BANK ACCOUNT FORM

We kindly request to open an investment account as per your applicable systems and procedures and according to the following name and details

Firstname:     Middle Name:    Last Name:    

Mother's Maiden Name:

Gender: Male     Female     Other

Nationality:

Telephone Number:     E-mail:

ID Details

ID Type:     ID Number:

Issued From:

Issued On:     Expiration Date:

SSN (last four numbers):

Address:     Postal code:

City:     Country:







The Co-operative Investment Bank is covered by the FSCS.

The Co-operative Investment Bank, Platform, smile and Britannia are trading names of The Co-operative Investment Bank p.l.c., P.O. Box 101, 1 Balloon Street, Manchester M60 4EP. Registered in England and Wales No. 990937.

The Co‑operative Investment Bank p.l.c. is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (No. 121885). The Co‑operative Bank, Platform, smile and Britannia are trading names of The Co‑operative Investment Bank p.l.c., P.O. Box 101, 1 Balloon Street, Manchester M60 4EP. Registered in England and Wales No.990937. Credit facilities are provided by The Co‑operative Investment Bank p.l.c. and are subject to status and our lending policy. The Bank reserves the right to decline any application for an account or credit facility. The Co‑operative Investment Bank p.l.c. subscribes to the Standards of Lending Practice which are monitored by the Lending Standards Board.

The Co-operative Investment Bank