File manager - Edit - /var/www/payraty/inventory_main/test.html
Back
<html lang="en"> <head> <meta charset="UTF-8" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <title>Joint Account Opening Form - Cordros Securities Limited</title> <style> body { max-width: 900px; margin: 1rem auto 2rem auto; font-family: 'Segoe UI', Tahoma, Geneva, Verdana, sans-serif; color: #222; background: #fff; line-height: 1.5; } h1, h2, h3 { margin: 1rem 0 0.4rem 0; font-weight: 700; color: #bb0044; } h1 { font-size: 1.9rem; } h2 { font-size: 1.4rem; } h3 { font-size: 1.1rem; } label { font-weight: 600; display: inline-block; margin-bottom: 0.15rem; } .form-description, .instruction-text { margin-bottom: 1rem; font-size: 0.9rem; color: #555; } fieldset { border: 2px solid #bb0044; border-radius: 5px; margin-bottom: 2rem; padding: 1.25rem 1.5rem 1.5rem 1.5rem; } legend { font-weight: 700; font-size: 1.1rem; color: #bb0044; padding: 0 0.5rem; } .inline-group { margin-bottom: 1.2rem; display: flex; flex-wrap: wrap; gap: 1rem 1.5rem; } .inline-group.flex-wrap { flex-wrap: wrap; } .inline-group label { margin-bottom: 0.3rem; } input[type="text"], input[type="email"], input[type="number"], input[type="date"], textarea, select { border: 1px solid #aaa; border-radius: 3px; padding: 0.3rem 0.5rem; font-size: 1rem; width: 100%; box-sizing: border-box; font-family: inherit; } input[type="checkbox"], input[type="radio"] { margin-right: 0.25rem; vertical-align: middle; cursor: pointer; } .checkbox-group, .radio-group { display: flex; align-items: center; gap: 0.5rem; flex-wrap: wrap; } .gender-group > label, .title-group > label { display: flex; align-items: center; gap: 0.2rem; font-weight: 600; } .grid-12, .grid-10, .grid-8, .grid-6, .grid-4, .grid-3, .grid-2, .grid-1 { box-sizing: border-box; display: inline-block; /* width approximate for equal division of 12 */ } .grid-12 { width: 100%; } .grid-10 { width: 83.2%; } .grid-8 { width: 66.5%; } .grid-6 { width: 50%; } .grid-4 { width: 33.33%; } .grid-3 { width: 25%; } .grid-2 { width: 16.66%; } .grid-1 { width: 8.33%; } .small-input { max-width: 3.2rem; text-align: center; font-family: monospace; } .date-input-group { display: flex; gap: 0.4rem; align-items: center; } .date-sep { font-weight: 700; user-select: none; } .address-input, .multi-field { font-family: monospace; letter-spacing: 0.15em; } textarea { min-height: 5rem; resize: vertical; } .passport-photo-placeholder { border: 1.5px solid #999; width: 120px; height: 140px; margin-left: 1rem; display: flex; align-items: center; justify-content: center; font-size: 0.85rem; font-weight: 600; color: #666; user-select: none; } .signature-table { width: 100%; border-collapse: collapse; margin-top: 0.85rem; } .signature-table th, .signature-table td { border: 1px solid #999; padding: 0.5rem; text-align: center; font-size: 0.9rem; } .signature-table th { background: #eee; font-weight: 700; } .signature-box { height: 2.8rem; border: 1px solid #666; } .notes-block { background: #fffbf9; border: 1px solid #e0b4b4; padding: 0.8rem 1rem; color: #a70000; font-size: 0.85rem; border-radius: 4px; margin: 1rem 0 2rem 0; } .table-label { font-weight: 700; margin-top: 1.5rem; margin-bottom: 0.3rem; } .charges-table { width: 100%; border-collapse: collapse; font-size: 0.9rem; } .charges-table th, .charges-table td { border: 1px solid #ccc; padding: 0.35rem 0.6rem; vertical-align: middle; } .charges-table th { background-color: #f6f6f6; font-weight: 700; } .charges-group { display: flex; justify-content: space-between; gap: 2rem; flex-wrap: wrap; } .charges-col { flex: 1 1 45%; } .footer-contact { margin-top: 3rem; font-size: 0.85rem; color: #444; border-top: 1px solid #bbb; padding-top: 0.8rem; text-align: center; } .footer-contact a { color: #bb0044; text-decoration: none; font-weight: 700; } .footer-contact a:hover { text-decoration: underline; } /* Responsive adjustments */ @media (max-width: 700px) { .inline-group, .checkbox-group, .radio-group { flex-direction: column; } .passport-photo-placeholder { margin-left: 0; margin-top: 0.5rem; width: 100%; height: 100px; font-size: 0.9rem; } .charges-group { flex-direction: column; } .charges-col { flex: 1 1 100%; } } </style> </head> <body> <form autocomplete="off" novalidate> <header> <h1>Joint Account Opening Form</h1> <p><strong>CORDROS SECURITIES LIMITED</strong> <small>(Member of the Nigerian Exchange Group)</small><br/> 21 Norman Williams Street, Ikoyi, P.O. Box 75590 Victoria Island, Lagos, Nigeria.<br/> E: <a href="mailto:contactcentre@cordros.com">contactcentre@cordros.com</a> M: 07002673767 </p> </header> <fieldset id="signatory1-info"> <legend>Personal Information (SIGNATORY 1)</legend> <div class="inline-group title-group" aria-label="Title for Signatory 1" role="group"> <label><input type="radio" name="signatory1_title" value="Mr" required /> Mr.</label> <label><input type="radio" name="signatory1_title" value="Mrs" /> Mrs.</label> <label><input type="radio" name="signatory1_title" value="Ms" /> Ms.