Imprest Retirement Form

FORM ID: CDS/FORM/02C
APPLICATION TO OPEN A CDS SECURITIES ACCOUNT
(To be submitted in duplicate and delivered to the Manager Domestic Markets)
Manager Domestic Markets
Bank of Tanzania
P.O. Box 2939
Dar es Salaam
Date: …………..…………………
I / We hereby apply to open a CDS securities account with the following details which I/We
confirm to be correct.
1. APPLICANTS DETAILS
MINOR ACCOUNT DETAILS
NAME OF ACCOUNT
CDS ID (if exists)
Date of Birth (DD-MM-YYYY)
GUARDIAN DETAILS
A
Name
B
Relationship
C
Postal Address
D
Physical Address
E
Fax
F
E-mail
G
TIN# & Place of Issue
H
Nationality
I
Residence
CDS ID (if exists)
J
Tax Status (If exempted provide
K
evidence)
Passport # & Place of Issue
L
Expiry Date (DD-MM-YYYY)
M Voter ID #
N
Driving License #
O
National ID #
P
Occupation
Q
Employer
R
Employment ID #
S
Date of Birth (DD-MM-YYYY)
T
Mobile No.
Not Exempted
Exempted
2. SETTLEMENT BANK DETAILS
BANK DETAILS
A
B
C
D
E
F
G
H
*NB:
Bank Name
Branch Name
Account No.*
Name of Account*
Address
Telephone
Fax
E-mail
The Account Number and Account Name shall be that of the Minor and shall correspond.
3. PERSONS AUTHORIZED TO OPERATE THE CDS SECURITIES ACCOUNT
NAME OF AUTHORIZED SIGNATORY
Surname
First name
SPECIMEN
SIGNATURE
Middle name
A
B
C
D
4. CATEGORY OF THE CDS SECURITIES ACCOUNT HOLDER
Please use the category of the account holder indicated as annex of this application (annex to CDS
form 2) that best describes the applicant to complete this section.
_________________________
Category of Account Holder
_____________________
Class
5. MANDATE FOR OPERATING CDS SECURITY ACCOUNT
I / We hereby agree to operate a CDS securities account in accordance with the rules prescribed in the
Central Depository System Dealing Agreement and the Central Depository System Rules and
Operational Guidelines; and request you to honor any instructions bearing signature(s) provided above
(and on your specimen signature cards).
____________________
Authorized Signature
_________________
Authorized Signature
Annex to CDS Form 2
Account Holder Categories Information Sheet
Category of Account holder
1.
Bank of Tanzania
2.
Government Agencies
3.
Banks
4.
Trust Companies
5.
Insurance Companies
6.
Other Financial Institutions
7.
Market Intermediaries
8.
Individuals
9.
Others
Class
BOT Open Market Operations
BOT Special Funds
Central Government
Government of Zanzibar
Local Governments
Parastatals
Non-Banks Financial Institution
Regional Banks
Community Banks
Deposit Money Banks
Pensions Funds
Provident Funds
Unit Trust
Social Security Regulatory Authority
Commissioner of Insurance
Insurance Company
Insurance Broker
Credit Institution
Bureau De Change
Authorized Dealer
Capital Markets and Securities Authority
Dar es salaam Stock Exchange
Mortgage Finance Company
Broker
Individual
Joint
Minor
Manufacturing Firm
Commercial Enterprise
Non-Government Organization (NGO)
Social Group
Religious Group
Educational Group
Micro-Finance Institution
Co-operative
Other Official Entities
Medical Health Schemes
Professional Organization
Health Institution
Attachment to CDS Form 02
SPECIMEN SIGNATURE CARD
(To be submitted in duplicate and delivered to the Manager Domestic Markets)
AFFIX
PHOTOGRAPH 1
HERE
Manager Domestic Markets
Bank of Tanzania
Date: ………………….
I the undersigned hereby request to open a CDS securities account in the
name…………………………………………..
Address…………………………………………
Telephone.………………………………………..
Fax.…………………………………………….
Email.…………………………………………...
AFFIX
PHOTOGRAPH 2
HERE
I/ We hereunder agree to conform to the rules governing the CDS securities
account within the Central Depository System Dealing Service.
The specimen signature(s) for person(s) who may be given the mandate to
sign on my behalf are:
SIGNATORIES:
FULL NAME
AFFIX
PHOTOGRAPH 3
HERE
SIGNATURE
1.
2.
3.
4.
The specimen card is returned herewith by the applicant of the CDS
securities account indicated on CDS Form 02
Yours faithfully ,………………………………………………………(Full Name)
AFFIX
PHOTOGRAPH 4
HERE
……………………………………………………….…(Signature)
For Central Depository Participant Official Use Only
Originated By: ______________________ Sign________________ Date_________________
Verified By: _________________________Sign________________ Date_________________
Approved By: _______________________ Sign________________ Date_________________
Central Depository Participant CDS ID: ……………………………………………………………
Central Depository Participant CDS SEC. A/C: …………………………………………………..
Remarks: _____________________________________________________________