MB01.

Q-GDCN/76

GIY NG K M & S DNG

TI KHON THANH TON, TH GHI N
(Dnh cho Khch hng c nhn ng k m ti khon thanh ton, pht hnh th ghi n, s dng dch v ngn hng in t,
ng k ln u hoc ng k b sung v ng k s dng gi sn phm ti khon thanh ton)

Knh gi: Ngn hng TMCP Vit Nam Thnh Vng (VPBank) - Chi nhnh/Phng giao dch: .

Ngy: .
I.THNG TIN KHCH HNG (thng tin du(*) l bt buc)
H v tn*: . Gii tnh*: Nam N
i tng*: C tr Khng c tr Ngy sinh*: .
Quc tch*: Khch hng lit k y tn cc quc gia m
Khch hng mang quc tch: Vit Nam Ni sinh*: .
S CMND/H chiu/Th cn cc cng dn*: . Ngy cp*:. Ni cp* : .
S th thc nhp cnh*(Trong trng hp l Vit kiu, ngi nc ngoi, ngi khng quc tch/ngi c t 2 quc tch tr ln): . Hiu lc*:
Ni cp:. t..n.
a ch ni hin ti*: Phng/X: .Qun/Huyn: .Tnh/TP: .
Thi gian c tr ti a ch hin ti (T nm)*: .
a ch thng tr*: .Phng/X: .Qun/Huyn: .Tnh /TP: .
in thoi di ng*: . in thoi c nh*: Email*: KHkhongcoemail@
a ch c tr ti nc ngoi*(Trong trng hp l Vit kiu, ngi nc ngoi, ngi khng quc tch/ngi c t 2 quc tch tr ln):..
Anh/Ch c th xanh do Chnh ph M cp khng?* C Khng
Anh/Ch c phi l c nhn lu tr ti M 1 khng (lu tr t nht 31 ngy trong nm hin ti v 183 ngy trong giai on 03 nm, bao gm nm hin ti v 02 nm lin k trc )?* C
Khng
Anh/Ch c hng dn chuyn tin thng xuyn no ti mt ti khon c duy tr ti Hoa K hoc hng dn nhn tin thng xuyn t mt a ch ti Hoa K 2 khng?* C Khng
Anh/Ch c a ch ti Hoa K (bao gm c a ch hp th P.O.box) hay s in thoi Hoa K khng?* C Khng
Anh/Ch c y quyn cho ngi c a ch ti Hoa K khng?* C Khng
Anh/Ch c a ch gi qua hoc gi th l a ch duy nht ti Hoa K hay khng3?* C Khng

Tnh trng hn nhn*: c thn kt hn Khc (xin ghi r)

Trnh hc vn*: Trung hc Cao ng/i hc Sau i hc Khc (xin ghi r)
Hnh thc cng vic*:
T doanh CBNV Cng ty
Thi trang Ngn hng
Chuyn mn
gia dng Vin thng
in my Bc s Sn xut Khc
Gio vin Hc sinh/sinh vin
Vt liu Thng mi
Khc Cng an Khc Ngh hu
B i Lao ng t do
Khc Khc:
Gim c/Ph Gim c Trng phng/Ph phng Nhn vin/Chuyn vin
Chc v*: Hiu trng/Hiu ph Trng khoa/Ph khoa Cng nhn Khc
Tn c quan: .....
.., Phng/X: .., Qun/Huyn: .Tnh/TP: .
a ch c quan: Thi gian bt u lm vic ti c quan hin ti: Thng.. nm...
Di 4,5 triu/thng 30 ti di 45 triu/thng
4,5 ti di 7,5 triu/thng 45 ti di 75 triu/thng
Thu nhp hng thng (VND)*:
7,5 ti di 15 triu/thng 75 ti di 150 triu/thng
15 ti di 30 triu/thng T 150 triu/thng tr ln
H tn, CMND, a ch ca ngi c chuyn giao ti khon khi ch ti khon (hoc ch ti khon thanh ton chung) l c nhn cht hoc tuyn b mt tch:
..
* S in thoi v email c ng k mc Thng tin khch hng s l s in thoi v email mc nh cho giao dch Ngn hng in t (in thoi/email nhn OTP, mt khu truy cp ln u
v cc thng tin kch hot, thng tin ngn hng).
OTP l mt khu truy cp c s dng mt ln cho mi giao dch ngn hng in t pht sinh. Trc mi ln Khch hng thc hin giao dch, h thng ca VPBank s t ng gi OTP qua a ch
th in th hoc tin nhn SMS ti s in thoi di ng m Khch hng ng k vi VPBank.
II. THNG TIN GIA NH/TI SN
H tn y v/chng (Nu c): Nm sinh:. . in thoi di ng: ..
Hnh thc cng vic ca v/chng:
T doanh Chuyn mn CBNV Cng ty
Thi trang Bc s Ngn hng Khc
gia dng Gio vin Vin thng Hc sinh/sinh vin
in my Cng an Sn xut Ngh hu
Vt liu B i Thng mi Lao ng t do
Khc Khc Khc Khc:
S con trai: .. Nm sinh ca cc con: /../../.;
S con gi: .. Nm sinh ca cc con: ././.../.....;
Hnh thc s hu nh: Nh ring Nh b m Nh thu Nh cng ty Khc
S hu t: C/s lng: Khng

