CLIENT S QUESTIONNAIRE

Transcription

1 CLIENT S QUESTIONNAIRE AS Citadele banka, Reģ. nr Republikas laukums 2A, Rīga, LV-1010, Latvija Date... Dear Client! According to the provisions of the law and the standards of the international banking business, it is necessary for the bank to obtain the information as per questions listed in this questionnaire. The bank guarantees that the Client s personal data, data on the Client s accounts, deposits and deeds will be kept secret in accordance with the legislative requirements. Please fill in block letters. All amounts shall be indicated in EUR currency. Thank you for your understanding! 1. Basic information about the client 1.1. Company Name Registration number Legal status (e.g. JSC, Ltd. etc. ) Legal address... (street, house/building name or number, apartment/office No, city (region, inhabited place), zip code, country) 2. Contact information 2.1. Actual address of the main office (street, house/building name or number, apartment/office No, city (region, inhabited place), zip code, country) 2.2. Address for mail correspondence: legal address actual address of the main office other... (street, house/building name or number, apartment/office No, city (region, inhabited place), zip code, country) 2.3. Phone: office Name of the Country/code mobile Name of the Country/code FAX Contact person (the information provided herein will be used if the client can not be reached) 3.1. Type of Bank's service/operation, in reference to which the contact person is to be contacted if client can not be reached: J-N Responsible dept... Client number... (To be filled in by Bank) 3.2. Name, surname Identity number or date of birth Actual address... (street, house/building name or number, apartment/office No, city (region, inhabited place), zip code, country) 3.5. Phone: at work at home mobile FAX Services, products of the Bank, which the client plans to use: 4.1. current account 4.2. savings account 4.3. term deposit 4.4. payment card 4.5. loan / Leasing 4.6. currency transactions 4.7. transactions with financial instruments 4.8. remote account services 4.9. other (specify)... PANN/AN-S-J-EN LV 1 of 5 of Client s representative:...

2 5. Information on tax residency Tax residency means a country under whose laws and regulations the Client shall be considered a tax resident of that country based on the location of the Client s management, the Client s place of registration/incorporation, or based on any other criteria which pursuant to the national law of the relevant country serves as the basis for considering the Client as a tax resident in that country and taxation of the Client s income in the relevant country. 5.1 Country/countries where the Client is a tax resident May be omitted if the answer to Question 6. Or 13.1 is Yes Name of the Country Taxpayer identification number The taxpayer identification number may be omitted if the company is only a tax resident of the Republic of Latvia 6. If the company is any of the following legal entities? Yes No If answer is Yes, please mark accordingly 6.1 state / municipal institution or a company wholly owned by a state / municipal institution 6.2 central bank 6.3 joint stock company whose shares are traded regularly on a regulated market of financial instruments 6.4 intergovernmental/transnational organisation which has a valid agreement regarding the location of its headquarters in the Republic of Latvia and from the operation of which no income is acquired by private individuals 7. Sectors of economic activity, for which purposes Client will use the Bank s offered services/products: Description of business activity, for which purposes Client will use the Bank s offered services/products: 8. Accounts in other banks 8.1. DON T HAVE 8.2. DO HAVE (specify the banks and the countries, where the accounts are opened): Bank Country 9. Reason to choose SC "Citadele banka": 9.1. favorable tariffs 9.2. favorable collaboration conditions 9.3. Bank s reputation 9.4. other persons' recommendations 9.5. other (specify) Actual period of the company s economic activity years months PANN/AN-S-J-EN LV 2 of 5 of Client s representative:...

