7/21/2019 Fica Declaration

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and that s/he resides with me at the above address.

To confirm proof of residence, I have attached the following documents:

• ID document

• Proof of residential address

I, the declarant , hereby certify that the above information is true and correct. I real ise that should any of this information be false, I will be

liable for prosecution or penalties under the law.

Signed at on this of 20

Formal Residential Address Confirmation

T 0860 10 20 43 F +27 21 941 0770

BSE Building, 89 Voortrekker Road, Bellville 7535 PO Box 12451, Die Boord, Stellenbosch 7613

capitecbank.co.za

Capitec Bank Branch Name

Fica DeclarationDeclaration of Residential Address

To be completed for clients who are unable to provide any of the approved documents.

(State the nature of the relationship. E.g. son, mother, uncle, domestic worker, boarder.)

Declarant’s Details (Person making the declaration)

Applicant’s Details (Person opening the account)

I, the declarant, confirm that the applicant is my

Address Details

ID Number/Passport Number

ID Number/Passport Number

Name

Name

Surname

Surname

Residential Address

Postal Code

YearMonthDayPlace

A registered credit provider. NCR Reg. No.: NCRCP13 Capitec Bank Limited Reg. No.: 1980/003695/06 Page of 1

Fica Declaration 03/03/2015

1

Signature of declarant