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APPLICATION CONTRACT FOR OPENING AND MAINTAINING A BANK ACCOUNT
FM09.99.22/04
AND PROVISION OF BANK SERVICES FOR PRIVATE INDIVIDUALS
Customer I__I__I__I__I__I__I
CUSTOMER PERSONAL DETAILS / SPECIMEN SIGNATURE
Name of the account holder, spelled in Bulgarian ....
Name of the account holder, spelled in Latin letters ......
Personal ID / UIC as per BULSTAT/Tax Identif.
I__I__I__I__I__I__I__I__I__I__I Country of citizenship ...
Date of birth . Country of birth ... Place of birth ......
ID document I__I__I__I__I__I__I__I__I__I issued on by ......
Address as per registration: City/place of residence .... Post
code I__I__I__I__I
Street , block, entrance, floor, apartment Country ..
Mailing address: City/place of residence ..... Post code
I__I__I__I__I
Street , block, entrance, floor, apartment Country ..
E-mail .. Mobile phone number Home phone number Fax ....
Workplace .... Position .. Office phone number ...
Specimen signature
..................................................................................
ACCOUNTS
I would like to open:
Current account BGN EUR USD Other
currency...................................................
Saving account No Limitations BGN I wish to use the Automatic
Savings service
I grant my explicit consent for every transaction with debit
card Maestro Visa Electron
with IBAN BG..RZBB9155. in Bulgaria (ATM withdrawal, payment of
goods and services, incl. online payments),
the Bank to transfer 5% of the transaction amount from the
account to which the card is issued to a Savings account. The
transfer will be made subject to the availability of sufficient
funds in the account to which the card is issued.
Saving account No Limitations EUR USD Other currency
.............
Special account BGN EUR USD Other currency...........
Other account according Art. 6 of Ordinance 3 of the Central
Bank BGN EUR USD Other currency ......
Signature
.......................................................................
RAIFFEISEN ONLINE
I would like to use the following rights on accounts in
Raiffeisen ONLINE*:
Active for all existing accounts Passive for all existing
accounts
Active for all existing and future accounts Passive for all
existing and future
accounts
I would like to use the following rights on products in
Raiffeisen ONLINE*:
Active for all existing and future products
Passive for all existing and future products
*When setting other specific rights beyond the scope of this
section (limits, rights under a specific account, group signatures,
signature
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hierarchy, etc.), please, complete FM 05.08.13 Application form
for providing electronic services to private individuals and legal
entities
Raiffeisen ONLINE, E-statements, Phonebanking ABIS .
Access via native application for mobile devices Yes / No
When selecting active rights on accounts and/or products,
please, specify an additional security tool:
SMS authorization
I would like to receive a SMS authorization code on number:
) banking via the internet site of the service:
+359I__I__I__I__I__I__I__I__I__I__I
b) banking via native application for mobile devices (smart
phones, tablets, etc.): +359I__I__I__I__I__I__I__I__I__I__I
Token I would like to use a Token hardware device for
confirmation of orders for:
banking via the internet site of the service
banking via native application for mobile devices (smart phones,
tablets, etc.)
The price in the amount of BGN will be paid cash / from account
BG I__I__I RZBB9155
I__I__I__I__I__I__I__I__I__I__I
I received my Token device with serial No:
............................................... / I received my
initial PIN in a sealed envelope
UES universal electronic signature
None via the internet site of the service
None - via native application for mobile devices
I received my user name and password in a sealed envelope with
serial No: .................... date .......... time...........
Signature
........................................................... FOR
OFFICIAL USE ONLY
Current account IBAN BG I__I__I RZBB 9155
I__I__I__I__I__I__I__I__I__I__I Bank consultant
I__I__I__I__I__I__I__I__I__I__I
Saving account IBAN BG I__I__I RZBB 9155
I__I__I__I__I__I__I__I__I__I__I
Special account IBAN BG I__I__I RZBB 9155
I__I__I__I__I__I__I__I__I__I__I
RAIFFEISEN E-STATEMENTS
I would like all my current and future accounts to be registered
for Raiffeisen E-statements
Please indicate the frequency of e-statements: Weekly
Monthly
I would like to receive an e-mail with notification for a newly
generated e-
statement
I received my user name and password in a sealed envelope with
serial ..............................date
......................................hour
............................
Signature
......................................................
DECLARATIONS
Herewith, I assent that the Bank preserve, process and use my
personal information, which has become known in connection to the
present Contract and submit it to a third part upon observation of
the Personal Data Protection Act. I am familiar with the purpose
and means of processing the information, the voluntary nature of
submitting it and the consequences caused by refusal of submission,
the access rights and amendment of data.
I hereby declare that I am informed for my right to object
against processing of my personal data for the means of direct
marketing.
I hereby declare that I have received, duly informed of and I
unconditionally accept the General Conditions for the provision of
payment
services of Raiffeisenbank (Bulgaria) EAD.
I hereby declare that I have received, duly informed of and I
unconditionally accept the General Business Conditions, the Tariff
and the
Interest rates bulletin of Raiffeisenbank (Bulgaria) EAD.
I hereby declare that I have received, duly informed of and I
unconditionally accept the General Conditions for issuing and
provision of Saving
account No Limitations.
I hereby declare that I have received, duly informed of and I
unconditionally accept the General Conditions for using the service
Raiffeisen
Online.
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I hereby declare that, I am responsible for all actions taken on
my part after receiving an access to Raiffeisen Online service
I hereby declare that I have received, duly informed of and I
unconditionally accept the General Conditions for using the service
Raiffeisen
E-statements.
I hereby declare that I oblige to keep an archive of the
documents generated by Raiffeisen E-statements service on my
personal data
carrier for a period of 18 months after their generation.
I hereby declare that with the signing of this Contract I
confirm the authenticity of the supplied details, I authorize the
Bank to check them at
any time. I am obliged to notify the Bank immediately of
subsiquent changes in the supplied details .
I hereby declare that I agree to supply the Bank with all
necessary information and documents, with regard to the Measures
against Money
laundering and the Regulation for the Implementation of the
Measures against Money laundering and the current Bulgarian
legislation upon
demand.
With the opened account/s will be operated under the regulations
governing banking activities in Bulgaria.
I am aware of the punitive responsibility, stipulated in Art.313
of the Criminal code, should any of the contents stated above be
wrong.
Required documents: ID document of the account holder .
Date .. Place
........................................................
Raiffeisenbank (Bulgaria) EAD:
..................................... Signature
............................... FOR OFFICIAL USE ONLY employee
initials in
Midas
date hour signature
Application accepted by/Account opened by Account checked by
Application/Contract scanned by Application/Contract checked and
approved by Initiated in Raiffeisen Online by Username and password
for Raiffeisen ONLINE are given by IT dept: Approved by: Confirmed
by: PK 09.01 /Supplement
7/..............................................................................................................................................................................................................................................................................(
for Bank use only )
