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Bank detail form

for KIC InnoEnergy Scholarship holders (MSc EMINE)


Name of the KIC InnoEnergy Programme
EMINE
Name
Daniel Catalin

Current Address (street, c/o, postal code, city, country)


Drottning Kristinas Vag 43B, 1309, 114 28, Stockholm,
Sweden

Family name
Tanase

E-mail
Danbeta11@gmail.com
Telephone
+40733073430

Information for transfer of funds


Name of the bank
Raiffeisen Bank

Social security number, if applicable


1930214297259

Address of the bank


Calea Floreasca, Nr. 246C, Sector 1,
014476

City
Bucuresti

SWIFT code
RZBRROBU

Bank account number


17899719

Country
Romania

IBAN number
RO37 RZBR 0000 0600 1789 9719

I consent to the deduction of the part of the KIC InnoEnergy Scholarship that is contributed to the
participation cost.
Stockholm, 28.08.2015

Place and date


Please return this form by e-mail or fax to:
Christine DOMINJON
E-mail: Christine.dominjon@grenoble-inp.fr

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Signature

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