Banking Products and Services Application Form
J00158-2013-V1-2603
Solutions for all your banking needs
Standard Chartered Bank Kenya Limited is regulated by the Central Bank of Kenya.
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Please tell us about yourself
1
Full name F
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T
M
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D
D
L
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L
Nationality
Identity document
Date of birth
D
Gender
D
M
M
Male
Y
Y
Y
S
T
Passport
National ID
Married
Single
Passport / National ID
Y
Female
Marital status
Number of dependants Education
A
Other
Number of children High School
Diploma
Undergraduate
Post-graduate
Other
Mother’s maiden name (security feature for your protection. Mandatory field for Debit and Credit Cards)
Contact details
1A
Telephone (Mobile)
Please sign to verify your Mobile number
Telephone (Office)
Mobile operator
Official email address Personal email address Mailing address
P
Preferred eStatement address
O
B
O
X
C
Official e-mail address
O
D
E
C
I
T
Y
Personal e-mail address
Employment / business details
1B
Nature of employment
Salaried
Self-employed
Employment terms
Permanent
Contract
Others
Name of employer / business Occupation / designation Employment / staff number
Contact at employer
Contract tenure
Contract expiry
Duration at current organisation
Years
NAME
Months Salary receipt date
Monthly gross income
D
D
D
D
F
L
M
M
Y
O
O
R
Y
Y
Y
Rental income
Address of employer (for salaried employees) / Address of business (for self-employed) B
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T
P
O
1C
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B
O
N
G R
X
C
O
D
O
A
D
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C
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T
Y
Residential details
Type of residence Duration at residence
Self-owned Years
Rented
Company provided
Other
Months
J00158-2013-V1-2603
Residential address
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1D
Bank details (Please indicate your Bank account details)
Account with Standard Chartered Bank (if applicable)
A
C
C
O
U
N
T
N
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M
B
E
R
Account with any other Bank
A
C
C
O
U
N
T
N
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B
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R
Name of other Bank
Branch name of the other Bank
Which solutions / products would you like to apply for?
2
Current Accounts
Solutions Home Solution: Salary Solution:
Mortgage with Credit Card and Current Account
All In One Account
Safari Savings Account
Ordinary Current Account
Safari Junior Account
Personal Loan with Current Account and Credit Card
Hifadhi Account
Diva Safari Savings Account
Diva Current Account
HomeSaver
Salary Solution Lite: Personal Loan with Current Account Easy Banking:
Savings Accounts
salary account?
Please note: Type of account and type of credit card needs to be selected Lending Products
Education Saver
Please Note: Will this be your
Credit Card with Current Account
Yes
No
Fixed Deposit
Regular Cash Corporate Covered Guaranteed
Fixed Deposit
Personal Loan
Currency Options
Auto Loan
Personal Loan
KES
USD
Mortgage
Ordinary Current Account
KES
USD
EUR
GBP
JPY
CHF
AUD
Credit Card
Safari Savings Account
KES
USD
EUR
GBP
JPY
CHF
AUD
Fixed Deposit
KES
USD
EUR
GBP
JPY
CHF
AUD
USD
EUR
GBP
JPY
CHF
AUD
Overdraft
Education Saver Please note: All Current Accounts and Solutions come with Mobile and Online Banking. Once you have selected any of the above products, please fill in the relevant product section(s) below.
2A
Fixed deposit
Deposit amount Transfer deposit from account Tenure of deposit
Call Deposit
1 month
3 months
6 months
1 Year
Other
Renewal instructions
Renew only principal amount
Renew principal plus accrued interest
Maturity instructions
Uplift and Credit to
Interest payout options
Monthly
Quarterly
Half yearly
Annually
On maturity
Credit interest to Account Number Special instructions For Joint Accounts, Joint Applicant to complete section 8 of this form.
2B
Unsecured overdraft
J00158-2013-V1-2603
Amount required Salary Account Number*
A
C
C
O
U
N
T
N
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B
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R
* For a new relationship, the Salary Account Number need not be filled in at this point in time. The overdraft will be linked to the Salary Current Account once it is opened.
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Personal loan
2C
New loan
Top up
Balance transfer
Loan amount applied
Loan duration (months)
School fees
Home improvement
Purchase
Purchase price
KES Million
Deposit paid
KES Million
Loan amount
KES Million
Re-mortgage
Amount outstanding
KES Million
Additional amount
KES Million
Loan amount
KES Million
Construction
Construction amount
KES Million
Loan amount
KES Million
Purpose of loan
Medical
Car
Other
Mortgage
2D
Equity release / Top up Loan amount Loan Tenure
KES Million
Years
Property type
Property tenure
Bungalow
Freehold
Apartment
Leasehold
Maisonette / Townhouse
Address of property to be financed (for valuation purposes) LR number
Plot number
Town
Road
Name of estate
Person to be contacted for valuation Name
Telephone
For Joint Mortgage, Joint Applicant to complete section 8 of this form.