3 11. Number of employees in the company The financial report of the company shall be submitted to a state institution NO YES (specify, whether the financial report about the last reporting period has been submitted): NO YES (specify institution, where submitted): Financial report is available publicly: NO YES (specify the source): The Client s statement of the Client s kind of activity and the beneficial owners 13.1 Does the Client render any of the following services within the framework of its business activity? 1) acceptance of deposits (as the Client s main kind of activity) within the framework of banking or similar business; 2) trading in money market instruments (cheques, bills, derivatives, deposit certificates etc.), interest rate and index instruments, foreign exchange instruments, transferable securities or commodity futures traded on a regulated market dealing as per orders of its clients or on behalf thereof ; 3) individual and/or collective securities portfolio management performed by the Client as per orders of its clients or on behalf thereof; 4) other investment, administration or management of financial assets on behalf of other persons; 5) savings insurance providing for life insurance operations with the accumulation of savings, including making investments on behalf of its clients and the obligation of disbursement of the capital accrued; 6) holding of financial assets of other persons (if the client s gross income from holding such assets and the rendering of related financial services makes at least 20% of the client s gross income) YES (please submit Form W8-BEN-E or provide a GIIN number certifying the Client s FACTA compliance) NO Does the Client have any beneficial owners¹ other than tax residents² of the Republic of Latvia? (May be omitted if the Client s answer to Question 6 or 13.1 is Yes ) ¹ Beneficial Owner (BO) - a natural person who is the owner of client - legal person or who controls the client, or on whose behalf, for whose benefit or in whose interests business relationship is being established or an occasional transaction is being executed, and it is at least: - in the case of legal persons, a natural person who owns, in the form of direct or indirect shareholding, more than 25 per cent of the capital shares or voting stock of the legal person or who directly or indirectly controls it; - in the case of legal arrangements, a natural person, who owns, or for whose interests a legal arrangement is established created or operating, or directly or indirectly exercises control over it, including the founder, trustee or supervisor (manager) of such entity. ² A tax resident means an individual whose income is subject to taxation under the laws and regulations of relevant country, e.g., based on the place of permanent residence, duration of the stay (usually 183 days and more in the period of 12 months), close personal or economic relations or other criteria serving as the basis for the taxation of income in the relevant country (e.g. in the US, inter alia a US citizen/resident who has been assigned a residence permit (Green Card) shall be deemed a US tax resident) YES NO 13.3 If Yes, please specify the country in which the beneficial owner 1 is a tax resident and submit a statement of the Client s income structure ³ Name of the Country Name of the Country Name of the Country Name of the Country... ³ Please consult with the Client s manager as to the necessity to fill in the statement Does the Client have any beneficial owners¹ who are a politically exposed person⁴, family member of a politically exposed person⁵, or person closely associated to a politically exposed person⁶? ⁴ A politically exposed person a natural person, who in the Republic of Latvia or in foreign countries occupies or has been entrusted with prominent public functions : head of State, head of state administrative unit (municipality), head of government, minister, deputy of minister or deputy of minister s deputy, state secretary or other upper level official in government or state administrative unit (municipality), member of parliament or member of other similar legislative bodies, member of governing bodies (board) of a political party, judge of constitutional court, higher court or judge in a different level court (member of court institutions), member of highest revision (audit) institution council or board, member of central bank s council or board, ambassador, charge affaires, chief officer in the armed forces, member of management or supervisory bodies of State owned enterprises, Head of an international organization (director, deputy director), and member of the board or a person who is in a similar position in this organization. ⁵Family member of a politically exposed person - politically exposed person s spouse or a person similar to spouse status (considered as such only if the law of according state stipulate this status), child, or a child of politically exposed person s spouse or a person similar to spouse status, his spouse or a person similar to spouse status, parent, grandparent, grandchild, brother or sister. ⁶Person closely associated to politically expose person natural person who has business or other type of close relationship with politically exposed person, who is a shareholder in the same legal entity as politically exposed person, or who has sole beneficial ownership of a legal arrangement which is known to have been set up for the de facto benefit of a politically exposed person YES (please provide information on the Client s beneficial owners who are a politically exposed person, family member of a politically exposed person, or person closely associated to a politically exposed person by filling in the Statement about beneficial owners) NO PANN/AN-S-J-EN LV 3 of 5 of Client s representative:...

