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

...

ID document I__I__I__I__I__I__I__I__I__I issued on

Address as per registration: City/place of residence
Street , block, entrance, floor, apartment
Mailing address: City/place of residence

..

Workplace

......

by ......

....

.....

Street , block, entrance, floor, apartment

E-mail

Place of birth

....

Home phone number

Post code I__I__I__I__I

Country

..

Post code I__I__I__I__I

Mobile phone number

...

Country

..

Fax ....

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
Special account

EUR USD Other currency .............

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
Active for all existing and future accounts

Passive for all existing 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

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 estatement

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.

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:

.....................................

FOR OFFICIAL USE ONLY

...............................

employee initials in

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:

Signature

Approved by:

........................................................

date

Midas

Confirmed by:

PK 09.01 /Supplement 7/..............................................................................................................................................................................................................................................................................(

for Bank use only )

hour

signature