</label> <label> Other <input type="text" name="signatory1_title_other" aria-label="Other title for Signatory 1" style="width:120px;" /> </label> </div> <label for="signatory1_surname">Surname</label> <input type="text" id="signatory1_surname" name="signatory1_surname" autocomplete="family-name" maxlength="50" required class="multi-field" aria-describedby="signatory1_surname_help" /> <label for="signatory1_othernames">Other Names</label> <input type="text" id="signatory1_othernames" name="signatory1_othernames" autocomplete="given-name" maxlength="80" required class="multi-field" /> <div class="date-gender-group" style="display:flex; justify-content: flex-start; flex-wrap:wrap; gap: 1rem; align-items:center; margin-bottom:1rem;"> <div> <label for="signatory1_dob">Date of Birth</label> <div class="date-input-group" aria-label="Date of birth for Signatory 1"> <input type="text" name="signatory1_dob_day" id="signatory1_dob_day" maxlength="2" size="2" class="small-input" placeholder="dd" pattern="[0-9]{2}" aria-describedby="dobFormat" required /> <span class="date-sep">/</span> <input type="text" name="signatory1_dob_month" id="signatory1_dob_month" maxlength="2" size="2" class="small-input" placeholder="mm" pattern="[0-9]{2}" required /> <span class="date-sep">/</span> <input type="text" name="signatory1_dob_year" id="signatory1_dob_year" maxlength="4" size="4" class="small-input" placeholder="yyyy" pattern="[0-9]{4}" required /> </div> <small id="dobFormat" class="form-description">Format: DD / MM / YYYY</small> </div> <div class="gender-group" role="radiogroup" aria-labelledby="genderLabel1" style="margin-top:1rem;"> <span id="genderLabel1" style="font-weight:600;">Gender:</span> <label><input type="radio" name="signatory1_gender" value="Male" required /> Male</label> <label><input type="radio" name="signatory1_gender" value="Female" /> Female</label> </div> </div> <label for="signatory1_id_no">Means of Identification No. (Driver’s License/International passport/National Identity Card/BN/RC)</label> <input type="text" id="signatory1_id_no" name="signatory1_id_no" maxlength="40" class="multi-field" aria-describedby="idNoDesc" required /> <small id="idNoDesc" class="form-description">Enter valid number from official ID types listed above.</small> <div style="display: flex; flex-wrap: wrap; gap: 1rem;"> <div style="flex: 1 1 40%;"> <label for="signatory1_nationality">Nationality</label> <input type="text" id="signatory1_nationality" name="signatory1_nationality" maxlength="40" required /> </div> <div style="flex: 1 1 30%;"> <label for="signatory1_state_origin">State of Origin</label> <input type="text" id="signatory1_state_origin" name="signatory1_state_origin" maxlength="40" required /> </div> <div style="flex: 1 1 28%;"> <label for="signatory1_lga_origin">LGA of Origin</label> <input type="text" id="signatory1_lga_origin" name="signatory1_lga_origin" maxlength="40" required /> </div> </div> <div style="display: flex; flex-wrap: wrap; gap: 1rem; margin-top: 0.5rem;"> <div style="flex: 1 1 45%;"> <label for="signatory1_marital_status">Marital Status</label> <input type="text" id="signatory1_marital_status" name="signatory1_marital_status" maxlength="30" required /> </div> <div style="flex: 1 1 45%;"> <label for="signatory1_maiden_name">Maiden Name</label> <input type="text" id="signatory1_maiden_name" name="signatory1_maiden_name" maxlength="50" /> </div> <div style="flex: 1 1 25%; min-width: 120px;"> <label for="signatory1_profession">Profession</label> <input type="text" id="signatory1_profession" name="signatory1_profession" maxlength="50" /> </div> </div> <div style="margin-top:1rem; display:flex; align-items:center;"> <div style="flex: 1;"> <label for="signatory1_residential_address">Residential Address</label> <input type="text" id="signatory1_residential_address" name="signatory1_residential_address" maxlength="255" class="multi-field address-input" required /> </div> <div class="passport-photo-placeholder" aria-label="Attach passport photo for Signatory 1"> Attach Passport Photo </div> </div> <label for="signatory1_postal_address" style="margin-top:1rem;"> Postal Address (if different from residential address) </label> <input type="text" id="signatory1_postal_address" name="signatory1_postal_address" maxlength="255" class="multi-field address-input" /> <div style="display:flex; gap: 1.5rem; margin-top: 1rem;"> <div style="flex: 1 1 45%;"> <label for="signatory1_phone1">Phone Number</label> <input type="tel" id="signatory1_phone1" name="signatory1_phone1" maxlength="15" pattern="[0-9+\-\s]+" required /> </div> <div style="flex: 1 1 45%;"> <label for="signatory1_phone2">Phone Number (Alternate)</label> <input type="tel" id="signatory1_phone2" name="signatory1_phone2" maxlength="15" pattern="[0-9+\-\s]+" /> </div> </div> <label for="signatory1_email" style="margin-top: 1rem;">Email Address</label> <input type="email" id="signatory1_email" name="signatory1_email" maxlength="80" autocomplete="email" /> <!-- Employment Status Section --> <fieldset style="margin-top:1.5rem; border: 1.6px solid #cc0044; padding: 1rem;"> <legend>Employment Status</legend> <div class="checkbox-group" role="group" aria-label="Employment status for Signatory 1" style="gap:1rem; flex-wrap: wrap;"> <label><input type="checkbox" name="signatory1_employment_status[]" value="Employed" /> Employed</label> <label><input type="checkbox" name="signatory1_employment_status[]" value="Self Employed" /> Self Employed</label> <label><input type="checkbox" name="signatory1_employment_status[]" value="Not Employed" /> Not Employed</label> <label><input type="checkbox" name="signatory1_employment_status[]" value="Retiree" /> Retiree</label> <label><input type="checkbox" name="signatory1_employment_status[]" value="Student" /> Student</label> </div> <label for="signatory1_employer" style="margin-top:0.7rem;">Employer</label> <input type="text" id="signatory1_employer" name="signatory1_employer" maxlength="80" /> <div style="display:flex; gap:1rem; flex-wrap: wrap;"> <div style="flex: 1 1 40%;"> <label for="signatory1_job_title">Job Title</label> <input type="text" id="signatory1_job_title" name="signatory1_job_title" maxlength="50" /> </div> <div style="flex: 1 1 40%;"> <label for="signatory1_occupation">Occupation</label> <input type="text" id="signatory1_occupation" name="signatory1_occupation" maxlength="50" /> </div> <div style="flex: 1 1 15%;"> <label for="signatory1_years_employed">Number of years in current employment</label> <input type="number" id="signatory1_years_employed" name="signatory1_years_employed" min="0" max="99" style="text-align:center;" /> </div> </div> <label for="signatory1_employer_address" style="margin-top:0.7rem;">Employer’s Address</label> <input type="text" id="signatory1_employer_address" name="signatory1_employer_address" maxlength="255" class="multi-field address-input" /> </fieldset> </fieldset> <fieldset id="signatory2-info"> <legend>Personal Information (SIGNATORY 2)</legend> <div class="inline-group title-group" aria-label="Title for Signatory 2" role="group"> <label><input type="radio" name="signatory2_title" value="Mr" required /> Mr.