‫ﻧﻤﻮﺫﺝ )ﺃ( ﺑﻨﻮﻙ‬

‫ﻧﻤﻮﺫﺝ ﺗﺮﺧﻴﺺ – ﺑﻨﻚ ﻭﻃﻨﻲ‬
‫‪ -1‬ﺍﺳﻢ ﻃﺎﻟﺐ ﺍﻟﺘﺮﺧﻴﺺ‪.....................................................:‬‬
‫‪ -2‬ﺍﻟﻌﻨﻮﺍﻥ ‪.......................................................................................... :‬‬
‫ﺍﻟﻔﺎﻛﺲ ‪...................................:‬‬

‫ﺍﻟﻬﺎﺗﻒ ‪................................:‬‬
‫‪ -3‬ﻧﻮﻉ ﺍﻟﻨﺸﺎﻁ ﺍﻟﻤﻄﻠﻮﺏ‪:‬‬
‫ﺗﻘﻠﻴﺪﻱ‬

‫ﺇﺳﻼﻣﻲ‬

‫ﺑﻨﻚ ﺗﺠﺎﺭﻱ‬
‫ﺑﻨﻚ ﻣﺘﺨﺼﺺ‬
‫ﻋﻘﺎﺭﻱ‬
‫ﺻﻨﺎﻋﻲ‬
‫ﺃﺧﺮﻯ )ﺗﺬﻛﺮ(‬
‫‪ -4‬ﺭﺃﺱ ﺍﻟﻤﺎﻝ ‪- :‬‬

‫ﺍﻟﻤﺼﺮﺡ ﺑﻪ ‪.............................:‬‬
‫ﺍﻟﻤﺪﻓــــﻮﻉ ‪............................... :‬‬

‫ ) ﺭﺃﺱ ﺍﻟﻤﺎﻝ ﺍﻟﻤﺪﻓﻮﻉ ﺍﻟﻼﺯﻡ ﻟﺒﺪء ﺍﻟﻨﺸﺎﻁ ﻳﺠﺐ ﺃﻻ ﻳﻘﻞ ﻋﻦ ﻣﻠﻴﺎﺭ ﺭﻳﺎﻝ ﻗﻄﺮﻱ (‪.‬‬‫‪ -5‬ﺍﻟﻤﻘﺮ ﺍﻟﻤﻘﺘﺮﺡ ﻟﻠﺒﻨﻚ ﺍﻟﻤﻄﻠﻮﺏ ﺗﺮﺧﻴﺼﻪ‪-:‬‬
‫‪ -6‬ﺍﻟﻤﺮﻓﻘﺎﺕ ﺍﻟﻤﻄﻠﻮﺑﺔ‪-:‬‬
‫‪ o‬ﻋﻘﺪ ﺍﻟﺘﺄﺳﻴﺲ‪.‬‬
‫‪ o‬ﺍﻟﻨﻈﺎﻡ ﺍﻷﺳﺎﺳﻲ‪.‬‬
‫‪ o‬ﺩﺭﺍﺳﺔ ﺍﻟﺠﺪﻭﻯ ﺍﻻﻗﺘﺼﺎﺩﻳﺔ ﻣﺘﻀﻤﻨﺔ ﺧﻄﻂ ﺍﻷﻋﻤﺎﻝ ﻭﺍﻻﺳﺘﺮﺍﺗﻴﺠﻴﺎﺕ‬
‫ﻭﺍﻟﻤﻮﺍﺯﻧﺎﺕ ﺍﻟﺘﻘﺪﻳﺮﻳﺔ ﻭﺍﻟﻤﺆﺷﺮﺍﺕ ﺍﻟﻤﺎﻟﻴﺔ ﻟﺜﻼﺙ ﺳﻨﻮﺍﺕ‪.‬‬
‫‪ o‬ﺑﻴﺎﻥ ﺑﺄﺳﻤﺎء ﻭﺟﻨﺴﻴﺎﺕ ﻭﻋﻨﺎﻭﻳﻦ ﺍﻟﻤﺆﺳﺴﻴﻦ ﻭﻧﺴﺐ ﻣﺴﺎﻫﻤﺘﻬﻢ ‪.‬‬
‫‪ o‬ﺗﻌﻬﺪ ﻣﻦ ﺍﻟﻤﺆﺳﺴﻴﻦ ﺣﺴﺐ ﺍﻟﻨﻤﻮﺫﺝ ﺍﻟﻤﺮﻓﻖ‪.‬‬
‫‪ o‬ﺃﻳﺔ ﻣﻌﻠﻮﻣﺎﺕ ﺃﺧﺮﻯ ﻳﺮﻯ ﻃﺎﻟﺐ ﺍﻟﺘﺮﺧﻴﺺ ﺿﺮﻭﺭﺓ ﺍﻹﻓﺼﺎﺡ ﻋﻨﻬﺎ‪.‬‬
‫‪ o‬ﺭﺳﻮﻡ ﻃﻠﺐ ﺍﻟﺘﺮﺧﻴﺺ ‪ 50‬ﺃﻟﻒ ﺭﻳﺎﻝ ﻏﻴﺮ ﻗﺎﺑﻠﻪ ﻟﻠﺮﺩ‪.‬‬
‫ﺗﻮﻗﻴﻊ ﻃﺎﻟﺐ ﺍﻟﺘﺮﺧﻴﺺ‬

