Central Bank of Kenya

SECTION B PERSONAL DETAILS (Please Tick appropriate box) To be filled for joint account Status: Single Joint National ID/Passport No. Visa Expiry Date: D D M M Y Y Y Y Title: Mr. Mrs Ms: Other First Name: Middle Name: Surname Other P.O. Box Code PIN (specify) Nationality /City/County Country Date of birth D D M M Y Y Y Y Home Tel Mobile Place of residence Country of residence Place of birth Gender Male Female Education Level Post Graduate Graduate Diploma Marital Status: Single Married Other Certificate High School Other No. Of Children 5-18yrs Above 18 0-4 yrs Are you an American citizen? Next of Kin Relationship Yes No Account Signatory Yes No 1. Bank, Branch 2. Bank, Branch SOURCE OF INCOME a) Employed Date of Employment Gross Monthly Salary Occupation/Profession Designation/Position Nature of Employer(Sector) b) Self-Employed Nature of Business Employers Name Employers Address Office email Monthly Income/Turnover Business Location How did you hear about FCB? Staff Existing Customer Media Channels (Radio, TV, Internet, Social Media) Others (Please Specify) Version: 2019 Page 2 of 6 First Community Bank is regulated by the Central Bank of Kenya

SECTION C PERSONAL DETAILS (Please Tick appropriate box) To be filled for joint account Status: Single Joint National ID/Passport No. Visa Expiry Date: D D M M Y Y Y Y Title: Mr. Mrs Ms: Other First Name: Middle Name: Surname Other P.O. Box Code PIN (specify) Nationality /City/County Country Date of birth D D M M Y Y Y Y Home Tel Mobile Place of residence Country of residence Place of birth Gender Male Female Education Level Post Graduate Graduate Diploma Marital Status: Single Married Other Certificate High School Other No. Of Children 5-18yrs Above 18 0-4 yrs Are you an American citizen? Next of Kin Relationship Yes No Account Signatory Yes No 1. Bank, Branch 2. Bank, Branch SOURCE OF INCOME a) Employed Date of Employment Gross Monthly Salary Occupation/Profession Designation/Position Nature of Employer(Sector) b) Self-Employed Nature of Business Employers Name Employers Address Office email Monthly Income/Turnover Business Location How did you hear about FCB? Staff Existing Customer Media Channels (Radio, TV, Internet, Social Media) Others (Please Specify) Version: 2019 Page 3 of 6 First Community Bank is regulated by the Central Bank of Kenya

SECTION D Young Community Savers Account (please fill the following details for the minor/child) First Name Middle Name Surname Birth Certificate Number Date of birth D D M M Y Y Y Y SECTION E Products details (to be filled by new and existing customers) I wish to apply for: (Product) - (Please Tick appropriate box) Standard Account Alpha Busara Savings Check Plus Invest Plus (Fixed Maturity) Labbeyk Savings Lulu Lulu Plus Personal Current Sahlah Salary Students Ufanisi Binafsi Umma Foreign Currency Other / Specify Exclusive Banking Products Elegant Elite Foreign Currency Club Currency KSH USD GBP EUR Additional Account Services I wish to apply for a Cheque book Number of Leaves 25 50 100 Debit Card Internet Banking (Fill in separate form) Mobile Banking Sms Alert Phone No. Email for Statement Delivery Income Details Average deposits expected Please state source of funds Mandate Authority or Account Mandate (Tick as Appropriate for Joint Accounts): Singly All Customer Declaration(to be filled by all customers) By signing hereunder, I/We unequivocally agree and accept: a) To open an account in my/our name/company name and authorize you to undertake any enquiries necessary in connection with this application. b) This mandate and agreement. c) That you may make credit reference and other enquiries about me/us now and at any other time in future for the purpose of considering and requests for services and/or credit facilities. d) That this mandate and agreement includes the bank s terms and conditions that may be accessed in any of First Community Bank s banking halls and at First Community Bank s official website http://www.firstcommunitybank.co.ke or upon request of a copy of the terms and conditions. e) That we have read and understood the terms and conditions and agree to be bound by them. f) That the terms and conditions may be amended from time to time. g) That I / We have understood all the charges related to the Bank s products as per the Banks tariffs displayed in the Banking hall and the Banks official website Further, I / We also confirm that I / We are not exclusively engaged in any trade business or activities that is not permitted under Shariah Law and the Laws of Kenya. Version: 2019 Page 4 of 6 First Community Bank is regulated by the Central Bank of Kenya

First Signatory SPECIMEN SIGNATURE AFFIX PHOTO Name ID/Passport No. P.P Expiry Date Second Signatory SPECIMEN SIGNATURE AFFIX PHOTO Name ID/Passport No. P.P Expiry Date Third Signatory SPECIMEN SIGNATURE AFFIX PHOTO Name ID/Passport No. P.P Expiry Date For Official Use only List of Documents required/received Introduction Reference National ID/Passport Copy Passport photos PIN Certificate Blacklist Checked Cheque Book Ordered Debit Card Ordered Application Dully Filled IPRS Initial Deposit Received Kshs. Cash Cheque Transfer Marketed By RM Code Account Number Date Input by Customer Service Approved by Branch Ops. I confirm that I have checked that all the above details have been completed in accordance with KYC procedures and that relevant documents are attached. I confirm acceptance of this customer relationship with First Community Bank Limited. Branch Manager Name Date Branch stamp Here Date Version: 2019 Page 5 of 6 First Community Bank is regulated by the Central Bank of Kenya

FCB CAO DEPT. Introduction Reference National ID/Passport Copy Passport photos PIN Certificate Blacklist Checked IFRS Application Dully Filled Approved By CAO Stamp Here Date CARD CENTRE SMS Alert Registration Mobile Banking Registration Input By Approved By Segmentation Form (Please Tick appropriate box) Monthly salary of Above Kshs 400,000 or maintaining an FMA/Savings of Ksh 5 million and above Monthly salary of Between Kshs 200,000- to Ksh 399,999 or maintaining an FMA/Savings of Ksh 2 million to Ksh 4,999,999 Monthly salary of Between Kshs 100,000- to Ksh 199,999 or maintaining an FMA/Savings of Ksh 100,000 to Ksh 1,999,999 Monthly salary of Up to Kshs 99,999 or maintaining an FMA/Savings of Ksh 99,999. Version: 2019 Page 6 of 6 First Community Bank is regulated by the Central Bank of Kenya