Ezibank Registration Form
"Pursuant to requirements of law, nbs is obtaining information and will take necessary actions to verify your identity." Please note that nbs may require additional information from you before processing your account. nbs terms and conditions apply
Applicants Name
*
First Name
Middle Name
Last Name
Email address:
*
Confirmation Email
example@example.com
Do you have a active Samoan mobile number?
*
Please Select
Yes
No
Please Select
Your mobile number
*
Please enter a valid phone number.
Format: 0000000.
Do you have a Mobile Wallet with Digicel and/or Vodafone
Yes
No
Which is your preferred mobile provider?
Please Select
Digicel
Vodafone
Please select your preferred mobile provider.
Which Mobile Wallet are you registering your Ezibank with?
*
Please Select
Digicel MyCash
Vodafone M-Tala
Please select one option.
Do you have a NBS Account with us? If not, we can create one for you.
*
No, please create a new Savings Account for Ezibank
Yes, I have a Ezibank Savings Account number (please enter in field)
Address
*
Village
Street Address Line 2
District
State / Province
Postal / Zip Code
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
Gender
*
Male
Female
Marital Status
*
Married
Single
Divorced
Other
Which Proof of Identity will you be submitting with this application?
*
Valid Samoan or Overseas Passport
Valid Samoan Drivers license
Other
Proof of Identity
*
Browse Files
Drag and drop files here
Choose a file
Please upload a copy of your drivers license, or passport). Please ensure it is valid.
Cancel
of
I hereby indemnify the use of my data for legal, service and promotional purposes by nbs and Digicel/Vodafone
*
Yes
No
I hereby confirm that I hold a nbs savings account & Digicel/Vodafone mobile number and all information provided is correct
*
Yes
No
Customer Signature
The signature noted is for acceptance of terms.
Customer Signature Upload (if you are unable to sign above)
Browse Files
Drag and drop files here
Choose a file
We will use this signature for accepting terms and conditions,. nbs may require additional verification of signature.
Cancel
of
Take a photo (must include your full face without any obstructions)
*
Submit
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