PERSONS WITH DISABILITIES FORM

In accordance with Section 10 of the Bank of Ghana Financial Inclusion of Persons with Disabilities Directive, 2025, financial service providers, including Zenith Bank (Ghana) Ltd, are required to collect relevant data to identify customers who are persons with disabilities. Required Information:

1. Disability Status

Are you a person with disability?

Yes

No

2. Nature of Disability

If you selected ‘Yes’ above, please indicate the nature of your disability by ticking any of the following boxes.

Visual impairment e.g. Neurological and physical disabilities.

Hearing impairment e.g. Physical, developmental and neurological disabilities.

Sensory impairment e.g. Psycho-social, intellectual, neurological and developmental disabilities.

3. The information is required solely to enable Zenith Bank to serve you better and for reporting purposes to Bak of Ghana in line with the referenced Directive.

I hereby consent to the above and indemnify the Bank from the information provided.