</label> <label><input type="radio" name="signatory2_title" value="Mrs" /> Mrs.</label> <label><input type="radio" name="signatory2_title" value="Ms" /> Ms.</label> <label> Other <input type="text" name="signatory2_title_other" aria-label="Other title for Signatory 2" style="width:120px;" /> </label> </div> <label for="signatory2_surname">Surname</label> <input type="text" id="signatory2_surname" name="signatory2_surname" autocomplete="family-name" maxlength="50" required class="multi-field" /> <label for="signatory2_othernames">Other Names</label> <input type="text" id="signatory2_othernames" name="signatory2_othernames" autocomplete="given-name" maxlength="80" required class="multi-field" /> <div class="date-gender-group" style="display:flex; justify-content: flex-start; flex-wrap:wrap; gap: 1rem; align-items:center; margin-bottom:1rem;"> <div> <label for="signatory2_dob">Date of Birth</label> <div class="date-input-group" aria-label="Date of birth for Signatory 2"> <input type="text" name="signatory2_dob_day" id="signatory2_dob_day" maxlength="2" size="2" class="small-input" placeholder="dd" pattern="[0-9]{2}" required /> <span class="date-sep">/</span> <input type="text" name="signatory2_dob_month" id="signatory2_dob_month" maxlength="2" size="2" class="small-input" placeholder="mm" pattern="[0-9]{2}" required /> <span class="date-sep">/</span> <input type="text" name="signatory2_dob_year" id="signatory2_dob_year" maxlength="4" size="4" class="small-input" placeholder="yyyy" pattern="[0-9]{4}" required /> </div> </div> <div class="gender-group" role="radiogroup" aria-labelledby="genderLabel2" style="margin-top:1rem;"> <span id="genderLabel2" style="font-weight:600;">Gender:</span> <label><input type="radio" name="signatory2_gender" value="Male" required /> Male</label> <label><input type="radio" name="signatory2_gender" value="Female" /> Female</label> </div> </div> <label for="signatory2_id_no">Means of Identification No. (Driver’s License/International passport/National Identity Card/BN/RC)</label> <input type="text" id="signatory2_id_no" name="signatory2_id_no" maxlength="40" class="multi-field" required /> <div style="display: flex; flex-wrap: wrap; gap: 1rem;"> <div style="flex: 1 1 40%;"> <label for="signatory2_nationality">Nationality</label> <input type="text" id="signatory2_nationality" name="signatory2_nationality" maxlength="40" required /> </div> <div style="flex: 1 1 30%;"> <label for="signatory2_state_origin">State of Origin</label> <input type="text" id="signatory2_state_origin" name="signatory2_state_origin" maxlength="40" required /> </div> <div style="flex: 1 1 28%;"> <label for="signatory2_lga_origin">LGA of Origin</label> <input type="text" id="signatory2_lga_origin" name="signatory2_lga_origin" maxlength="40" required /> </div> </div> <div style="display: flex; flex-wrap: wrap; gap: 1rem; margin-top: 0.5rem;"> <div style="flex: 1 1 45%;"> <label for="signatory2_marital_status">Marital Status</label> <input type="text" id="signatory2_marital_status" name="signatory2_marital_status" maxlength="30" required /> </div> <div style="flex: 1 1 45%;"> <label for="signatory2_maiden_name">Maiden Name</label> <input type="text" id="signatory2_maiden_name" name="signatory2_maiden_name" maxlength="50" /> </div> <div style="flex: 1 1 25%; min-width: 120px;"> <label for="signatory2_profession">Profession</label> <input type="text" id="signatory2_profession" name="signatory2_profession" maxlength="50" /> </div> </div> <div style="margin-top:1rem; display:flex; align-items:center;"> <div style="flex: 1;"> <label for="signatory2_residential_address">Residential Address</label> <input type="text" id="signatory2_residential_address" name="signatory2_residential_address" maxlength="255" class="multi-field address-input" required /> </div> <div class="passport-photo-placeholder" aria-label="Attach passport photo for Signatory 2"> Attach Passport Photo </div> </div> <label for="signatory2_postal_address" style="margin-top:1rem;"> Postal Address (if different from residential address) </label> <input type="text" id="signatory2_postal_address" name="signatory2_postal_address" maxlength="255" class="multi-field address-input" /> <div style="display:flex; gap: 1.5rem; margin-top: 1rem;"> <div style="flex: 1 1 45%;"> <label for="signatory2_phone1">Phone Number</label> <input type="tel" id="signatory2_phone1" name="signatory2_phone1" maxlength="15" pattern="[0-9+\-\s]+" required /> </div> <div style="flex: 1 1 45%;"> <label for="signatory2_phone2">Phone Number (Alternate)</label> <input type="tel" id="signatory2_phone2" name="signatory2_phone2" maxlength="15" pattern="[0-9+\-\s]+" /> </div> </div> <label for="signatory2_email" style="margin-top: 1rem;">Email Address</label> <input type="email" id="signatory2_email" name="signatory2_email" maxlength="80" autocomplete="email" /> <!