PRISTUPNICA ZA FIZIKA LICA

INDI,IDUA1 A!!1I(ATI2N 023M

Podaci o osobi Ime i prezime Name and Surname Ulica i broj Address eMail eMail Personal Details JMBG National ID Number Mesto Town Mobilni telefon Mobile !"one #onta$t podaci %e biti upotrebljeni za dosta&ljanje oba&e'tenja (ontact details will be used to deli&er alerts Ser&ice Details *eb ser&is *eb Ser&ice Account details ,aluta (urrencSMS ser&is SMS Ser&ice Transa$cije Transactions Ma$simalni iznos transa$cije Ma.imal Transaction Amount

!odaci o uslu)ama Internet ban$arst&o Internet ban$in) !odaci o ra+unima Broj ra+una Account Number

Izja&a $orisni$a User statement Izja&ljujem pod punom materijalnom i $ri&i+nom od)o&orno'%u da su podaci u o&oj pristupnici ta+ni/ S&i odnosi $oji proiste$nu $ori'%enjem uslu)e ele$trons$o) ban$arst&a bi%e re)ulisani prema op'tim a$tima ban$e u du"u poziti&ni" za$ons$i" propisa/ I "ereb- confirm under penalt- of perjur- or fraud t"at all details I "a&e )i&en in t"is form are true and accurate All issues resultin) from use of electronic ban$in) ser&ices are to be re)ulated accordin) to t"e General Act of t"e ban$ and applicable laws/

!otpis $orisni$a User Si)nature !opunja&a Ban$a Broj pristupnice Application number Datum prijema Aplication Date 0illed b- t"e Ban$ !ristupno mesto !lace of Application !rimio Acceptant