.................................................. :‬ﺍﻟﺘﻮﻗﻴـﻊ ‪.............................. :‬ﺍﻟﺘﻮﻗﻴـﻊ ‪.......... :‬ﺍﻟﺼﻔﺔ‪ .......................................... :‬ﺍﻟﺼﻔﺔ‪ ............................................................................ :‬ﺍﻟﺘﻮﻗﻴـﻊ ‪.............................. :‬ﺍﻟﺼﻔﺔ‪ ........ :‬ﺍﻟﺘﻮﻗﻴـﻊ ‪.. :‬‬ ‫ﺍﻻﺳﻢ ‪ ......................... :‬ﺍﻟﺘﻮﻗﻴـﻊ ‪.................................................‫ﺗﻌﻬـــــــــﺪ‬ ‫ﻧﻘـﺮ ﻧﺤﻦ ﺍﻟﻤﻮﻗﻌﻴﻦ ﺃﺩﻧﺎﻩ ﺃﻧﻨﺎ ﻗﺪ ﺃﻃﻠﻌﻨﺎ ﻋﻠﻰ ﻣﺮﺳﻮﻡ ﺑﻘﺎﻧﻮﻥ ﺭﻗﻢ ) ‪ (33‬ﻟﺴﻨﺔ ‪2006‬‬ ‫ﺑﺸﺄﻥ ﻣﺼﺮﻑ ﻗﻄﺮ ﺍﻟﻤﺮﻛﺰﻱ ﻭﺕﻓﻬﻤﻨﺎ ﺍﻟﺘﺎﻡ ﻟﺠﻤﻴﻊ ﻣﻮﺍﺩ ﻭﺃﺣﻜﺎﻡ ﺍﻟﻘﺎﻧﻮﻥ‪.. :‬‬ ‫ﺍﻻﺳﻢ ‪ . :‬‬ ............... :‬‬ ‫ﺍﻻﺳﻢ ‪ ........ :‬ﺍﻟﺼﻔﺔ‪ ................................................... :‬‬ ‫ﺍﻻﺳﻢ ‪ .......