Instructions: Please fill this form in BLOCK LETTERS. Scan or take a clear photo of the form and your supporting documents, then email to customercare@madapwalletcard.com.ng

SECTION A: ACCOUNT DETAILS
SECTION B: 9PSB KYC & BANKING DETAILS
[ ] What was the name of your first pet?
[ ] In what city or town did your parents meet?
[ ] What was the make and model of your first car?
[ ] What is the first name of your favourite childhood teacher?
[ ] What was the name of the street you lived on in third grade?
[ ] What is your oldest sibling's middle name?
[ ] What was the name of your first childhood friend?
[ ] What is the name of the hospital where you were born?
SECTION C: BUSINESS & LEGAL

PAYMENT & ATTACHMENT CHECKLIST

Annual Membership Fee: ₦30,000

Account Name: MonuGold American DAP WalletCard Ltd | Account Number: 1029781819 | Bank: UBA PLC

Ensure the following are attached to your email:
[ ] Evidence of Payment (₦30,000 Receipt)
[ ] Copy of Utility Bill (Proof of Address)
[ ] Live Photo / Selfie (Passport equivalent)
[ ] CAC Certificate (For Alliance Partners/LTD only)
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Make sure all sections are filled and submitted by email with attached payment to customercare@madapwalletcard.com.ng

Account
9PSB KYC
Business & Legal

9PSB Banking Details

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