‫ﻧﺼ ّﻴﺔ ﻗﺼرية أﻓﺮاد‬

ّ ‫منﻮذج ﻃﻠﺐ ﺧﺪﻣﺔ رﺳﺎﺋﻞ‬

Short message service application form for individuals

..................... : ‫اﻟﺘﺎرﻳﺦ‬ ......................... : ‫اﻟﻔﺮع‬

‫ﺗﻐري رﻗﻢ اﻟﻬﺎﺗﻒ‬ ‫اﺷﱰاك ﺟﺪﻳﺪ‬
CUSTOMER INFORMATION

Customer Name ‫اﺳﻢ اﻟﺰﺑﻮن‬

Passport No. ‫رﻗﻢ ﺟﻮاز اﻟﺴﻔﺮ‬

Account No. ‫رﻗﻢ اﻟﺤﺴﺎب‬

Mobile No. ‫رﻗﻢ اﻟﻬﺎﺗﻒ اﻟﻨﻘﺎل‬

‫ﺗﺎﻛﺪ ﻣﻦ رﻗﻢ اﻟﻬﺎﺗﻒ اﻟﻨﻘﺎل‬

Address ‫ﻋﻨﻮان اﻟﺴﻜﻦ‬

USTOMER CONFIRMATION
CCUSTOMER DECLARATION ‫إﻗﺮار اﻟﺰﺑﻮن‬

Authorized Signatory

Name: --------------------------------------------------------------------------------------------------------------------------------------------------------- :

Signature: ------------------------------------------------------------ : Date: ------------------------------------------------------------------ :

FOR BANK USE ONLY ‫ﻻﺳﺘﻌامل اﳌﴫف ﻓﻘﻂ‬

RECEIVED AND VERIFIED BY ‫اﺳﺘﻠﻤﺖ وﺗﻢ ﻣﻄﺎﺑﻘﺔ اﻟﺘﻮﻗﻴﻊ ﻣﻦ ﻗﺒﻞ‬

TIME ‫اﻟﻮﻗﺖ‬ DATE ‫اﻟﺘﺎرﻳﺦ‬

SIGNATURE ‫اﻟﺘﻮﻗﻴﻊ‬

MEMBERSHIP FEES DEDUCATION Individuals 18 LYD ‫ل‬.‫ د‬18 ‫اﻷﻓﺮاد‬ ‫ﺧﺼﻢ رﺳﻮم اﻻﺷﱰاك‬

Individuals 10 LYD ‫ل‬.‫ د‬10 ‫اﻷﻓﺮاد‬ ‫ﺧﺼﻢ ﺗﻐﻴري رﻗﻢ اﻟﻬﺎﺗﻒ‬

NAME AND STAFF SIGNATURE ‫اﺳﻢ وﺗﻮﻗﻴﻊ اﳌﻮﻇﻒ‬

Bank Forms : ٠١/٢٠