Auto loans
2E
Purchase price
Deposit paid New Car
Type of car
Used Car Car make
Loan amount
Loan tenor (months)
Car model
Year of manufacture
Cards (Credit and / or Debit Cards as applicable)
2F
Name as it should appear on your Debit and / or Credit Card M
A
X
1
9
C
H
A
R
A
C
T
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S
Daily cash withdrawal limit that you want on your Debit Card
KES 30,000
Other KES
Credit Card repayment
Cash / cheque
Debit my account every month on the payment due date
Repayment amount
Minimum amount due
Total amount due
For Supplementary Credit Card, Supplementary Applicant to complete section 8 of this form.
3
Account operating mandates for Current, Savings and Term Deposit Accounts
J00158-2013-V1-2603
Mode of operation
Signatory for Joint Account
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Current Account
Individual
Joint
Savings Account
Individual
Joint
Fixed Deposit Account
Individual
Joint
Current Account
Any one of us
All of us
Other
Savings Account
Any one of us
All of us
Other
Fixed Deposit
Any one of us
All of us
Other
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3A
Mandate for cash covered lending products
Cash covered product applied for
Personal loan
Credit Card
Auto Loan
Overdraft
Amount applied for KES / USD Cash cover linked to Fixed Deposit Account
A
C
C
O
U
N
T
N
U
M
B
E
R
Amount held under lien
4
Please consider these valuable services
eStatements for your Current, Savings and Credit Card Accounts will be sent to your preferred e-mail address as indicated in Section 1A of the form. We will not send physical statements if you have opted for e-Statements. We will send loan statements only through email. If the frequency for receiving Bank account eStatement is not selected, then the default frequency for sending out the statements will be monthly. For physical paper statements please select below. Physical statement (Banking Account)
Yes
No
Frequency
Daily
Physical statement (Credit Cards)
Yes
No
Frequency
Monthly
Number of leaves
30
Number of cheque books required
Weekly
Monthly
50
100
Quarterly
Cheque books are issued with all Current Accounts. Cheque books are optional for Hifadhi Current Account and need to be applied for above.
Bill Payment (Applicable for Mobile Banking and ATMs) Kenya Power
A
C
C
O
U
N
T
N
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M
B
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R
Alias
Multichoice (DSTV)
A
C
C
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U
N
T
N
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Alias
5
Interest rate and fees
Product
Interest Rate
Arrangement Fee
Personal Loans (variable interest rate) Auto Loans (variable interest rate) Mortgage (variable interest rate) Mortgage (part fixed rate) Overdraft (variable interest rate) Fixed Deposit Your loan is priced off the Retail Reference Rate (KES/USD) which is the Bank’s internal benchmark rate. Please refer to our tariff guide for a more detailed and exhaustive list of fees and charges on all our products. The tariff guide is available at any of our branches. Alternatively, it is also available on our website www.standardchartered.co.ke
6
Referee details Referee 1
Referee 2 (Must be a relative)
Name (in full) Relationship with applicant
J00158-2013-V1-2603
Years acquainted with applicant Telephone (office) Telephone (mobile) Name of referee’s employer
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Declaration
7
By signing these General Terms and Conditions: • you agree that the Bank will send all correspondence in electronic form using email or any other electronic media. However, the Bank reserves the right to send paper correspondence at your last known address as per our records. • you are the ultimate beneficial owner of the account opened in relation to the minor; you do not hold the accounts or any funds in the account as a trustee, nominee, agent or other capacity. The minor has no right or interest in any funds in the account. • you represent and warrant that all information (including any documents) you have given us in connection with this application including minor accounts if applicable is correct, complete and not misleading. If this is not the case, you may be personally liable. You must notify us if you become aware that any information you have given changes, is incorrect or misleading. • you represent and warrant that you have power and all necessary authorisations to own your assets and carry on any business you conduct, to enter into each of our banking agreements and any other arrangement with us and to comply with your obligations and exercise your rights under them. • you authorise us to disclose to, and verify any of the information you have given to us or your credit standing from anyone we may consider appropriate (such as an authority or credit reference agency). • you confirm that your personal information provided in this application form and that of your joint account holder (if any) or authorised person (if any) will apply to the account(s) you hold with us unless you expressly tell us otherwise. • you consent to each of Standard Chartered Bank PLC and its subsidiaries and affiliates (including each branch or representative office) (“Standard Chartered Group”), its officers, employees, agents and advisers disclosing information relating to you (including details of our banking agreement, the accounts, the products or any arrangement with us) to our head office and any other member of the Standard Chartered Group in any jurisdiction (“permitted parties”); professional advisers, service providers (whether located in Kenya or outside Kenya) for the purposes of providing any service to you in connection with this application (including data processing), or independent contractors to, or agents of, the permitted parties, such as debt collection agencies, data processing firms and correspondents who are under a duty of confidentiality to the permitted parties, any actual or potential participant