Stakeholder Registration

PERSON INFORMATION (For Individuals)
First Name*
Last Name*
Nationality*
Email Address*
Mobile Number*
BENEFICIARY BANKING INFORMATION
Bank Name*
Country*
Account Name: (name as it appears on bank account):*
Bank Account No*
IBAN*
DECLARATION
DECLARATION*
I/We hereby confirm that the information provided herein is accurate, correct and complete and authorize the Vilal to direct payment to the above account.

SUPPLIER INFORMATION
Company Name*
Parent Company Name (if applicable)*
Web Site URL (if applicable)*
Activity*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Person*
Title*
Telephone No*
E-mail Address*
BENEFICIARY BANKING INFORMATION
Bank Name*
Bank ID*
SWIFT Code*
Branch Name*
Street Address*
City*
State/ Province*
Country Code*
Account Name: (name as it appears on bank account):*
Bank Account Currency*
Bank Account No*
Account Type:*
IBAN*
Transit Code (if any)
DECLARATION
DECLARATION*
I/We hereby confirm that the information provided herein is accurate, correct and complete and authorize the VILAL to direct payment to the above account.
Phone
This field is for validation purposes and should be left unchanged.