III. NG K M TI KHON
Ti khon thanh ton Ti khon a tin ch
Loi ti khon Ti khon VP Super Khc
Loi tin VND USD Khc
ng k nhn sao k Nhn qua email
Nhn qua SMS

IV. NG K M TH
Th Autolink
Th ghi n ni a Th VPSuper Trao sau
Th khc:. Trao ngay (khng c tn khch hng trn th)
Th ghi n quc t MC2 Th Platinum MasterCard Th Platinum MasterCard VNA

1
C nhn lu tr ti Hoa K y c hiu l c nhn lu tr ti Hoa K (i) t nht 31 ngy trong nm hin ti v (ii) 183 ngy trong giai on 3 nm, bao gm nm hin ti v 2 nm lin k trc (s ngy nm hin ti + 1/3 s
ngy ca nm lin trc + 1/6 s ngy ca 2 nm trc nm hin ti)
2
Cc hng dn chuyn tin v nhn tin y c hiu l cc hng dn chuyn tin/nhn tin thng xuyn p dng cho thi im hin ti c cung cp bi ch ti khon, hoc mt ngi i din ca ch ti khon, s lp li
m khng cn hng dn no thm bi ch ti khon
3
a ch gi qua hay a ch gi th c hiu l yu cu Bu in Hoa K gi th cho mt a ch xc nh thay v giao th cho ngi nhn. Ngoi ra, ch ti khon/ngi c y quyn khng c a ch c tr hoc a ch
gi th no khc.
 Th Lady MasterCard
Th Gold Club MasterCard Khc
S ti khon lin kt vi th TK chnh TK ph th 1 TK ph th 2
Tn in ni trn th (ti a 20 k t, ch in hoa, khng du):
Khch hng ng k 1 trong 2 thng tin di y kch hot Th. Nu Khch hng la chn trng thng tin Cu hi bo mt, Khch hng s kch hot Th bng hnh thc gi in ln tng i
CSKH 24/7 hoc bng hnh thc gi tin nhn theo c php quy nh ca VPBank. Nu Khch hng la chn trng thng tin M bo mt , Khch hng s kch hot Th bng hnh thc gi tin
nhn theo c php quy nh hoc bng hnh thc gi in thoi ln h thng Phone Banking hoc bng hnh thc gi in ln tng i CSKH 24/7 ca VPBank. Ngoi cc hnh thc kch hot nu
trn, Khch hng c th kch hot th theo cc hnh thc khc theo quy nh ca VPBank tng thi k.
Cu hi bo mt: H v tn m ch th: Tn trng tiu hc ca ch th: .
M bo mt (gm 4 ch s) :
ng k nhn th:
Nhn ti Chi nhnh pht hnh
Gi cho khch hng qua ng Bu in (khch hng chu chi ph chuyn pht) ti a ch:
V. CC NI DUNG NG K KHC:
1. ng k s dng dch v Ngn hng in t: (KH khng ng s dng dch v)
Bng vic k Giy ng k ny, Khch hng ng ng k s dng dch v Internet Banking (VPBank Online) vi thng tin ng k nh sau:
Tn truy cp
(Khch hng c s dng ng dng VPBank Mobile khi ng k Internet Banking thnh cng)
Phng thc nhn m OTP mc nh Qua email Qua TDD
ng k gi dch v Gi truy vn Gi tiu chun Gi cao cp
ng k hn mc giao dch Hng A Hng AA Hng AAA
Khch hng la chn ng k mt hoc cc dch v sau y:
VPBank SMS
VPBank Bankplus (p dng cho thu bao di ng Viettel). S in thoi ng k VPBank Bankplus
2. ng k s dng Gi sn phm ti khon thanh ton:
ng k s dng Gi sn phm ti khon thanh ton a tin tch Executive Package
Trn c s c, c gii thch, hiu r v cc tnh nng, c im, iu kin ca Gi ti khon thanh ton a tin ch Executive Package, Khch hng ng ng k s dng Gi ti khon thanh ton a tin ch theo quy nh ca
VPBank vi thng tin ng k v c ch thc hin nh sau:

