KNOW YOUR CUSTOMER (KYC)

KNOW YOUR CUSTOMER (KYC)

Filling Station KYC Form

SECTION A: GENERAL INFORMATION

Instructions:
· This form should be completed in BLOCK LETTERS.
· All fields are mandatory unless stated otherwise.
· Section C (Declaration) should be completed by all categories of customers.
· Attach all required supporting documents as per the checklist in Section D.

 (To be completed by all applicants)

COMPANY DETAILS

DETAILS COMPANY OWNER/DIRECTORS 1

DETAILS COMPANY OWNER/DIRECTORS 2

FINANCIAL INFORMATION 1

FINANCIAL INFORMATION 2 (If More Than Two)

FINANCIAL INFORMATION 3 (Alternative Source of Funding)

REFERRAK DETAILS (Staff or Existing Company)

SECTION B: RETAILER ADDITIONAL INFORMATION

(Retail Stations Only)

BUSINESS ASSETS (For RORO Stations Only)

TANK DETAILS

Products (PMS, AGO, DPK)

Manufacturer

Capacity (Liters)

Status (Active)

PUMP DETAILS

Manufacturer 

Model

Serial Number

Status (Active?)

Products (PMS, AGO, DPK0

No Of Nozzles

DETAILS OF NEXT OF KIN//EMERGENCY CONTACT

DETAILS OF GUARANTOR 1

DETAILS OF GUARANTOR 2

SECTION D: DECLARATION

(To be completed by all applicants)

RELIABLE ENERGY, UNLIMITED POSSIBLITIES                    

RELIABLE ENERGY, UNLIMITED POSSIBLITIES