Catre/To: RAIFFEISEN BANK S.A.

Agentia/Agency: STIRBEI VODA

Data/Date: ###

DISPOZITIE EMITERE ORDIN DE PLATA CONDITIONAT/REQUEST FOR ISSUANCE OF CONDITIONAL PAYMENT ORDER *

(Formularul se completeaza lizibil, manual cu majuscule sau prin procedeu automatizat/The form shall be filled in with capitals, legible
or automatically)
Numele Ordonatorului/Applicant's name: CIF Ordonator / Client ID- se va completa de catre Banca: CNP: 1560518227806

TUTUCA CONSTANTIN

Va rugam sa emiteti in numele meu/nostru prin Swift un Ordin de Plata Conditionat, reprezentand:/
Please issue via Swift Conditional Payment Order representing:
…RAMBURSARE TOTALA CREDIT NR. CONTRACT 7291933 DIN DATA 25/07/2019……………………………………………………………
………………………………………………………………………………………………………………………………………………………
si sa transferati din contul meu/nostru// and transfer from my/our current account:

Cod IBAN platitor/Payer's IBAN: R O R Z B R

suma de/amount:

Moneda/ Suma in cifre/ Suma in litere/Amount in letters:

Currency: Amount in figures: PATRUZECISITREIMIIOPTZECISIPATRURONSIOP
RON 43.084,8 TZECIBANI
catre/to:
Banca Beneficiarului/Beneficiary's Bank: BRD - GROUPE SOCIETE GENERALE

SWIFT BRDEROBU

Numele Beneficiarului (inclusiv numele IFN)/Beneficiary's name (including Financial Institution, if case):
TUTUCA CONSTANTIN
CUI Beneficiar / Beneficiary URC 1560518227806

Cod IBAN Beneficiar/

Beneficiary's IBAN: R O 9 2 B R D E 3 0 0 S V 5 3 1 8 3 1 1 3 0 0 0

Mesaj SWIFT/SWIFT message:

Plata sumei in contul Beneficiarului este conditionata de/The payment to beneficiary's account is conditioned by 1):
LICHIDAREA TOTALA A CREDITULUI 18
7291933 DIN DATA 25/07/2019

Valabilitatea/Expiry Date: 15 ZILE DE LA EMITERE. In cazul neindeplinirii conditiilor stipulate pana la aceasta data, suma
va fi returnata catre RBRO, fara dobanda/In case of nonfulfilment by this date of the above mentioned conditions the amount
will be refunded to RBRO without interest.
Comisioane aplicate/Commissions 2):
Emitere - aplicat la valoarea sumei transferate/Issuing - calculated to the transferred amount
Modificari/Amendments
Anulare/ Cancellation
Speze swift/Swift Charges
Comisioanele RBRO vor fi/ Raiffeisen Bank commissions will be:
- in sarcina mea/noastra/in our charge X in sarcina Beneficiarului/in beneficiary's charge

Comisioanele bancii beneficiare vor fi/ Beneficiary bank commissions will be :

- in sarcina mea/noastra/in our charge in sarcina Beneficiarului/in beneficiary's charge X
RAIFFEISEN BANK S.A., CLIENT_Nume prenume_____TUTUCA CONSTANTIN______________
Nr. operator cf. Reg.UE 2016/679- 1967/189 _____________________________________________________
X TITULAR
Unitate/Departament:_________________________ ☐ MANDATAR
Reprezentant Bancar________________________________ ☐ REPREZENTANT LEGAL
Semnatura autorizata/ Bank signature: Semnatura__________________________________

Data:___________________________ Data: 28/08/2020

Prin semnarea acestui document certific ca am luat la cunostinta de informatiile mentionate pe verso/ By signing this form I certify that I am aware of the information on the back-side.
Se intelege ca aceasta remitere va fi efectuata pe riscul meu/nostru sub
orice aspect, si nici Dvs., nici corespondentii Dvs. nu veti fi
raspunzatori fata de urmarile unei intarzieri, greseli sau omisiuni in
timpul transferului sau platii sau interceptarii mesajului. Termenii si
conditiile generale prevazute de Banca se vor aplica in cazul acestei
cereri.
1)
Se vor mentiona conditiile de indeplinit si/sau documentele de
prezentat.
2)
Comisioanele se vor percepe in valuta contului platitor, reprezentand
contravaloarea comisioanelor exprimata in EUR calculata la cursul
BNR din ziua platii. In cazul in care comisioanele se suporta de catre
ordonatorul platii, acesta are obligatia sa asigure sumele necesare
incasarii de catre banca a contravalorii comisioanelor, prin debitarea
automata a contului platitor, la data emiterii ordinului de plata.
*) In cazul ordinelor de plata conditionate emise in vederea preluarii
unui credit, suntem de acord ca mesajul swift transmis sa contina si
conditia urmatoare: "Suma va fi utilizata exclusiv pentru lichidarea
datoriilor aferente contractului(lor) si/sau facilitatii(lor) nr.
…………………………din data de …..………….. acordata(e) de
banca mai sus mentionata beneficiarului mentionat mai sus" (datele se
vor completa de catre Ordonator).
Subsemnatul ordonator declar pe propria raspundere, avand deplina
cunostinte despre prevederile legale privind falsul in declaratii, ca
fondurile transferate au origine licita si au ca suport tranzactii reale,
justificate prin documente. Prezenta operatiune respecta prevederile
legale in vigoare, are caracter licit, nu are drept scop "spalarea"
banilor sau finantarea de acte de terorism si se circumscrie activitatii
mele statutare. Totodata, ma oblig ca in termen de 2 zile sa prezint
orice documente solicitate de banca, cunoscand faptul ca banca isi
rezerva dreptul de a nu efectua operatiunea in cazul neprezentarii
acestor documente.
It is understood that this remittance will be made on my / our risk on all
points, and neither you nor your correspondents will not be liable for
any consequences of delays, errors or omissions that might occur during
the transfer, payment or message interception. Bank's General
Conditions will apply for this request.
1)
Precedent conditions and/ or other documents to be presented
should be mentioned.
2)
Fees and commission will be charged from the paying account
currency, by applying NBR exchange rate for EUR, valid on the date of
payment. In case the commission are indicated to be charged from the
ordering customer, he must make the due amounts available for the
Bank on the issuance date, in order to charge it through automatic debit
transaction.
*) In case of Conditional Payment Orders issued for refinancing, we
agree to include in the SWIFT message, the following condition: "The
amount will be exclusively utilized for debts liquidation arising from the
contract(s) and / or facility(ies) no. ………………………… date …..
………….. granted by the above mentioned bank to the above mentioned
beneficiary " (data shall be filled in by the Applicant).
The undersigned applicant, I declare on my own responsibility, having
full knowledge of the perjury regulations, that the funds subject to this
transfer are generated by real transactions, based on justifying
documents. This operation is compliant with the current regulations and
is not intended to "money laundering" or terrorist activities financing
and is under my object of activity.
Also, I
agree that within 2 days to submit any other documents requested by the
bank, being informed that the bank reserves the right not to perform the
operation in case of non-presenting these documents.
De asemenea, in cazul anularii sau expirarii ordinului de plata
conditionat, declar ca nu voi solicita dobanda aferenta perioadei
scurse din momentul transferarii sumei la emitarea ordinului de plata
conditionat si pana la data returnarii acesteia de catre Banca
Beneficiarului.
Also, in case of cancellation or expiration of the conditional payment
order, I certify that I will not ask for interest related to the period
elapsed from the issuance of the conditional payment order up to the
date that the amount is returned by the Beneficiary Bank.