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Anexa 1 la F1- Cerere de \nscriere/actualizare date persoane juridice/entit`]i f`r` personalitate juridic` Informa]ii

Anexa 1 la F1- Cerere de \nscriere/actualizare date persoane juridice/entit`]i f`r` personalitate juridic` Informa]ii privind beneficiarul real

Appendix 1 to the client’s registration form for legal entities Information on the real beneficiary

Denumire client / Client Name

Cod unic de \nregistrare (CUI)/ Unique Registration Code (URC)*

Denumire client / Client Name Cod unic de \nregistrare (CUI) / Unique Registration Code (URC)*
Denumire client / Client Name Cod unic de \nregistrare (CUI) / Unique Registration Code (URC)*

*In cazul \n care clientul nu are alocat CUI, se va completa Codul de |nregistrare Fiscal`/ Should no URC be available, the Fiscal Code will be provided

Declar`m c` / Declare that:

p persoanele identificate \n prezentul document de]in calitatea de beneficiar real al oric`rei tranzac]ii sau

opera]iuni ce se realizeaz` pe parcursul rela]iei de afaceri [i/sau ocazional` dintre Client [i Banc` / persons identified in this document have the status of the real beneficiaries of any transaction, operations or activity that are made during business relationship and / or occasionally between Client and Bank:

1.

Nume

 

prenume/ Name,

Surname

Data na[terii/

Date of Birth

/

/

Locul na[terii/

Place of Birth

 

CNP/ Personal

 

Ceta]enie/

 

Identification

number

Nationality

Domiciliul/

 

Re[edin]a/

Residence

 

Domicile

Nr. Telefon/Fax /

 

E-mail

 

Phone/Fax No

Ocupa]ia/

Occupation

 

Denumire angajator/

Employer name

 

|n cazul persoanelor fizice

nerezidente/

individuals:

For non-resident

Func]ia public` important` de]inut`/ important public function held

 

Membru direct al familiei dl/dnei/ direct family member of Mr./Mrs

Persoana expus` politic / Politically exposed person

p

DA/ YES

p NU/ NO

|n caz afirmativ, se va bifa situa]ia

aplicabil` [i se vor completa

informa]iile solicitate/

check the applicable situation and fill in the requested information.

If so, please

,

ce de]ine func]ia public` important`/

who holds significant public office Asociat al dl/dnei/ Associate with Mr. / de]ine func]ia public` important`/ who holds significant public office

ce

2.

Nume

 

prenume/ Name,

Surname

Data na[terii/

Date of Birth

/

/

Locul na[terii/

Place of Birth

 

CNP/ Personal

 

Ceta]enie/

 

Identification

number

Nationality

Domiciliul/

 

Re[edin]a/

Residence

 

Domicile

Nr. Telefon/Fax /

 

E-mail

 

Phone/Fax No

Ocupa]ia/

Occupation

 

Denumire angajator/

Employer name

 

|n cazul persoanelor fizice

nerezidente/

individuals:

For non-resident

Func]ia public` important` de]inut` / important public function held

 

Persoana expus` politic/ Politically exposed person

p NU/ NO

p

DA/ YES

Membru direct al familiei dl/dnei / direct family member of Mr./Mrs

 

,

ce de]ine func]ia public` important`/

|n caz afirmativ, se va bifa situa]ia

aplicabil` [i se vor completa

If so, please

check the applicable situation and fill

in the requested information.

informa]iile solicitate /

who holds significant public office Asociat al dl/dnei / Associate with Mr. / de]ine func]ia public` important` / who holds significant public office

ce

Raiffeisen Bank S.A. Administra]ia Central` Pia]a Charles de Gaulle nr.15, sector 1, Bucure[ti Cod 011857 România Telefon +40 21 306 1000 Fax +40 21 230 0700 E-mail: centrala@raiffeisen.ro www.raiffeisen.ro C.U.I. 361820 Num`r de \nregistrare \n Registrul Comer]ului J40/44/1991 Num`r de \nregistrare \n Registrul Bancar RB-PJR-40-009/1999 Cod de \nregistrare fiscal` RO361820 Capital Social 1.200 mil Lei Societate administrat` în sistem dualist Cod BIC RZBRROBU Raiffeisen Direct: 0800 802 02 02 – apel gratuit din re]eaua Romtelecom

40024542

3. Nume

 

prenume/ Name,

Surname

Data na[terii/

Date of Birth

/

/

Locul na[terii/

Place of Birth

 

CNP/ Personal

 

Ceta]enie/

 

Identification

number

Nationality

Domiciliul/

 

Re[edin]a/

Residence

 

Domicile

Nr. Telefon/Fax /

 

E-mail

 

Phone/Fax No

Ocupa]ia/

Occupation

 

Denumire angajator/

Employer name

 

|n cazul persoanelor fizice

nerezidente/

individuals:

For non-resident

Func]ia public` important` de]inut` / important public function held

 

Membru direct al familiei dl/dnei / direct family member of Mr./Mrs

Persoana expus` politic/ Politically exposed person

p NU/ NO

|n caz afirmativ, se va bifa situa]ia

aplicabil` [i se vor completa

informa]iile solicitate /

check the applicable situation and fill

in the requested information.

If so, please

p DA/ YES

,

ce de]ine func]ia public` important`/

who holds significant public office Asociat al dl/dnei / Associate with Mr. / de]ine func]ia public` important` / who holds significant public office

ce

p Nu exist` un beneficiar real, \n conformitate cu defini]ia legal`, deoarece / No real beneficiary, according to

legal definition, because:

p

niciun ac]ionar persoan` fizic` nu de]ine 25%+1 ac]iuni [i nu exist` nicio persoan` fizic` sau grup de persoane fizice care s` controleze \n vreun mod organele de administrare / no

individual shareholder does have 25%+1 share and there is no person or group of individuals in any way to control administrative bodies

p

societate/actionar majoritar (cel putin 75% din capital social) listat pe o piata reglementata /

company / shareholder (with minimum 75% of equity) listed on a regulated market

p

autoritati publice nationale/societati cu actionar majoritar statul /

companies with the State as main shareholder

national public authorities /

p

alte cazuri/ other cases

Prin prezenta declar`m c` ne-a fost pus la dispozi]ie Ghidul de completare a formularelor pentru clien]i persoane juridice / We hereby declare that a copy of the Legal Entities Forms Guide was made available to us.

Nume [i prenume reprezentant legal /

Legal Representative Name and Surname

Semn`tura Reprezentant Legal /

Legal Representative Signature

Data/

Date

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