REGISTRATION FORM

Mandatory for individuals eligible to receive payment/reimbursement from the OSCE

(ALL the fields are mandatory)

PERSONAL DETAILS
Gender: Family Name: First name:

Mr.☐/Ms.☐

Date of birth: Nationality: Country of birth:

dd/mm/yyyy

ADRESS DETAILS
Country: Street Name and No: Post Code: City:

Tel. Type Country code No: e-mail:

BANK DETAILS
Account Holder Bank Name:

Bank Address: IBAN:

SWIFT/BIC Code: Account Number:

Bank/Sort Code: (if SWIFT/BIC code not available) Card Number (if available):
N/A

Requested by: Date: Signature:

dd/mm/yyyy

PLEASE ATTACH A COPY OF YOUR PASSPORT OR NATIONAL ID DOCUMENT

Additional Notes (optional)

 Incorrect or incomplete bank details may cause delays of payment

 Any bank charges sustained due to incomplete or incorrect bank details will be incurred by the individual
 In case of any changes (family name, address, bank details etc.) the form must be resubmitted

Privacy Notice: By submitting this form and the information provided herein, you agree and consent to the collection and processing of your personal data
provided in accordance with OSCE regulations and rules.