‬‬ ‫ﻭﻧﺘﻌﻬﺪ ﻧﺤﻦ ﺍﻟﻤﻮﻗﻌﻴﻦ ﺃﺩﻧﺎﻩ ﺑﺎﻻﻟﺘﺰﺍﻡ ﺍﻟﺘﺎﻡ ﺑﻜﻞ ﻣﺎ ﺟﺎء ﻣﻦ ﻣﻮﺍﺩ ﻭﺃﺣﻜﺎﻡ ﻓﻲ ﺍﻟﻘﺎﻧﻮﻥ‬ ‫ﻭﺑﺎﻟﻮﻓﺎء ﺑﺸﺮﻭﻁ ﺍﻟﺘﺮﺧﻴﺺ ﻭﺑﺠﻤﻴﻊ ﺍﻟﻘﻮﺍﻧﻴﻦ ﻭﺍﻷﻧﻈﻤﺔ ﻭﺍﻟﺘﻌﻠﻴﻤﺎﺕ ﺫﺍﺕ ﺍﻟﻌﻼﻗﺔ ﺍﻟﻤﻌﻤﻮﻝ‬ ‫ﺑﻬﺎ ﻓﻲ ﺩﻭﻟﺔ ﻗﻄﺮ‪ ،‬ﻭﻛﺎﻓﺔ ﻣﺘﻄﻠﺒﺎﺕ ﻣﺼﺮﻑ ﻗﻄﺮ ﺍﻟﻤﺮﻛﺰﻱ ﻭﻛﻞ ﻣﺎ ﺃﺻﺪﺭﻩ ﻭ ﻣﺎ ﻳﺼﺪﺭﻩ‬ ‫ﻣﻦ ﺗﻌﻠﻴﻤﺎﺕ ﻟﺘﻨﻈﻴﻢ ﺃﻋﻤﺎﻝ ﺍﻟﺒﻨﻮﻙ ﻭﺍﻹﺷﺮﺍﻑ ﻭﺍﻟﺮﻗﺎﺑﺔ ﻋﻠﻴﻬﺎ‪ ،‬ﻛﻤﺎ ﻧﺘﻌﻬﺪ ﺑﺼﺤﺔ ﻭﺩﻗﺔ‬ ‫ﺟﻤﻴﻊ ﺍﻟﺒﻴﺎﻧﺎﺕ ﻭﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﻤﻘﺪﻣﺔ ﺑﻬﺬﺍ ﺍﻟﻄﻠﺐ ﻭﺑﻜﻞ ﻣﺎ ﺃﺭﻓﻖ ﺑﻪ ﻣﻦ ﻣﺴﺘﻨﺪﺍﺕ ﻭ ﻻ ﺗﻮﺟﺪ‬ ‫ﺃﻱ ﻣﻌﻠﻮﻣﺎﺕ ﺇﺿﺎﻓﻴﺔ ﻫﺎﻣﺔ ﺃﺧﺮﻯ ﺑﺨﻼﻑ ﺍﻟﻤﺬﻛﻮﺭﺓ ﻓﻲ ﻫﺬﺍ ﺍﻟﻄﻠﺐ ﻗﺪ ﻳﻜﻮﻥ‬ ‫ﺣﺴﺐ ﻋﻠﻤﻨﺎ ﺓ‬ ‫ﻟﻬﺎ ﺗﺄﺛﻴﺮﻋﻠﻰ ﻗﺮﺍﺭ ﻣﺼﺮﻑ ﻗﻄﺮ ﺍﻟﻤﺮﻛﺰﻱ ﺑﺎﻟﻤﻮﺍﻓﻘﺔ ﻣﻦ ﻋﺪﻣﻪ ﻭﻧﻘﺮ ﺑﻤﺴﺆﻟﻴﺘﻨﺎ ﺍﻟﻘﺎﻧﻮﻧﻴﺔ‬ ‫ﻋﻦ ﺃﻱ ﺑﻴﺎﻧﺎﺕ ﺃﻭ ﻣﻌﻠﻮﻣﺎﺕ ﻳﺜﺒﺖ ﻋﺪﻡ ﺻﺤﺘﻬﺎ‪............................‬‬ ‫ﺗﻮﻗﻴﻊ ﺃﻋﻀﺎء ﺍﻟﻠﺠﻨﺔ ﺍﻟﺘﺄﺳﻴﺴﻲﺓ *‬ ‫ﺍﻻﺳﻢ ‪ ......................................................... :‬ﺍﻟﺼﻔﺔ‪ ..

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