Application to open a foreign currency savings account

Slobodni smo zamoliti Vas da zahtjev popunite itko, tiskanim slovima, koristei kemijsku olovku ili tintu./

Fill the application form legibly, using a ball-point pen or ink pen, in capital letters.

Personal details of the Applicant

Ime i prezime/ First Name and
Last Name

OIB

Adresa stanovanja/ Address

Mobilni
telefon/
Cellular
E-mail adresa/
E- mail
address
Rezident/
Resident

Telefon/ Home Tel No.

Telefaks/ Fax number

Oznaka rezidentnosti/ Status of
residence:

broj osobne
iskaznice i
mjesto
izdavanja/ ID
card number and
place of
issuance
Mjesto i
potanski broj/
City and postal
code
Telefon na
poslu/ Work Tel.
No.

Nerezident/ Non- resident

Nain dostave izvatka (samo na pismeni zahtjev Klijenta): (zaokruiti broj)/ Statement delivery method (upon the written request of the
Cutomer only): (circle the number)
1

Potom/ by mail

a)

Telefaksom/ by fax

u poslovnici KentBank d.d. in the branch.

ne dostavlja se/ not to be delivered

Na adresu s osobne iskaznice/ to the ID card address

Punomo/ Authorization
Za raspolaganje sredstvima na deviznom tednom ulogu, otvorenom temeljem ovog zahtjeva, opunomoujem:/ I, hereby, give authority to
manage funds on the foreign currency account to the following person:
Ime i prezime/ First Name and
Last Name

OIB

Adresa stanovanja/ Address

Telefon/ Phone

Mobilni
telefon/ Mobile

broj osobne
iskaznice i
mjesto
izdavanja/ ID
card number and
place of
issuance
Mjesto i
potanski broj/
City and postal
code
Telefon na
poslu/ Phone at
work

E-mail adresa/
E mail
address
Opunomoenik IMA NEMA pravo zatvoriti devizni tedni ulog./ Authorized person HAS GOT/ HASN'T GOT the right to close the foreign
currency savings deposit account.
Telefaks/ Fax

Pod materijalnom i krivinom odgovornou potvrujem da su podaci koje sam popunio(la) u ovom zahtjevu ispravni i istiniti. Pozitivnim rjeenjem ovog
zahtjeva potvrujem da prihvaam ope uvjete poslovanja i akte Banke koji reguliraju ovu problematiku.
Izriito izjavljujem da sam KentBank d d. dobrovoljno stavio(la) na raspolaganje podatak o svom osobnom identifikacijskom broju, te dajem suglasnost Banci

da se istim koristi u cilju identifikacije, zatite baninih i mojih osobnih interesa u poslovanju.. Under penalty of perjury I hereby certify that the
information I have filled in this application are true and correct. I confirm that I accept the general terms and regulations of the Bank relating to this
issue.
I explicitly declare that I voluntarily made available information on my personal identity number to KentBank d. d. and I, hereby, give my consent
that the same is used for the purpose of identifying, protecting the bank's and my personal interest in the business operations.

Potpis podnositelja zahtjeva/

Applicant's signature:

Potpis opunomoenika/ Authorized person's signature:

------------------------------------------------

-----------------------------------------

Popunjava Banka/ To be filled by the Bank

Datum zaprimanja zahtjeva/ Date of application receipt:
Datum otvaranja rauna/ Date of opening account:
Peat i potpis Banke/ Seal and signature of the Bank:
Broj rauna/ Account no: