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2 years ago

Claim Form.pdf - Snoras

Claim Form.pdf - Snoras

Claim Form.pdf -

AB BANK SNORAS – CREDITORS’ CLAIM FORM____ __________________ 20____To AB Bank SNORAS in BankruptcyLegal entity code 112025973A.Vivulskio str. 7, VilniusCall centre:Phone: 8 800 272 72 (from Lithuania)+370 5 239 22 39 (from abroad)We would recommend using this form submission of your claims. Please fill in the form in capital letters and provide all the information indicated in the form clearly and correctly. Please fill out allrelevant sections of the form and sign and date it at the bottom of this page. Please note, that claims should be lodged as they were outstanding to the date of 7 December, 2011.1. CREDITORName, surname / Legal entity namePersonal code / Legal entity codeDate of birthPersonal document name(e.g. passport, personal ident. card)NumberResidential address / Registeredoffice addressCorrespondence address / Tradingaddress (if different from residential /registered office address)E-mail addressPhoneMobile phoneFaxContact person for Legal entity(position, name, surname)Contact number(Of contact person of legal entity)By providing the email address and the phone number, the Creditor authorizes AB bank Snoras in bankruptcy, its administrator, agents and employees to communicate with theyou, the creditor named herein, and any contact person, employee or agent of the creditor in respect of the claim or any other matters referred to herein by way of post, phone, faxor email.2. TYPE OF CLAIM (tick the relevant box. If more than one box applies, please tick all relevant boxes)Depositor ( please fill 3.1. table)Bond holder ( please fill 3.1. table)Shareholder ( please fill 3.1. table)Deposit Certificate holder (please fill the 3.1. table)Provision of goods / services ( please fill 3.2. table)Other (please fill the 3.3. table)3. INFORMATION ABOUT THE CLAIMS AGAINST AB BANK SNORAS IN BANKRUPTCY:3.1. Concerning the previously available bank products:Deposits (savings accounts) Sum CurrencyFunds in current accounts Sum CurrencyDeposit certificate Sum Currency1 / 3

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