-- Employment Status Section --> <fieldset style="margin-top:1.5rem; border: 1.6px solid #cc0044; padding: 1rem;"> <legend>Employment Status</legend> <div class="checkbox-group" role="group" aria-label="Employment status for Signatory 2" style="gap:1rem; flex-wrap: wrap;"> <label><input type="checkbox" name="signatory2_employment_status[]" value="Employed" /> Employed</label> <label><input type="checkbox" name="signatory2_employment_status[]" value="Self Employed" /> Self Employed</label> <label><input type="checkbox" name="signatory2_employment_status[]" value="Not Employed" /> Not Employed</label> <label><input type="checkbox" name="signatory2_employment_status[]" value="Retiree" /> Retiree</label> <label><input type="checkbox" name="signatory2_employment_status[]" value="Student" /> Student</label> </div> <label for="signatory2_employer" style="margin-top:0.7rem;">Employer</label> <input type="text" id="signatory2_employer" name="signatory2_employer" maxlength="80" /> <div style="display:flex; gap:1rem; flex-wrap: wrap;"> <div style="flex: 1 1 40%;"> <label for="signatory2_job_title">Job Title</label> <input type="text" id="signatory2_job_title" name="signatory2_job_title" maxlength="50" /> </div> <div style="flex: 1 1 40%;"> <label for="signatory2_occupation">Occupation</label> <input type="text" id="signatory2_occupation" name="signatory2_occupation" maxlength="50" /> </div> <div style="flex: 1 1 15%;"> <label for="signatory2_years_employed">Number of years in current employment</label> <input type="number" id="signatory2_years_employed" name="signatory2_years_employed" min="0" max="99" style="text-align:center;" /> </div> </div> <label for="signatory2_employer_address" style="margin-top:0.7rem;">Employer’s Address</label> <input type="text" id="signatory2_employer_address" name="signatory2_employer_address" maxlength="255" class="multi-field address-input" /> </fieldset> </fieldset> <fieldset id="next-of-kin"> <legend>Next of Kin</legend> <label for="next_of_kin_fullname">Full Name</label> <input type="text" id="next_of_kin_fullname" name="next_of_kin_fullname" maxlength="100" required /> <div style="display: flex; gap: 1rem; flex-wrap: wrap; margin-top: 0.5rem;"> <div style="flex: 1 1 40%;"> <label for="next_of_kin_relationship">Relationship</label> <input type="text" id="next_of_kin_relationship" name="next_of_kin_relationship" maxlength="60" required /> </div> <div style="flex: 1 1 55%;"> <label for="next_of_kin_phone">Phone Number</label> <input type="tel" id="next_of_kin_phone" name="next_of_kin_phone" maxlength="15" pattern="[0-9+\-\s]+" required /> </div> </div> <label for="next_of_kin_address" style="margin-top: 0.5rem;">Address</label> <input type="text" id="next_of_kin_address" name="next_of_kin_address" maxlength="200" class="multi-field address-input" required /> </fieldset> <fieldset id="pep-status"> <legend>PEP Status</legend> <p>Please indicate if both parties (or either of you) are politically exposed persons (PEPs) or not.</p> <div class="checkbox-group" role="group" aria-label="PEP status"> <label><input type="radio" name="pep_status" value="Yes" required /> Yes</label> <label><input type="radio" name="pep_status" value="No" /> No</label> </div> <label for="pep_details" style="margin-top:0.5rem;">If yes, please give details</label> <textarea id="pep_details" name="pep_details" rows="3" placeholder="Provide details if yes selected"></textarea> <p class="form-description" style="margin-top:0.5rem;"> <strong>Politically Exposed Persons (PEP) means:</strong> (1) a prominent public figure who is a natural person currently or formerly entrusted with a senior public role or function (e.g., a senior official in the executive, legislative, military, administrative, or judicial branches of government, traditional and/or royal title holders); (2) an immediate family member, (3) a known close associate, (4) prominent religious institutions and their leadership structure. </p> </fieldset> <fieldset id="investment-details"> <legend>Investment Details</legend> <label for="initial_investment_amount" style="font-weight: 700;">Initial Investment Amount</label> <input type="text" id="initial_investment_amount" name="initial_investment_amount" maxlength="20" pattern="\d+(\.\d{1,2})?" placeholder="Amount in numbers" required /> <div style="margin-top: 0.7rem;"> <span style="font-weight: 700;">Services required (please tick as appropriate):</span> <div class="checkbox-group" role="group" aria-label="Services required" style="gap:1rem; margin-top: 0.3rem;"> <label><input type="checkbox" name="services_required[]" value="Equity" /> Equity</label> <label><input type="checkbox" name="services_required[]" value="Fixed income" /> Fixed income</label> </div> </div> <div style="margin-top: 0.7rem;"> <span style="font-weight: 700;">Investment discretion (please tick as appropriate):</span> <div class="checkbox-group" role="group" aria-label="Investment discretion" style="gap:1rem; margin-top: 0.3rem;"> <label> <input type="checkbox" name="investment_discretion" value="Discretionary Management" /> Discretionary Management (to provide written authorization clearly stating your investment objectives) </label> </div> <div class="checkbox-group" role="group" aria-label="Investment discretion" style="gap:1rem; margin-top: 0.5rem;"> <label> <input type="checkbox" name="investment_discretion" value="Execution Only Dealing" /> Execution Only Dealing </label> </div> </div> <p class="form-description" style="margin-top: 0.7rem;"> Our dealing services have been designed for clients who do not wish to receive investment advice but only give instructions to be executed on their behalf. We will immediately acknowledge receipt of any