4 14. Place(-s) where economic activity is carried out Economic activity is carried out in the country of registration of the Company: YES NO (specify, in which country economic activity is carried out): Branches, representative offices in other countries: DON T HAVE DO HAVE (specify actual address): (street, house/building name or number, apartment/office No, city (region, inhabited place), zip code, country) 15. Planned monthly accounts turnover in the Bank Incoming payments Purpose of payments: proceeds from buyers or receipts of service proceeds from participation in other companies investments of owners of the company loans other (specify) Partners from whom the payments are to be received: Name Outgoing payments Country of registration Country where the account, from which a payment will be made, is opened Purpose of payments payments for supplies and services mandatory state payments (taxes, fees) repayment of loans administrative expenses wages (specify periodicity: once a quarter, once a month, once a week) investments (specify investment sphere) other (specify) Partners to whom the payments are to be made: Name Monthly transactions in accounts (EUR): Country of registration Country where the account, to which a payment will be made, is opened Transaction type Quantity Average turnover Incoming transfers Cash deposits Outgoing payments Cash withdrawals Payments with a payment card for goods and services Cash withdrawals using a card PANN/AN-S-J-EN LV 4 of 5 of Client s representative:...

5 15.4. Planned maximum amount of one transaction (EUR) Transaction type Non-cash transaction, incl. using a payment card Cash transaction Amount 16. Company is used as: international trade company holding/majority stockholder company human resources company intellectual property management company licensing / franchising company company for participation in share market and fund raising international investment company ownership rights management company financial group management company logistics service company personal savings company other (describe): 17. Other customers of the Bank who can provide recommendations to the Bank in relation to the Customer DON T HAVE DO HAVE: Company name / Name, surname Registration number /Identity code or date of birth Legal representative s name, surname (only for legal entities) Company name / Name, surname Registration number /Identity code or date of birth Legal representative s name, surname (only for legal entities) I hereby certify, that origin of funds that is available to company is legal, and its source is: profit loans investments owner s capital (shareholder, participants) other (specify):... I hereby certify that the information provided in the Customer questionnaire is complete and true and I am aware I will be held liable according to applicable laws for providing false or misleading information. I also certify that I am authorized on behalf of the Customer to provide the information and self-certifications mentioned in the Customer questionnaire, and the information in my possession is sufficient to provide this information and self-certifications. I undertake to inform the Bank immediately about changes in the information provided in the Customer questionnaire.... Client representative s name, surname signature Date... Account No:... Fill in if the Questionnaire will be send to the Banka by FAX (Only for the Bank s client!) Digipass No:... Key 1: K Key 2: I,..., the Banks s employee (Bank s authorized person) has accepted the Questionaire. (Name, surname) Date..., stamp... PANN/AN-S-J-EN LV 5 of 5

