BANK OF AFRICA – TOGO
Boulevard du 13 janvier, BP : 220 Lomé –Togo
Fax : 335 Tel : (228) 98 73 26 84
E-mail :
bankofafrica.bfh@accountant.comNEXT OF KIN IDENTIFICATION FORM
Please complete all the sections correctly to avoid delay in processing of your application. Kindly note
that 48 hours is given to return this form to the Bank to enable us carrying out our official / Bank
duties.
APPLICANT’S INFORMATION
Your full Name: .............................................................................................................
Your full Address: ..............................................................................................................
Occupation: .................................................................................................................
Nationality: ..............................................................................................................
OFFICIAL IN OUTRY OF THE DECEASED
Full name of the Deceased: .................................................................................................
Your relationship with the Deceased: ....................................................................................
Deceased date of Birth: .......................................... Age: ....................................................
Cause / Date of Death: ..........................................................................................................
Deceased Res. address in Togo: ..........................................................................................
Deceased Occupation when he was alive: .................................................................................
.......................................................................................................................................
Type of account operated by the deceased with this Bank: .........................................................
File N° of the deceased with this Bank: ..................................................................................
DECLARANT
I Mr. / Mrs. ......................................................................................., do hereby, state that
all the information contained herein, is true and no falsehood or whatsoever.
Date / Applicant’s Signature