Request for Contracting m-token for Business Entities
FOR ACCOUNT-IBAN
H R
2360 0 0 0 1
Name of the business entity1
1
From the Decision on Entry into the Register of Companies or other relevant document
PIN
Company Registration No.
M
AUXILIARY FOR
NOT TO BE
FILLED-IN
-
AUTHORIZED PERSON DATA
Name and surname
Citizen ID No.
PIN
Mobile phone number
Mobile phone brand
Mobile phone model
Identity document type
Valid until
Identity document number
Identity document issued by
Issuing country
ADDRESS (PLACE OF RESIDENCE)
Street and number
Postcode and place
ALTERNATIVE ADDRESS OF THE AUTHORIZED PERSON2
Street and number
Postcode and place
2
Activation key receipt
By mail3 The Bank shall also send statements of account and other notifications pertaining to private citizens’ account to the address indicated; to be filled in by authorised persons who would like their activation
key to be delivered to an alternative address.
Via SMS4
Receipt of identification key via e-mail
Delivery to the permanent residence address/alternative address
Sent to mobile phone numbers operated by both, domestic mobile phone operators and foreign mobile phone operators
3
4
Signature of the representative
Date of receipt
Bank stamp and signature
Signature of the representative
Stamp
May 2014
Place and date
The English translation of the original Form is provided for information purposes only.
Croatian original of the Form needs to be signed.
Welcome
Zahtjev za ugovaranje m-tokena za poslovne subjekte
za račun _ iban
H R
2360 0 0 0 1
Naziv poslovnog subjekta1
1
iz Rješenja o upisu ili odgovarajućeg akta
Matični broj
OIB
-
PODACI O OVLAŠTENIKU
Ime i prezime
MBG
OIB
Broj mobilnog uređaja
Tip mobilnog uređaja
Vrsta mobilnog uređaja
Vrsta identifikacijske isprave
Vrijedi do
Broj identifikacijske isprave
Izdavatelj identifikacijske isprave
Zemlja izdavanja
ADRESA PREBIVALIŠTA
Ulica i kućni broj
Broj pošte i mjesto
ALTERNATIVNA ADRESA OVLAŠTENIKA2
Ulica i kućni broj
Broj pošte i mjesto
Na upisanu adresu Banka će dostavljati i izvatke i ostalu pisanu komunikaciju po računima građana.
Upisuju ovlaštenici koji žele dostavu aktivacijskog ključa na adresu različitu od adrese prebivališta.
2
Primanje aktivacijskog ključa
Poštom3 SMS-om4
Primanje identifikacijskog ključa na e-mail
4
Mjesto i datum
Datum zaprimanja
Potpis zastupnika
Ovjera Banke
Dostava na adresu prebivališta/alternativnu adresu
Šalje se na brojeve mobilnih operatera u zemlji i inozemstvu
Potpis zastupnika
M.P.
svibanj 2014.
3