6 DECLARATION ABOUT BENEFICIAL OWNER J Client s ID... Dear client! According to requirements of the law "Law on the Prevention of Laundering the Proceeds from Criminal Activity (Money Laundering) and of Terrorist Financing", Clients of the Bank must submit to the Bank filled and signed Declaration about Beneficial Owners. Please fill in the Declaration about Beneficial Owner. The Bank guarantees that the Clients' personal data, data on the Clients' accounts, deposits and deeds will be kept secret block letters where it is necessary. Thank you for understanding! Initial declaration Amendments of previously provided information Declaration of BO change INFORMATION ABOUT THE CLIENT Company Name... Registration number No... Date of Registration... INFORMATION ABOUT BENEFICIAL OWNER 1 (BO) Name, surname... Date of birth... Place of birth (country)... Personal Identity number (for Latvia residents²)/ Identity number (for Latvia non-residents 3 )... Information on personal identification document (for Latvian non-residents) Type of document passport identity card Identity document No... Issuing date... Valid thru... Identity document issuing authority... Identity document issuing country... Actual address (street, house/building name or number, apartment/office No, city (region, inhabited place), zip code, country) INFORMATION ABOUT BO S OCCUPATION AND SOURCE OF FUNDS Does BO hold any of following positions: Yes (please indicate position) No legal advisor or legal arrangement and company service provider who opens accounts on his/her behalf with financial institutions to perform financial operations on customers' behalf external accountant who opens accounts with financial institution on his/her behalf to perform financial operations on customer's behalf real estate agent BO s personal activity (employment) sector (please specify according to NACE 2 classification):...;.... BO S SOURCE OF INCOME, SOURCE OF FUNDS: salary registered self-employment (specify type of activity)... from lease of the personal property (specify property type)... from real estate transactions (specify type of property)... dividends / interest loans (credits) inheritance gift scholarship pension other (specify)... INFORMATION OF OWNERSHIP SHARES: share or voting shares quantity (percentage)... % BO relation to Client: owner of capital shares/ voting shares declaration of trust direct ownership indirect ownership senior managing official (if the legal entity does not have any beneficial owner who either directly or indirectly owns the client a legal entity, including through participating interests of at least 25% of the company s shares, or who either directly or indirectly controls the client) other (please specify):... PLGK/PA-S-J-EN LV 1 from 3...

7 INFORMATION ABOUT POLITICALLY EXPOSED PERSON STATUS Is BO a politically exposed person 4, family member of a politically exposed person 5 or person closely associated with a politically exposed person 6? Yes, please fill in the following information Name, surname of a politically exposed person s No BO is politically exposed person Do not fill BO is a family member of a politically exposed person or a person closely associated with a politically exposed person The country where BO is currently/were formerly holding a politically exposed position Position (please specify) Head of State Head of state administrative unit (municipality) Head of government Minister, deputy of minister or deputy of minister s deputy State secretary Other high-level official in government or state administrative unit (municipality) Member of parliament or member of other similar legislative bodies Member of governing bodies (board) of a political party Judge of constitutional court, higher court or judge in a different level court (member of court institutions) Member of highest revision (audit) institution council or board Ambassador or chargés d affaires Member of Central bank s council or board Chief officer in the armed forces Member of management or supervisory bodies of State owned enterprises Director, deputy director and member of the board or equivalent function of an international organization or a person who is in a similar position in this organization CLIENTS SIGNATURE AND ACKNOWLEDGMENT I hereby certify that the information provided in this Declaration is complete and true and I undertake to inform the Bank immediately about any changes in the information provided about account and financial assets beneficial owner. I certify that I am aware I will be held liable according to applicable laws for providing false or misleading information. Relation with the Client BO of the Client Client s authorized person... Name, surname Date Account No*... Digipass number*... Key 1* K... Key 2*... * Fill in if the Declaration will be send to the Banka by FAX (Only for the Banks s client!) BANK REMARKS Representative of the Bank... Branch of the Bank... Seal PLGK/PA-S-J-EN LV 2 from 3

