(j Se~PRVA BANKA CG
OSNOV ANA 1901.
Organisation Details
PRISTUPNICA ZA ORGANIZACIJEORGANISATION APPLICATION FORM
Naziv organizacijeCompany Name
Maticni brojRegistration No.
Poreski brojTax.No.
Ulica i brojAddress
MjestoTown
Lice ovlasceno za zastupanjeAuthorized representative
Kontakt osobaContact Person
Kontakt telefonContact Phone
Pristup racunima kod drugih banaka?Access Accounts Held at Other Banks
0 Da 0 NeYes No Pristup racunima preko agencije?
Access Accounts Via AgencyODa ONe
Yes No
Internet bankarstvoIntemet Banking
0 Web servisWeb Service
0 FXDesktop aplikacijaFX Desktop Application
0 WAPservisWAP Service
0 FXEnterprise aplikacijaFX Enterprise Application
Mobilno bankarstvoMobile Banking
0 SMS servisSMS Service
Tele bankarstvoTele Banking
0 Govorni servisInteractive Voice Response
0 Faks servisFax
ObavjestenjaAlerts 0 Faks obavjestenjaFaxAlerts 0 E-mail obavjestenja
E-mail Alerts0 SMS obavjestenja
SMS Alerts
I..;l='r.m1 t;) IT1 oi ,Ii 11, I f; 1 Account Details
ValutaCurrency
Tip racuna*Account Type.
Broj racunaAccount Number
Authorized Users
* Tip racuna: tekuci I devizni I oroceni depozit I kredit* Account type: current / foreign / term deposit / loan
Ime i prezimeName and Surname
JMBGNational ID Number
.-.Izjavljujem pod punom materijalnom i krivicnom odgovornoscu da su podaci u ovoj pristupnici tacni. Prihvatam Opste uslove koriscenja uslugeelektronskog bankarstva koji su prilog ove pristupnice. Svi odnosi koji proisteknu koriscenjem usluge elektronskog bankarstva bice regulisaniprema opstim aktima banke u duhu pozitivnih zakonskih propisa. Ovim ovlascujem banku da gore navedene racune zaduzi za transakcije itroskove nastale koriscenjem usluge elektronskog bankarstva prema vazecim tarifama banke bez prethodnog obavjestenja.
I hereby confirm under penalty of perjury or fraud that all details I have given in this form are true and accurate. I have received, understand, agreewith and accept the General Terms and Conditions with this Application Form. All issues resulting from use of electronic banking services are to beregulated according to the General Act of the bank and applicable laws. I hereby irrevocable authorize the bank to charge my accounts listedabove with all transactions and fees resulting from the use of electronic banking services, according to its effective Bank Tariff without prior notice.
Pecat i potpis zastupnika ill prokuristeStamp and Signature of Authorized Representative
~;\'r.II'r.I~I~
Broj pristupniceApplication Number
Pristupno mjestoPlace of Application
Datum prijemaApplication Date
PrimioAcceptant
Transakcije Kolektivni potpisTransactions Group Authorization
0 Da 0 Ne 0 Da 0 NeYes No Yes No
0 Da 0 Ne 0 Da 0 NeYes No Yes No
0 Da 0 Ne 0 Da 0 NeYes No Yes No
CJ PRVA BANKA CG Ei'IT-1TII11f -
OSNOV ANA 1901.
Personal Details
PODACI 0 OVLASCENOM KORISNIKUAUTHORISED USER DETAILS
Mobilni telefon*Mobile Phone"
Faks*Fax"
JMBGNationalIDNumber
Ime i prezimeName and Sumame
Ulica i brojAddress Postanski broj
Postal Code
E-mail*E-mail"
* Kontakt podaci ce biti upotrebljeni za dostavljanje obavjestenja* Contact details will be used to deliver alerts
1L;.c:r:m1t:)~Internet bankarstvoIntemet BankinIl
D Web servisWeb SeN/ce
D FXDesktop aplikacijaFX Desktop Application
D FX Enterprise aplikacijaFX Enterprise Application
D SMS servisSMSSeN/ce
Mobilno bankarstvoMobile Banking
D WAPservisWAP SeNice
Tele bankarstvoTele Banking
D Govorni servisInteractive Voice Response
D Faks servisFax
ObavjestenjaAlerts D Faks obavjestenja
FaxAlertsDE-mail obavjestenja
E-mail AlertsD SMS obavjestenja
SMS Alerts
Account Details
Broj racunaAccount Number
Tip obav.*I
Broj racunaAlerttype" AccountNumber
ValutaCurrency
Napomena*Note"
201 Zakazano obavjestenje 0 izvodu202 Zakazano obavjestenje 0 stanju101 Obavjestenje 0 prilivu201 Scheduled Statement Alert202 Scheduled Balance Alert101 Instant Income Alert
Dostavlja se dnevno. U napomenu unesite ocekivano vrijeme prijema obavjestenja .Dostavlja se dnevno. U napomenu unesite ocekivano vrijeme prijema obavjestenja.Dostavlja se momentalno. U napomenu unesite minimalni iznos priliva za prijem obavjestenja.Delivered daily. Use note field to specify expected delivery time.Delivered daily. Use note field to specify expected delivery time.Delivered immediately. Use note field to specify minimal amount of income to receive alert .
~1:(']I_~IT1...-Izjavljujem pod punom materijalnom i krivicnom odgovornoscu da su podaci u ovoj pristupnici tacni. Prihvatam Opste uslove koriscenja uslugeelektronskog bankarstva koji su prilog ove pristupnice. Svi odnosi koji proisteknu koriseenjem usluge elektronskog bankarstva bice regulisaniprema opstim aktima banke u duhu pozitivnih zakonskih propisa.
I hereby confirm under penalty of perjury or fraud that all details I have given in this form are true and accurate. I have received, understand, agreewith and accept the General Terms and Conditions with this Application Form. All issues resulting from use of electronic banking services are to beregulated according to the General Act of the bank and applicable laws.
Potpis ovlascenog korisnikaSignature of Authorized User
..~ Filled by the bank
Broj pristupniceApplication Number
Datum prijemaApplication Date
Pristupno mjestoPlace of Application
PrimioAcceptant
Valuta I Maksimalni iznos transakcije I
Transakcije Samostalni potpisCurrency Maximaltransactionamount Transactions SingleSignature
D Da D Ne D Da D NeYes No Yes No
D Da D Ne D Da D NeYes No Yes No
D Da D Ne D Da D NeYes No Yes No
Dostava prekoDeliveryvia
D Faks D SMS DE-mailFax SMS E-mail
D Faks D SMS DE-mailFax SMS E-mail
D Faks D SMS DE-mailFax SMS E-mail