Gi ti khon thanh ton a tin ch Executive Package bao gm: Ti khon thanh ton, Th VP Super v Dch v ngn hng in t (VPBank SMS, VPBank online gi cao cp) theo thng tin ng k trn y.

Loi ti khon:

Loi 1: S d ti thiu l 500.000 VND v s d trung bnh 3 triu VND/thng trn ti khon

Loi 2: Khng yu cu s d ti thiu, cam kt tr lng v ti khon v mi thng pht sinh t nht 1 giao dch ghi c t giao dch tr lng, gi tr t 5 triu VND tr ln (duy tr s tin ny trn ti khon trong thi gian
ti thiu l 1 ngy lm vic)Ph qun l ti khon, ph ng ti khon v cc loi ph khc: Theo biu ph quy nh ca VPBank tng thi k.

Ti khon s c t ng chuyn sang trng thi tm kha sau 6 thng lin tip khng pht sinh cc giao dch ti chnh (khng bao gm cc giao dch tnh li ca VPBank) v/hoc theo cc quy nh khc v tm kha ti
khon ca VPBank trong tng thi k. chm dt vic tm kha, ti khon cn pht sinh giao dch ti chnh ti thiu 100.000 VND. Ngay ti thi im ti khon pht sinh giao dch ti chnh, VPBank c tip tc thu ph
Qun l ti khon theo nguyn tc v thu ph qun l ti khon ca VPBank trong trng hp VPBank cha thu s ph qun l ti khon cn thu.

Trng hp ti khon c s d bng (=) 0 trong 12 thng lin tip, VPBank c t ng ng ti khon. s dng li ti khon thanh ton, Khch hng phi m ti khon mi.

Khi Khch hng khng p ng c cc iu kin c hng cc u i theo Gi ti khon thanh ton a tin ch Executive Package, VPBank c quyn chm dt cc u i (nu c) dnh cho Khch hng ngay
khi Khch hng khng p ng c iu kin hng u i v thc hin thu ph i vi cc cc dch v/ sn phm m Khch hng ang s dng theo biu ph quy nh ca VPBank.

Cc c ch v cc quy nh khc lin quan n Gi ti khon thanh ton a tin ch Executive Package khng c ng k ti Giy ng k ny s c thc hin theo quy nh ca VPBank tng thi k.

ng k s dng Gi Sn phm ti khon thanh ton VPSuper

Trn c s c, c gii thch, hiu r v cc tnh nng, c im, iu kin ca Gi Sn phm ti khon thanh ton VP Super, Khch hng ng ng k s dng Gi Sn phm ti khon thanh ton VP Super theo quy nh ca VPBank
vi thng tin ng k nh sau:

- Gi ti khon thanh ton VP Super bao gm:

Ti khon VP Super
M mi ti khon theo thng tin ng k nu trn Chuyn i ti khon: ..

