Fill in the account opening application form here - Banca Transilvania

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Capacity (Delegate):Last name _____________________________________________________________ First name ____________________________________________________________National Identification Number |________________________| holder of _____________________ serial __________ no. ___________________ CustomerNumber _______________________________.Addition Modification RemovalTo perform the following operations:Filing bankingdocumentsPicking up bankingdocuments (includingaccount statements)Depositing cash in thecurrent / card / collectingaccountSigning accompanying slipfor Checks / PNs / Bills ofexchangeException*Authorization expiry date ____________________________*The exception detailed ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Capacity (Delegate):Last name _____________________________________________________________ First name ____________________________________________________________National Identification Number |________________________| holder of _____________________ serial __________ no. ___________________ CustomerNumber _______________________________.Addition Modification RemovalTo perform the following operations:Filing bankingdocumentsPicking up bankingdocuments (includingaccount statements)Depositing cash in thecurrent / card / collectingaccountSigning accompanying slipfor Checks / PNs / Bills ofexchangeException*Authorization expiry date ____________________________*The exception detailed ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________In authorizing the delegate above mentioned to sign the accompanying slip for the cheque/promissory note/ bill of exchange, I herebyassume, in my capacity as legal representative, the following responsibilities and consequences which aply for the situations presentedbelow:If the debit instrument is inconsistent, lacks details, has invalid mandatory details or features alterations, wrinkles, stains, which affectthe visibility of certain sections, the remitting bank might be unable to settle it in the electronic system, or the drawee bank might rejectit for technical reasons. In this case the settlement of the debit instrument shall be charged according to BT’s applicable decision atthat time. I hereby acknowledge that the presentation/settlement terms via the alternative circuit are longer and hereby accept thismanner of collection, being fully informed on the possibility of losing the right of protest and recourse under the provisions laid down inthe applicable legal provisions.If the debit instrument is received by Banca Transilvania S.A. at a date in relation to which the submission for payment is after the legalsubmission deadline, in accordance with the applicable legal regulations, I hereby accept the fact that I might lose the right of protestand recourse in case the drawer refuses the payment, as such protest must occur before the expiry of the submission deadline.ACCOUNT OPERATING CONDITIONS:1. Depositing cash on the current/ card/ collector account may also be performed by other individuals (external depositors): YES |__| NO |__|.2. For the performed transactions I request the account statement:- daily |__|;- monthly |__|.Date: _____________________Legal representative’s signatureStamp
DATA FILLED IN BY THE BANK:Reference no. ______________________________ Date ________________________________Operator’s last name and first name ______________________________________________________ Position _____________________ Signature _____________________Supervisor’s last name and first name ____________________________________________________ Position _____________________ Signature _____________________
Page 1: To be filled in by the bank________

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