8 ¹ Beneficial Owner (BO) - a natural person who is the owner of client - legal person or who controls the client, or on whose behalf, for whose benefit or in whose interests business relationship is being established or an occasional transaction is being executed, and it is at least: - in the case of legal persons, a natural person who owns, in the form of direct or indirect shareholding, more than 25 per cent of the capital shares or voting stock of the legal person or who directly or indirectly controls it; - in the case of legal arrangements, a natural person, who owns, or for whose interests a legal arrangement is established created or operating, or directly or indirectly exercises control over it, including the founder, trustee or supervisor (manager) of such entity. ² Resident - a natural person registered in the Population Register of the Republic of Latvia and to whom a personal identity number has been granted, as well as a physical person, whilst they are residing in Latvia, on the basis of a permanent or temporary residence permit issued by the Ministry of the Interior of the Republic of Latvia. 3 Non-resident - a natural person who is not registered in the Population Register of the Republic of Latvia and to whom a personal identity number of Latvia has not been granted. 4 A politically exposed person - a natural person, who in the Republic of Latvia or in foreign countries occupies or has been entrusted with prominent public functions : head of State, head of state administrative unit (municipality), head of government, minister, deputy of minister or deputy of minister s deputy, state secretary or other upper level official in government or state administrative unit (municipality), member of parliament or member of other similar legislative bodies, member of governing bodies (board) of a political party, judge of constitutional court, higher court or judge in a different level court (member of court institutions), member of highest revision (audit) institution council or board, member of central bank s council or board, ambassador, charge affaires, chief officer in the armed forces, member of management or supervisory bodies of State owned enterprises, Head of an international organization (director, deputy director), and member of the board or a person who is in a similar position in this organization. 5 Family member of a politically exposed person politically exposed person s spouse or a person similar to spouse status (considered as such only if the law of according state stipulate this status), child, or a child of politically exposed person s spouse or a person similar to spouse status, his spouse or a person similar to spouse status, parent, grandparent, grandchild, brother or sister. 6 Person closely associated to politically expose person - natural person who has business or other type of close relationship with politically exposed person, who is a shareholder in the same legal entity as politically exposed person, or who has sole beneficial ownership of a legal arrangement which is known to have been set up for the de facto benefit of a politically exposed person. PLGK/PA-S-J-EN LV 3 from 3

9 STATEMENT ON THE INCOME STRUCTURE OF AN ENTITY Client's number... JSC Citadele banka, Reg. No Republikas laukums 2A, Rīga, LV-1010, Latvija Date... Client Name... Registration number... Legal address... (street, house No/building/name, apartment No, city (district, populated place), postal code, country) Hereby I certify that the Client: A IS an active entity that is not a financial institution*, t.i. the Client meets at least one of the following criteria: - less than 50% of the Client's gross income for the preceding calendar year is passive income** and less than 50% of the assets held by the Client during the preceding calendar year are assets that are held for the production of passive income; - the Client is not yet operating a business/has no prior operating history, but is investing capital into assets with the intent to operate a business other than that of a financial institution, provided that the Client does not qualify for this exception after the date that is 24 months after the date of the initial organisation of the Client; - the activities of the Client consist of holding (in whole or in part) the outstanding stock of, or providing financing and services to, one or more subsidiaries that engage in trades or businesses other than the business of a financial institution; - the Client was not a financial institution* in the past 5 (five) years, and is in the process of liquidating its assets or is reorganising with the intent to continue or recommence operations in a business other than that of a financial institution; - the Client primarily engages in financing and hedging transactions with, or for, related entities that are not financial institutions, and does not provide financing or hedging services to any entity that is not a related entity, provided that the group of any such related entities is primarily engaged in a business other than that of a financial institution, or the Client meets all of the following requirements: - it is established and operated exclusively for religious, charitable, scientific, artistic, cultural, athletic, or educational purposes; or it is established and operated as a professional organisation, business league, chamber of commerce, labour organisation, agricultural or horticultural organisation, civic league or an organisation operated exclusively for the promotion of social welfare, - it is exempt from income tax in its jurisdiction of residence; - it has no shareholders or members who have a proprietary or beneficial interest in its income or assets, - the applicable laws of the Client's jurisdiction of residence or the Client's formation documents do not permit any income or assets of the Client to be distributed to, or applied for the benefit of, a private person or non-charitable entity other than pursuant to the conduct of the Client's charitable activities, or as payment of reasonable compensation for services rendered, or as payment representing the fair market value of property which the Client has purchased, and - the applicable laws of the Client's jurisdiction of residence or the Client's formation documents require that, upon the Client's liquidation or dissolution, all of its assets be distributed to a governmental entity or other non-profit organisation, or escheat to the government. PANR/AP-S-J-RU LV 1of 3

