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Securities Account Opening

Please complete the information below to open a securities account.
1. Nationality
Khmer
Foreigner
2. Type of Account
Individual
Corporate
3. Title
Mr.
Mrs.
Ms.
4. Name
5. Date of Birth dd/mm/yyyy
6. Identification Type
ID Card
Passport
7. Identification No.
8. Phone
9. E-mail
10. Contact Address
Only enter the blue characters


ACLEDA Securities Plc.
Registration No. 00002713

#61, Preah Monivong Blvd., Sangkat Srah Chork,
Khan Daun Penh, Phnom Penh, Cambodia.
Tel: +855 (0)23 999 966 / 999 977 / 723 388, +855 (0)15 723 388
E-mail: info@acledasecurities.com.kh
Website: www.acledasecurities.com.kh

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