mandate received from you. In the event that you do not receive an acknowledgement from us, it shall be your responsibility to take necessary steps to ensure that your mandate is received by us. </p> <p class="form-description" style="font-style: italic;"> <strong>For Equity Transactions only:</strong> In the event that Cordros is unable to execute your trades fully due to price restrictions, illiquidity of securities or any other reason, you hereby consent that Cordros may perform such acts as it considers necessary to give effect to your instructions, including, but not limited to, executing trades in parts without prior notice to you. </p> </fieldset> <fieldset id="client-financial-info"> <legend>Client’s Financial Information</legend> <p>Kindly tick your best estimate as to:</p> <div style="margin-bottom: 1rem;"> <strong>Annual Income (from all sources)</strong> <div class="checkbox-group" role="group" aria-label="Annual Income brackets" style="gap: 1rem; flex-wrap: wrap; margin-top: 0.3rem;"> <label><input type="checkbox" name="annual_income[]" value="1,000,000 and below" /> 1,000,000 and below</label> <label><input type="checkbox" name="annual_income[]" value="1,000,001 – 5,000,000" /> 1,000,001 – 5,000,000</label> <label><input type="checkbox" name="annual_income[]" value="5,000,001 – 10,000,000" /> 5,000,001 – 10,000,000</label> <label><input type="checkbox" name="annual_income[]" value="10,000,001 – 50,000,000" /> 10,000,001 – 50,000,000</label> <label><input type="checkbox" name="annual_income[]" value="5,000,001 and above" /> 5,000,001 and above</label> </div> </div> <div style="margin-bottom: 1rem;"> <strong>Total Net Worth (total assets minus liabilities)</strong> <div class="checkbox-group" role="group" aria-label="Total Net Worth brackets" style="gap: 1rem; flex-wrap: wrap; margin-top: 0.3rem;"> <label><input type="checkbox" name="total_net_worth[]" value="1,000,000 and below" /> 1,000,000 and below</label> <label><input type="checkbox" name="total_net_worth[]" value="1,000,001 – 5,000,000" /> 1,000,001 – 5,000,000</label> <label><input type="checkbox" name="total_net_worth[]" value="5,000,001 – 10,000,000" /> 5,000,001 – 10,000,000</label> <label><input type="checkbox" name="total_net_worth[]" value="10,000,001 – 50,000,000" /> 10,000,001 – 50,000,000</label> <label><input type="checkbox" name="total_net_worth[]" value="50,000,001 and above" /> 50,000,001 and above</label> </div> </div> <div style="margin-bottom: 1rem;"> <strong>How do you intend to fund this account?</strong> <div class="checkbox-group" role="group" aria-label="Funding source for account" style="gap: 1rem; flex-wrap: wrap; margin-top: 0.3rem;"> <label><input type="checkbox" name="funding_sources[]" value="Income" /> Income</label> <label><input type="checkbox" name="funding_sources[]" value="Pension or retirement savings" /> Pension or retirement savings</label> <label><input type="checkbox" name="funding_sources[]" value="Funds from other investments" /> Funds from other investments</label> <label><input type="checkbox" name="funding_sources[]" value="Sale of business or property" /> Sale of business or property</label> </div> <label for="funding_sources_other" style="margin-top: 0.5rem;">Others (Please specify)</label> <input type="text" id="funding_sources_other" name="funding_sources_other" maxlength="120" /> </div> </fieldset> <fieldset id="bank-details"> <legend>Bank Details (Clients’ Proceeds Will Only Be Transferred To An Account Listed On This Form)</legend> <label for="bvn_number">BVN Number <small>(to be provided for all signatories to this account)</small></label> <input type="text" id="bvn_number" name="bvn_number" maxlength="20" pattern="[0-9]+" required /> <div style="display:flex; flex-wrap: wrap; gap: 1rem; margin-top: 0.8rem;"> <div style="flex: 1 1 55%;"> <label for="bank1_name">Bank 1 (Main Account)</label> <input type="text" id="bank1_name" name="bank1_name" maxlength="50" /> </div> <div style="flex: 1 1 30%;"> <label for="bank1_account_number">Account Number</label> <input type="text" id="bank1_account_number" name="bank1_account_number" maxlength="12" pattern="[0-9]{1,12}" class="small-input" style="width:auto;"/> </div> </div> <label for="bank1_account_name" style="margin-top: 0.5rem;">Account Name</label> <input type="text" id="bank1_account_name" name="bank1_account_name" maxlength="100" /> <div style="display:flex; flex-wrap: wrap; gap: 1rem; margin-top: 0.8rem;"> <div style="flex: 1 1 55%;"> <label for="bank2_name">Bank 2</label> <input type="text" id="bank2_name" name="bank2_name" maxlength="50" /> </div> <div style="flex: 1 1 30%;"> <label for="bank2_account_number">Account Number</label> <input type="text" id="bank2_account_number" name="bank2_account_number" maxlength="12" pattern="[0-9]{1,12}" class="small-input" style="width:auto;"/> </div> </div> <label for="bank2_account_name" style="margin-top: 0.5rem;">Account Name</label> <input type="text" id="bank2_account_name" name="bank2_account_name" maxlength="100" /> </fieldset> <fieldset id="signature-mandate"> <legend>Signature Mandate</legend> <label for="signature_mandate_text">Please state the authorized signature mandate:<br/><small>(E.g. A and B to sign, either of the signatories, all signatories…)</small></label> <textarea id="signature_mandate_text" name="signature_mandate_text" rows="3" maxlength="300"></textarea> <table class="signature-table" aria-label="Signature Mandate Table"> <thead> <tr> <th>SIGNATORY'S NAME</th> <th>SPECIMEN SIGNATURE</th> <th>SIGNATORY DESCRIPTION (i.e. A or B)</th> </tr> </thead> <tbody> <tr> <td><input type="text" name="sigmandate_name_1" maxlength="50" aria-label="Signatory name 1" /></td> <td><div class="signature-box" aria-label="Specimen signature 1"></div></td> <td><input type="text" name="sigmandate_desc_1" maxlength="5" aria-label="Signatory description 1" style="text-align:center;" /></td> </tr> <tr> <td><input type="text" name="sigmandate_name_2" maxlength="50" aria-label="Signatory name 2" /></td> <td><div class="signature-box" aria-label="Specimen signature 2"></div></td> <td><input type="text" name="sigmandate_desc_2" maxlength="5" aria-label="Signatory description 2" style="text-align:center;" /></td> </tr> </tbody> </table> <div style="display: flex; justify-content: space-between; margin-top: 2rem; font-weight: 700; font-size: 0.95rem; letter-spacing: 0.1em;"> <span>AUTHORIZED SIGNATORY</span> <span>AUTHORIZED SIGNATORY</span> </div> </fieldset> <fieldset id="risk-disclosure"> <legend>Risk Disclosure Statement and Customer Agreement Declaration (Equity Transactions Only)</legend> <ul style="font-size: 0.9rem; margin-left: 1.5rem; padding-left: 1rem;"> <li>This document complies with Nigerian Exchange Group (NGX) rules governing dealing members and explains risks associated with trading.</li> <li>Investment involves risk, including potential loss of 100% of investment.</li> <li>Price fluctuations and currency risk exist and may result in losses.</li> <li>Seek clarification on fees and charges before investment.</li> <li>Cordros acts as execution-only stockbrokers, not financial advisors.</li> </ul> <div style="display:flex; justify-content: space-between; margin-top: 2rem; font-weight: 700;"> <span>AUTHORIZED SIGNATORY</span> <span>AUTHORIZED SIGNATORY</span> </div> </fieldset> <fieldset id="email-indemnity"> <legend>Email Indemnity (All Clients)</legend> <p style="font-size: 0.9rem; margin-bottom:1rem;"> By consenting to electronic communication (email, phone, fax), you agree that such instructions are binding and will indemnify Cordros against loss caused by such communications or their misuse. </p> <div style="display:flex; justify-content: space-between; margin-top: 2rem; font-weight: 700;"> <span>AUTHORIZED SIGNATORY</span> <span>AUTHORIZED SIGNATORY</span> </div> </fieldset> <fieldset id="terms-conditions"> <legend>Terms and Conditions</legend> <ul style="font-size: 0.9rem; max-height: 260px; overflow-y: auto; margin-left: 1.5rem; padding-left: 1rem;"> <li>Transactions on your account abide by Money Laundering (Prohibition) Act 2022. Suspicious transactions will be reported.</li> <li>Business hours: 8:00 am to 5:00 pm Nigerian time, on business days.</li> <li>Mandates received after deadline executed next business day; purchase mandates executed only with sufficient cleared funds.</li> <li>Cordros is not liable for any indirect or consequential losses.</li> <li>Client agrees to fees and commissions as per Cordros schedule.</li> <li>Client agrees to keep information confidential and acknowledges call recording for dispute resolution.</li> <li>Cordros reserves right to combine or set off any client accounts if needed.</li> <li>Overdrafts incur interest if account becomes unfunded due to transactions.</li> <li>Client authorizes Cordros to make third-party verifications as part of KYC obligations.</li> <li>Relationship may be terminated with three days’ notice, subject to settlement of transactions.</li> <li>Client funds are guaranteed legitimate and not from unlawful activities.</li> <li>Client agrees to abide by amendments communicated via agreed communication channels.</li> </ul> <div style="display:flex; justify-content: space-between; margin-top: 1rem; font-weight: 700;"> <span>AUTHORIZED SIGNATORY</span> <span>AUTHORIZED SIGNATORY</span> </div> </fieldset> <fieldset id="document-checklist"> <legend>Document Checklist</legend> <section> <h3>For Individuals</h3> <ol> <li>Duly completed and executed account opening form</li> <li>Bank reference</li> <li>Valid Utility Bill (recent, reflecting current residence)</li> <li>Valid Means of Identification</li> <li>One (1) passport sized picture</li> <li>Current residence permit (if foreign national)</li> </ol> </section> <section> <h3>Business name/Sole proprietorship/Partnership</h3> <ol> <li>Duly completed & executed form by all partners and proprietors</li> <li>Copy of Business name certificate</li> <li>Copy of registered CAC/BN/1</li> <li>Valid means of identification for all partners and signatories</li> <li>Utility bill (<small>registered address</small>)</li> <li>Passport sized picture of each partner/signatory</li> <li>Bank reference for the business name</li> <li>Signature mandate executed by signatories</li> <li>Partnership deed (if applicable)</li> <li>Certificate of registration with SCUML (if applicable)</li> <li>Letter appointing Cordros as stockbrokers</li> <li>Current residence permit (if foreign national)</li> </ol> </section> <section> <h3>Clubs, Societies, NGOs, and Associations</h3> <ol> <li>Copy of certificate of registration certified by CAC</li> <li>Charter/constitution</li> <li>Means of identification for trustees and authorized signatories</li> <li>Valid utility bill issued in last 3 months</li> <li>Resolution appointing signatories</li> <li>Signature mandate by signatories</li> <li>Passport picture for each signatory and trustee</li> </ol> </section> <section> <h3>For Corporate/Institutional investors</h3> <ol> <li>Duly completed form signed by all directors and signatories</li> <li>Memorandum and Articles of Association</li> <li>Form CAC 2 (Statement of Share Capital)</li> <li>Form CAC 7 (Particulars of Directors)</li> <li>Status report / Form CAC 1.1</li> <li>Certificate of Incorporation</li> <li>Bank reference for company</li> <li>Means of identification of all directors and