(TO BE PRINTED ON THE COMPANY’S LETTER HEADED PAPER) The ...

(TO BE PRINTED ON THE COMPANY'S LETTER HEADED PAPER)

The Managing Director Fidelity Bank Plc. 2, Kofo Abayomi Street Victoria Island Lagos

Dear Sir,

APPLICATION FOR THE USE OF FIDELITY BANK VIRTUAL ACCOUNT TO RECEIVE PAYMENTS The Fidelity Virtual Accounts, also referred as `Bank Transfer', are temporary accounts that are used for payment transaction in the place of a real physical account. The account is in conformity with NUBAN standard for Nigeria Uniform Account Number that allows consumers transfer from any bank account of the destination account via USSD, Mobile or internet Banking.

At the point of payment, the paying customers are provided with either a static or dynamic account that enables them to make a transfer from any Bank of their choice to credit the account displayed. Funds are subsequently swept to the merchant's settlement account in Fidelity Bank.

In consideration of the Bank granting access to the Merchant to accept payment through this channel, We/I hereby confirm that we/I have read and understand the product and request for the Bank to extend this solution to us.

Preferred Setup Name: Business Address:

Service Description: Settlement Account: Website Address: Contact Tel: Contact Email

Surname First Name Address Phone Number Email Address

SETUP INFORMATION Contact Person Information

Dated this ______________ day of ______________________ 20______

SIGNED, SEALED & DELIVERED by the within named (INSERT NAME OF MERCHANT)

__________________________ (INSERT NAME OF SIGNATORY)

__________________________ (INSERT NAME OF SIGNATORY)

Account Officer: Signature:

FOR BANK USE ONLY

Date:

Branch Name;

I certify that customer has met the KYC requirements in accordance with the policy of Central Bank of Nigeria and signatory(ies) verified.

Note: This form is to be printed on company's letter headed paper, completed, scanned, and sent via email to corporatee-services@fidelitybank.ng.

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