Dch v Ngn hng in t (VPBank SMS, VPBank online gi cao cp)

Th VP Super
(theo thng tin ng k nu trn)

- Cc quy nh khc lin quan n Gi Sn phm ti khon thanh ton VP Super khng c ng k ti Giy ng k ny s c thc hin theo quy nh ca VPBank tng thi k.
ng k s dng Gi sn phm ti khon thanh ton chun - Standard Bundle
Trn c s c, c gii thch, hiu r v cc tnh nng, c im, iu kin ca Gi Sn phm ti khon thanh ton chun - Standard Bundle, Khch hng ng ng k s dng Gi Sn phm ti khon thanh ton chun - Standard
Bundle theo quy nh ca VPBank vi thng tin ng k nh sau:

- Gi Sn phm ti khon thanh ton chun - Standard Bundle bao gm: Ti khon thanh ton, Th Autolink v Dch v ngn hng in t (VPBank SMS, VPBank online gi tiu chun) theo thng tin ng k trn y.

- Cc quy nh khc lin quan n Gi Sn phm ti khon thanh ton chun - Standard Bundle khng c ng k ti Giy ng k ny s c thc hin theo quy nh ca VPBank tng thi k.
Xc Nhn Ca Khch Hng:

1. Ti xc nhn rng cc chi tit, thng tin nu trn l chnh xc, cp nht v y . Ti ng Ngn hng xc thc cc thng tin nu trn t bt k ngun thng tin no m Ngn hng c c.

2. Ti hiu rng, mt tuyn b sai hoc che giu v tnh trng thu ca c nhn Hoa K c th dn n cc ch ti theo php lut thu ca Hoa K, bao gm c FATCA.

3. Ch k ca Ti ti Giy ng k ny s ng thi l ch k mu m Ti s s dng trn cc chng t giao dch c thc hin trc tip ti Tr s Ngn hng. Trong trng hp ch k ca Ti theo Giy ng k ny khc vi
ch k ng k trc ti VPBank th ch k ca Ti ti Giy ng k ny s l ch k c hiu lc v c s dng thay th cho cc mu ch k khc ng k ti VPBank (nu c) trn tt c cc chng t giao dch
m Ti thc hin trc tip ti Tr s Ngn hng. Trng hp Ti ng k m thm ti khon thanh ton qua website ca VPBank, Ti ng rng ch k ca Ti ti Giy ng k ny s ng thi l ch k mu m Ti s s
dng trn cc chng t giao dch i vi cc ti khon .

4. Trng hp Ti ng k nhn th, pin qua ng bu in, Ti ng v xc nhn rng VPBank c coi l hon thnh vic giao nhn th, pin cho ti khi th, pin c giao ti a ch m ti ng k vi VPBank.
Ti cam kt chu mi ri ro pht sinh do vic ng k nhn th, pin theo phng thc ny tr trng hp ri ro pht sinh do li ca VPBank.

5. Bng vic k tn di y, Ti xc nhn c, hiu r v ng tun theo cc iu kin v iu khon ti Bn iu khon v iu kin v s dng ti khon thanh ton v th ghi n, dch v ngn hng in t ca Ngn
hng, cam kt tun th v chu s rng buc bi cc quy nh ca Ngn hng lin quan ti cc chng trnh, sn phm, u i m Ngn hng s trin khai. Bn iu khon & iu kin v s dng ti khon thanh ton v
Th ghi n, dch v ngn hng in t ca Ngn hng c cng b trn website http://www.vpbank.com.vn.
VI. CH K(NG THI L CH K MU
KHCH HNG/CH TH CHNH
Ch k 1 (K, ghi r h tn) Ch k 2 (K, ghi r h tn)

Ngy Giao dch vin/CSR Trng nhm GDV/TP DVKH

VII. DNH CHO NGN HNG (k, ghi r h tn) (k, ghi r h tn, ng du)
VPBank ng cung cp choXC
khchNHN CA
hng dch sau: HNG SAU KHI KIM TRA TNH TRNG FATCA CA KHCH HNG4
vNGN
Khch hng: c du hiu M khng c du hiu M
M ti khon, s ti khon
Ngi scan
Pht hnh th, s th: . (k, ghi r h tn)
4
Cn c trn thng
Dch v tin Khch
VPBank hng cung cp ti Phn dnh cho Khch hng
SMS
Dch v VPBank Online
Dch v VPBank Bankplus