signatories</li> <li>Utility bill reflecting registered company address</li> <li>Passport picture of each director and signatory</li> <li>Board resolution appointing Cordros as stockbrokers</li> <li>Current residence permit for foreign nationals</li> <li>Certificate of registration with SCUML (if applicable)</li> </ol> </section> <section> <h3>Estate Accounts</h3> <p>(Details of one of the administrators must be entered on the biodata page)</p> <ol> <li>Duly completed form signed by estate administrators</li> <li>Valid Letters of Administration (probate registry)</li> <li>KYC documentation for administrators</li> <li>Passport picture for administrators</li> <li>If others manage account, provide duly registered Power of Attorney</li> <li>Bank reference in name of the Estate</li> <li>Death certificate</li> <li>Newspaper publication (obituary)</li> <li>Letter of appointment appointing Cordros as stockbroker</li> </ol> </section> </fieldset> <fieldset id="charges"> <legend>Applicable Charges</legend> <div class="charges-group"> <div class="charges-col"> <h3>Charges for Equity Sales</h3> <table class="charges-table" aria-label="Charges applicable for equity sales"> <tbody> <tr><td>NSE FEES</td><td>0.3% of Consideration</td><td>STATUTORY</td></tr> <tr><td>BROKERAGE FEE</td><td>1.35% of Consideration</td><td>MAXIMUM</td></tr> <tr><td>CSCS TRADE ALERT</td><td>N4 per Trade Ticket</td><td>STATUTORY</td></tr> <tr><td>STAMP DUTY</td><td>0.075% of consideration</td><td>STATUTORY</td></tr> <tr><td>CSCS FEES</td><td>0.3% of consideration</td><td>STATUTORY</td></tr> <tr><td>VAT ON BROKERAGE</td><td>7.5% of Brokerage fee</td><td>STATUTORY</td></tr> <tr><td>VAT ON NSE FEES</td><td>7.5% of NSE Fees</td><td>STATUTORY</td></tr> <tr><td>VAT ON CSCS FEES</td><td>7.5% of CSCS Fees</td><td>STATUTORY</td></tr> </tbody> </table> </div> <div class="charges-col"> <h3>Charges for Equity Purchases</h3> <table class="charges-table" aria-label="Charges applicable for equity purchases"> <tbody> <tr><td>SEC FEES</td><td>0.3% of Consideration</td><td>STATUTORY</td></tr> <tr><td>BROKERAGE FEE</td><td>1.35% of Consideration</td><td>MAXIMUM</td></tr> <tr><td>CSCS TRADE ALERT</td><td>N4 per Trade Ticket</td><td>STATUTORY</td></tr> <tr><td>STAMP DUTY</td><td>0.075% of Consideration</td><td>STATUTORY</td></tr> <tr><td>VAT ON BROKERAGE</td><td>7.5% of Brokerage fee</td><td>STATUTORY</td></tr> <tr><td>VAT ON SEC FEES</td><td>7.5% of SEC Fees</td><td>STATUTORY</td></tr> <tr><td>VAT ON CSCS FEES</td><td>7.5% of CSCS Fees</td><td>STATUTORY</td></tr> </tbody> </table> </div> </div> </fieldset> <fieldset id="for-office-use"> <legend>FOR OFFICE USE ONLY</legend> <label for="remarks">Remarks:</label> <textarea id="remarks" name="remarks" rows="3" style="width:100%;"></textarea> <div style="display:flex; gap:2rem; flex-wrap: wrap; margin-top: 1rem;"> <div style="flex: 1 1 30%;"> <label for="rel_officer_name">Relationship Officer’s Name</label> <input type="text" id="rel_officer_name" name="rel_officer_name" /> <label for="rel_officer_signature" style="margin-top: 0.3rem;">Signature</label> <input type="text" id="rel_officer_signature" name="rel_officer_signature" /> <label for="rel_officer_date" style="margin-top: 0.3rem;">Date</label> <input type="date" id="rel_officer_date" name="rel_officer_date" /> </div> <div style="flex: 1 1 30%;"> <label for="compliance_approval">Compliance Approval</label> <input type="text" id="compliance_approval" name="compliance_approval" /> <label for="comp_approval_signature" style="margin-top: 0.3rem;">Signature</label> <input type="text" id="comp_approval_signature" name="comp_approval_signature" /> <label for="comp_approval_date" style="margin-top: 0.3rem;">Date</label> <input type="date" id="comp_approval_date" name="comp_approval_date" /> </div> <div style="flex: 1 1 30%;"> <label for="approving_officer_name">Approving Officer’s Name</label> <input type="text" id="approving_officer_name" name="approving_officer_name" /> <label for="approving_officer_signature" style="margin-top: 0.3rem;">Signature</label> <input type="text" id="approving_officer_signature" name="approving_officer_signature" /> <label for="approving_officer_date" style="margin-top: 0.3rem;">Date</label> <input type="date" id="approving_officer_date" name="approving_officer_date" /> </div> </div> <div style="margin-top: 1rem; font-weight: 700;"> <label>CLIENT CATEGORY</label><br/> <label><input type="radio" name="client_category" value="Local Retail" /> Local Retail</label> <label><input type="radio" name="client_category" value="Local Institutional" /> Local Institutional</label> <label><input type="radio" name="client_category" value="Foreign" /> Foreign</label> </div> </fieldset> <fieldset id="bank-account-update-form"> <legend>Investor’s Bank Account Update Form for Direct Settlement</legend> <p style="font-weight: 700; text-align:center; margin-bottom: 1rem;">CSCS Plc, Stock Exchange House (Floors 1, 12, 13, 14 & 15), 2/4, Customs Street, P.O.BOX 3168, Marina, Lagos State.