Open Personal Bank Account

All information given in this application form is strictly confidential and for the bank's internal use only. If you have any queries regarding the completion of this form please give us a call at +1 767 449 9254.

Please read the General Terms and Conditions of Griffon Bank Limited before completing and signing this form.

FAX ALONG WITH SUPPORTING DOCUMENTS TO +1 767 449 9257 WHEN COMPLETED AND SIGNED

You will be contacted via e-mail to finalize your account opening.

  1. Fill in all sections of this form
  2. Print the application
  3. Sign where indicated by “x”
  4. Enclose the required supporting documents
  5. Fax all pages to 1 767 449 9257, or scan and send to info@griffonbank.com
  6. Send everything to one of the following addresses:
Via regular mail:
P.O. BOX 1324, Roseau
Commonwealth of Dominica, W.I. 		Via courier mail:
Financial Center, Roseau
Commonwealth of Dominica, W.I.

Required Supporting Documents

  • A certified copy of passport (for account holder and any authorized person – certifier's contact information must be on the documentation they signed)
  • An original reference letter from a banker (for account holder and any authorized person – referee's contact information must be on the letter signed)
  • An original utility bill or other document, which proves current address (for account holder and any authorized person)
SECTION 1 APPLICATION
Account holder
Tick to add a 1st authorized person
Tick to add a 2nd authorized person
Full Name:
Date of birth:   
Place of birth:
Citizenship:
 
Current residential address:
(P.O. Box not acceptable)
Telephone number(s):
Facsimile number(s):
 
Occupation / Job Title:
Present employer:
 
Business address:
(P.O. Box not acceptable)
Telephone number(s):
Facsimile number(s):
 
Personal mailing address:
Mobile phone (if any):
E-mail address:
1st Authorized Person
Full Name:
Date of birth:   
Place of birth:
Citizenship:
 
Current residential address:
(P.O. Box not acceptable)
Telephone number(s):
Facsimile number(s):
 
Occupation / Job Title:
Present employer:
 
Business address:
(P.O. Box not acceptable)
Telephone number(s):
Facsimile number(s):
 
Personal mailing address:
Mobile phone (if any):
E-mail address:
When Griffon Bank Limited opens my account I would like to receive my account number by:
E-mail:
Facsimile:
Account management through the Internet Bank
To conduct my business with Griffon Bank Limited I would like to sign up for the management of my account through the Internet Bank. By using the Internet Bank I agree to the General Terms and Conditions of Griffon Bank Limited which are displayed at the Bank?s web site www.griffonbank.com
x _________________________
(Signature)
 
I would like an Internet Bank Login and Password sent by courier mail together with my Digital Signature and Client ID code to:
x _________________________
(Signature)
SECTION 2 SPECIMEN SIGNATURE CARD
Only the person(s) indicated below have signature power on the account:
 
Name of the account holder:
x _________________________
(Specimen signature)
 
 
SECTION 3 DECLARATION OF SOURCE OF FUNDS
Related Accounts:
(if any other accounts with Griffon Bank Ltd.)		 and
Nature of your occupation or business:
Purpose of the new account:
Initial deposit:
(minimum USD 5 000 or equivalent in another currency)		 in
Source of funds:
 
Please list who is/are the beneficial owners of the funds in this account:


Name of beneficial owner:
Address of beneficial owner:

Name of beneficial owner:
Address of beneficial owner:

Name of beneficial owner:
Address of beneficial owner:

Name of beneficial owner:
Address of beneficial owner:
 
Expected number of transactions per month:
Estimated average monthly balance: in
 
  I have read and accepted the General Terms and Conditions of Griffon Bank Limited.

I hereby declare that the funds deposited in my account at Griffon Bank Limited are of non-criminal origin.

I hereby declare that the information I have given above is true and correct.
Place:
Date:   
 
x _________________________
(Signature)
Please tick if you require a debit card application form
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