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Sucursala/ Branch:

CUI: Nr.Reg.Com:

Data/ Date:

Operator de date cu nr./ Data operator no.: 1547

Rezidenta/ Residence: Client Rezident/Resident Client Nerezident/Non-resident

Capital Social/ Registered Capital: Autohton/Local Mixt/Mixed Strain/Foreign

Forma de proprietate/ Ownership: Privat/Private Mixt/Mixed Stat/StateDetalii client/ Client details

Denumire Titular cont/ Account holder name:

Nr. Registrul Comertului/Trade Register No.: CUI/Fiscal code:

Capital social/Share capital: Moneda/Ccy

Adresa sediu social/Address o f registered of fice: Strada/Street:

Nr./No.: Bl.: Sc./Ent. Ap./App.: Localitate/City:

J udet/County: Tara/Country: Sector/District:

Telefon/ Phone: Fax: Web: E-mail:

Tara/Country: Cod CAEN: Obiect activitate/Object of activity:

Adresa sediu central/ Address of headquarters:

Adresa de corespondenta/ Mai li ng address*:

Forma de Organizare/Organization Form

Societate comerciala cu raspundere limitata sau pe actiuni/Limited or share Company

Regie autonoma/Regies autonomes Fundatie/Foundation

Reprezentanta/Representative office Persoana juridica non-profit/Non-profit company

Persoana fizica autorizata/Free lancer Altele/Others:

Alte Informati i/Addit ional in formation Companie Off-shore/Off-shore companyActionari Off-shore/Off-shore shareholders Companie cu actiuni la purtator/Bearer shares company

Solicitare client/ Client's request:

Subsemnata, reprezentata legal prin: The undersigned, dully represented by:

si prin: and by:

solicit deschiderea urmatoarelor conturi: I request the opening of the following accounts:

RON IBAN: R O BSEA

EUR IBAN: R O BSEA

USD IBAN: R O BSEA

IBAN: R O BSEA

IBAN: R O BSEA

IBAN: R O BSEA

Declaratie Sursa Fondurilor/Source Funds Statement*

EMPORIKI BANK ROMANIA S.A . Capital Social: 196.089.737,27 RON

Str.Berzei 19, Sector 1, Bucuresti, Romania Pag. 1 of 2 Cod unic de inregistrare: 8490099

+40 21 310.3955, +40 21 315.9783; +40 21 310.3991 Reg. Comertului Nr. J 40/3797/1996

bank@emporiki.ro; http://www.emporiki.ro Registrul Bancar Nr. RB-PJ R-40-033/1999

*Declaratie in conformitate cu Regulamentul BNR nr. 9/2008 privind "Cunoasterea clientelei in scopul prevenirii spalarii banilor si finantarii terorismului" / Statementas per

NBR Regulation no. 9/2008 on the KYC standards

CERERE DE DESCHIDERE CONT CURENT - PERSOANE JURIDICEACCOUNT OPENING APPLICATION - LEGAL ENTITIES

Se va compl eta de

catre Banca/ To be

filled in by the

Bank:

Subsemnatul .., declar

pe proprie raspundere, sub sanctiunea legii, ca sursa

fondurilor la momentul deschiderii contului si pe

parcursul relatiei cu banca, este si va fi:

The undersigned , I declare

in full responsibility and under the law provisions, that the

source of funds at the account opening date and during

the relation with the bank, is and will be:

7/28/2019 Cerere Deschidere Cont PJ Aprobat 15.12.2009 Valabil Din 17.12.2009

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Declaratie Beneficiar Real/Real Beneficiary Owner Statement*

Alte declarati i/Other Statements

Servicii suplimentare/ Additional services

Parola cont/ Account password**

Semnaturi/ Signatures

Titular de cont Banca

Stampila/Stamp Stampila/Stamp

** Parola poate contine: litere, cifre, caractere speciale. The password can contain: letters, numbers, simbols.

EMPORIKI BANK ROMANIA S.A . Capital Social: 196.089.737,27 RON

Str.Berzei 19, Sector 1, Bucuresti, Romania Pag. 2 of 2 Cod unic de inregistrare: 8490099

+40 21 310.3955, +40 21 315.9783; +40 21 310.3991 Reg. Comertului Nr. J 40/3797/1996

bank@emporiki.ro; http://www.emporiki.ro Registrul Bancar Nr. RB-PJ R-40-033/1999

*Declaratie in conformitate cu Regulamentul BNR nr. 9/2008 privind "Cunoasterea clientelei in scopul prevenirii spalarii banilor si finantarii terorismului" / Statement as per

NBR Regulation no. 9/2008 on the KYC standards

Representanti

legali / Legalrepresentatives

:

Nume/Name:

Semnatura: Aprobat de/Approved by:

Nume/Name:

Director Sucursala / Branch Manager

Semnatura /Signature:

Nume/Name:

Semnatura:

Nume/Name:

Functie/Position:

Semnatura /Signature:

Subsemnatul declar pe propria raspundere, sub

sanctiunea legii ca beneficiarul(ii) real(i) este/sunt

(nume,prenume):

The undersigned, I hereby state in full responsibility, under

the law provisions that the real beneficiary(ies) is/are

(name, surname):

Subsemnatul .., in

calitate de reprezentant legal al ..............................,

declar ca am luat cunostinta de prevederile Conditiilor

Generale de Afaceri ale Bancii, cu care declar ca sunt de

acord. Prin semnarea prezentei, confirm ca am primit un

exemplar al Conditiilor Generale de Afaceri ale Bancii si

imi asum raspunderea pentru realitatea si corectitudinea

datelor si informatiilor furnizate in prezentul formular.

The undersigned ., as

legal representative of .................................., I hereby

state to have acknowledge the stipulations of the Bank's

General Business Conditions, to wich I agree. By signing

the hereby statement, I confirm to have received a copy of

the Bank's General Business Conditions and I am liable for

the truthfulness and correctness of data and information

provided hereby.

Obtinerea de informatii prin telefon la Call Center/

Sucursala, privind soldurile conturilor dvs.si tranzactiile

efectuate pe acestea.

Obtaining informations by phone via Call Center/ Branch

relating to your account balance and your transactions.

Subsemnatul, ma oblig sa comunic bancii orice

modificare referitoare la cele declarate mai sus.

I am hereby liable for submitting the bank any

ammendment to the above.

Banca isi rezerva dreptul de a refuza efectuarea

tranzactiilor ordonate de client/de a inceta relatiile cuClientul in cazul unor declaratii false sau daca are

suspiciuni cu privire la realitatea celor declarate de catre

Client.

The Bank reserves the right to refuse performing the

transactions ordered bythe Client/to terminate the relationswith the Client in case of false statements or in case there

are suspicions on the truthfulness of the Client statements.