or sub-participant in relation to any of our obligations under our banking agreement between us, or assignee, novatee or transferee (or any officer, employee, agent or adviser of any of them), any credit reference agency, rating agency, business alliance partner, insurer or insurance broker of, or direct or indirect provider of credit protection to, or any permitted parties; any court, tribunal or authority (including an authority investigating an offence) with jurisdiction over the permitted parties; a merchant or member of VISA International or MasterCard International or China Union Pay where the disclosure is in connection with the use of a card; any authorised person or any security provider; anyone we consider necessary in order to provide you with the services in connection with an account. • you have read and understood or have been explained to (in the language you understand) our Customer Terms and the applicable documents referred to in Part A of our Customer Terms forming our banking agreement which are also available at any of our branches or on our website at www.standardchartered.co.ke and you agree to be bound by them. You acknowledge that you are bound by any variation we make to these documents, in accordance with our banking agreement. In particular, you understand that by entering into our banking agreement, you give indemnities, authorisations, consents and waivers and agree to limitations on our liability. • you consent to us contacting you at the address, email address and phone numbers you have provided to us, to give you information on other products and services that we, or our strategic partners, may offer. • if you are applying for a bundled product, you agree and acknowledge that we may vary or terminate the package offers or change the terms of the package by giving you notice. • you also understand that should you wish to terminate one of the bundled products, you agree that we may charge you an additional fee for the remaining product(s). • if you are applying for a bundled product which comprises insurance plans, you agree that the insurance under the plans is underwritten by our Insurance Service Provider. Our Insurance Service Provider is not our associate or subsidiary or related corporation. Our Insurance Service Provider is solely responsible for all coverage and compensation thereunder. We collect your information and send it to our Insurance Service Provider for processing and review. Collection of information does not necessarily mean that your insurance application will be approved. • you agree that the bank has the right to set off the amount held in lien against which a cash secured facility(ies) has been granted to me by the bank, in the event of default. I authorise the bank to purchase such foreign currency with the monies standing to the credit of my account(s) as may be necessary, to effect the set off and settle any outstanding on the loan facility where necessary to facilitate the offsetting of the facility in default. I agree that the lien will only be lifted upon full repayment of the facility(ies). I agree that I shall lay no claim whatsoever to the funds under lien until such time the facility is repaid in full. Signed:
______________________________________________________________________________________________________ Primary Applicant Date
Signed:
______________________________________________________________________________________________________ Secondary Applicant Date
Photographs
Specimen signatures (for Current, Savings Accounts and Fixed Deposits)
J00158-2013-V1-2603
Primary Applicant
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Joint Account / Supplementary Credit Card / Mortgage Joint Applicant details
8
Applying for:
Joint Account
Relationship with primary applicant
Spouse
Supplementary Credit Card
Mortgage
Parent
Other
Son
Daughter
Full name F
I
R
S
T
M
I
D
D
L
E
L
Nationality
Identity document
Date of birth
D
Gender
D
Male
M
M
Y
Y
Y
A
S
Passport
T
National ID
Passport / National ID
Y
Female
Marital status
Married
Single
Other
Source of funds Name as it should appear on your Debit Card / Supplementary Credit Card M
A
X
1
9
C
Supplementary Card limit
H
A
R
A
C
T
E
R
S
% of Card limit.
Mother’s maiden name (Security feature for your protection. Mandatory field for Debit and Credit Cards)
Photographs
Specimen signatures (for Secondary applicant)
Secondary / Joint Applicant
Contact details
9
Telephone (mobile)
Mobile operator
email address Mailing address
P
O
B
O
X
C
O
D
E
C
I
T
Y
Residential address
Employment / business details
10
Nature of employment
Salaried
Self-employed
Employment terms
Permanent
Contract
Others
Name of employer / business Occupation / designation Contract tenure
Contract expiry
D
D
M
M
Y
F
L
O
O
R
Y
Y
Y
Address of employer (for salaried employees) / Address of business (for self-employed)
J00158-2013-V1-2603
B
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B
O
N J00158 SCB KE CAF 2013.indd 2
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N
G R C
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A
D C
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Y
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11
For bank use only (Input as applicable for Loans and / or accounts)
A. To be filled by Sales/Branch Sales person's name
Closing ID
Sourcing ID
Signature
Referral person’s name
Referral ID
Sales/branch manager's name
Sales / branch manager's signature
B. To be filled by Branch Account Number
Relationship Number
Master Number Branch code Country of residence Segment code
Barcode For Debit Cards only
GL department ID ISIC Code Employer code (for salaried customers only) C. To be filled by Credit Initiation Approval conditions
Credit underwriter’s name
Signature & date
Credit approver’s name
Signature & date
J00158-2013-V1-2603
D. To be filled by Lending Operations (Loan Disbursement) Officer’s name
Signature & date
Manager’s name
Signature & date
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