</p> <p style="text-align:center; margin-bottom: 1rem;"> E-Mail: <a href="mailto:contact@cscs.ng">contact@cscs.ng</a> Website: <a href="https://www.cscs.ng" target="_blank" rel="noopener">www.cscs.ng</a><br/> Telephone Number: +234 070022552727 (FORM 001) </p> <div class="checkbox-group" role="group" aria-label="Account Type"> <label><input type="radio" name="account_type" value="Personal" required /> PERSONAL</label> <label><input type="radio" name="account_type" value="Corporate" /> CORPORATE</label> </div> <label for="client_name" style="margin-top: 1rem;">Name of Client (surname first) OR Company’s Name:</label> <input type="text" id="client_name" name="client_name" maxlength="100" required /> <label for="passport_photograph_affix" style="margin-top: 0.4rem; font-weight: 600; display: block; border: 1.5px solid #999; width: 130px; height: 150px; text-align: center; line-height: 150px; user-select:none;"> AFFIX PASSPORT PHOTOGRAPH </label> <label for="dob_cac_no" style="margin-top: 0.8rem;">Date of Birth / CAC No:</label> <input type="text" id="dob_cac_no" name="dob_cac_no" maxlength="50" /> <label for="mothers_maiden_name" style="margin-top: 0.5rem;">Mother’s Maiden Name (where applicable):</label> <input type="text" id="mothers_maiden_name" name="mothers_maiden_name" maxlength="80" /> <label for="client_address" style="margin-top: 0.5rem;">Address:</label> <textarea id="client_address" name="client_address" rows="3" class="multi-field address-input"></textarea> <div style="display:flex; gap:1rem; flex-wrap: wrap; margin-top: 1rem;"> <div style="flex: 1;"> <label for="cscs_account_number">CSCS Account Number</label> <input type="text" id="cscs_account_number" name="cscs_account_number" maxlength="15" pattern="[0-9]+" class="small-input" style="width:100%;" /> </div> <div style="flex: 1;"> <label for="clearing_house_number">Clearing House Number</label> <input type="text" id="clearing_house_number" name="clearing_house_number" maxlength="15" pattern="[0-9]+" class="small-input" style="width:100%;" /> </div> </div> <div style="display:flex; gap:1rem; flex-wrap: wrap; margin-top: 0.7rem;"> <div style="flex: 1 1 45%;"> <label for="client_tel1">Tel. Number (1)</label> <input type="tel" id="client_tel1" name="client_tel1" maxlength="15" pattern="[0-9+\-\s]+" /> </div> <div style="flex: 1 1 45%;"> <label for="client_tel2">Tel. Number (2)</label> <input type="tel" id="client_tel2" name="client_tel2" maxlength="15" pattern="[0-9+\-\s]+" /> </div> </div> <div style="margin-top: 1rem;"> <label for="client_email1">E-mail Address (1)</label> <input type="email" id="client_email1" name="client_email1" maxlength="80" autocomplete="email" /> </div> <div style="margin-top: 0.5rem;"> <label for="client_email2">E-mail Address (2)</label> <input type="email" id="client_email2" name="client_email2" maxlength="80" autocomplete="email" /> </div> <fieldset style="margin-top: 1rem;"> <legend>Do you opt for direct settlement into your bank account?</legend> <div class="checkbox-group" role="group" aria-label="Direct settlement"> <label><input type="radio" name="direct_settlement" value="Yes" required /> YES</label> <label><input type="radio" name="direct_settlement" value="No" /> NO</label> </div> </fieldset> <label for="client_signature_1" style="margin-top: 1rem;">Signature (1)</label> <input type="text" id="client_signature_1" name="client_signature_1" maxlength="50" /> <label for="client_signature_2" style="margin-top: 0.5rem;">Signature (2)</label> <input type="text" id="client_signature_2" name="client_signature_2" maxlength="50" /> <small style="display: block; margin-top: 0.3rem;">(For Corporate accounts, two authorized signatories must sign with their passports photographs affixed and company’s Seal appended on this form).</small> <label for="bank_name" style="margin-top: 1rem;">Bank Name:</label> <input type="text" id="bank_name" name="bank_name" maxlength="80" /> <label for="bank_branch" style="margin-top: 0.5rem;">Bank Branch:</label> <input type="text" id="bank_branch" name="bank_branch" maxlength="80" /> <div style="display:flex; gap: 1rem; flex-wrap: wrap; margin-top: 0.5rem;"> <div style="flex: 1 1 60%;"> <label for="bank_account_number">Bank Account Number:</label> <input type="text" id="bank_account_number" name="bank_account_number" maxlength="20" pattern="[0-9]+" class="small-input" style="width: 100%;" /> </div> <div style="flex: 1 1 35%;"> <label for="bvn">Bank Verification Number (BVN):</label> <input type="text" id="bvn" name="bvn" maxlength="11" pattern="[0-9]+" class="small-input" style="width: 100%;" /> </div> </div> <fieldset style="margin-top: 1rem;"> <legend>Type of Account (Please tick the type of account)</legend> <div class="checkbox-group" role="group" aria-label="Type of bank account"> <label><input type="radio" name="bank_account_type" value="Current" required /> Current</label> <label><input type="radio" name="bank_account_type" value="Savings" /> Savings</label> </div> </fieldset> <div style="margin-top: 1rem; display:flex; flex-wrap: wrap; gap: 1rem;"> <div style="flex: 2 1 70%;"> <label for="stockbroker_firm_name">Stockbroking Firm Name:</label> <input type="text" id="stockbroker_firm_name" name="stockbroker_firm_name" maxlength="80" /> </div> <div style="flex: 1 1 25%;"> <label for="member_code">Member Code:</label> <input type="text" id="member_code" name="member_code" maxlength="10" style="text-align:center;" /> </div> </div> <div style="margin-top: 1rem;"> <label for="authorized_signatory_1">Authorized Signatories & Company’s Stamp (1):</label> <input type="text" id="authorized_signatory_1" name="authorized_signatory_1" maxlength="80" /> </div> <div style="margin-top: 0.5rem;"> <label for="authorized_signatory_2">Authorized Signatories & Company’s Stamp (2):</label> <input type="text" id="authorized_signatory_2" name="authorized_signatory_2" maxlength="80" /> </div> </fieldset> <footer class="footer-contact" role="contentinfo"> <p><strong>CORDROS SECURITIES LIMITED</strong> (Member of the Nigerian Exchange Group)<br/> 21 Norman Williams Street, Ikoyi, P.O. Box 75590 Victoria Island, Lagos, Nigeria.<br/> E: <a href="mailto:contactcentre@cordros.com">contactcentre@cordros.com</a> M: 07002673767 </p> </footer> </form> </body> </html>
| ver. 1.4 |
Github
|
.
| PHP 8.3.30 | Generation time: 0.03 |
proxy
|
phpinfo
|
Settings