10 B C IS a passive entity that is not a financial institution*, i.e. does not meet the aforementioned criteria of an active entity IS an investment entity that meets the following criteria - the Client's gross income is primarily attributable to investing, reinvesting, or trading in financial assets, and - gross income attributable to the relevant activities equals or exceeds 50% of the Client's gross income during the shorter of: (i) the three-year period ending on 31 December of the year preceding the year in which the determination is made; or (ii) the period during which the Client has been in existence, and - the Client is managed by another company or entity that is a financial institution* If variant B or C has been chosen, please supply the following information on the Client's beneficial owners Client's Beneficial Owner*** 1) Name Date of birth and and surname... place of birth (country)... Address... (street, house No/building/name, apartment No, city (district, populated place), postal code, country) 2) Name Date of birth and and surname... place of birth (country)... Address... (street, house No/building/name, apartment No, city (district, populated place), postal code, country) 3) Name Date of birth and and surname... place of birth (country)... Address... (street, house No/building/name, apartment No, city (district, populated place), postal code, country) 4) Name Date of birth and and surname... place of birth (country)... Address... (street, house No/building/name, apartment No, city (district, populated place), postal code, country) PANR/AP-S-J-RU LV 2of 3

11 * Financial Institution an entity that renders any of the following services within the framework of its economic activities: - acceptance of deposits (as the Client s main kind of activity) within the framework of banking or similar business; - trading in money market instruments (cheques, bills, derivatives, deposit certificates etc.), interest rate and index instruments, foreign exchange instruments, transferable securities or commodity futures traded on a regulated market dealing as per orders of its clients or on behalf thereof; - individual and/or collective securities portfolio management performed by the Client as per orders of its clients or on behalf thereof; - other investment, administration or management of financial assets on behalf of other persons; - savings insurance or insurance services providing for guaranteed regular payout of savings to clients within the framework of insurance companies (holding insurance companies); - holding of financial assets of other persons (if the client s gross income from holding such assets and the rendering of related financial services makes at least 20% of the client s gross income). ** Passive Income is the part of the Client s income that consists of; 1) dividends; 2) interest and income equivalent to interest; 3) rents and royalties, other than rents and royalties derived in the active conduct of a business conducted by employees of the Client; 4) annuities; 5) the excess of gains over losses from the sale or exchange of financial assets that gives rise to the passive income described in the 1.-4.points (except income resulting from the core activity of a broker (dealer)); 6) the excess of gains over losses from transactions (including futures, forwards, options, and similar transactions) in any financial assets (except income resulting from the core activity of a broker (dealer)); 7) the excess of foreign currency gains over foreign currency losses (except income resulting from the core activity of a broker (dealer)); 8) net income from swaps (except income resulting from the core activity of a broker (dealer)); 9) amounts received under Cash Value Insurance Contracts; 10) other income, which by its economic nature is comparable to the passive income described in the 1.-9.points *** BO is a private individual who owns or controls, directly or indirectly, at least 25 per cent of the Client s share capital or total number of voting shares, or who otherwise controls the Client s business; or who has, directly or indirectly, the right to the Client s property, or who controls, directly or indirectly, at least 25 per cent of an entity other than a merchant; or for the benefit or interests of which business relationships are established /a transaction is performed with the Bank. A political party, association or cooperative society shall be deemed the beneficial owner of the respective political party, association or cooperative society. **** A tax resident means an individual whose income is subject to taxation under the laws and regulations of relevant country, e.g., based on the place of permanent residence, duration of the stay (usually 183 days and more in the period of 12 months), close personal or economic relations or other criteria serving as the basis for the taxation of income in the relevant country (e.g. in the US, inter alia a US citizen/resident who has been assigned a residence permit (Green Card) shall be deemed a US tax resident). of the Client's Representative I certify that the information provided in the Statement is complete and true, and I am aware that in case of provision of untrue data I bear responsibility in accordance with the effective legal acts, and I further certify that I am authorised to provide information and acknowledgements mentioned in this questionnaire on behalf of the Client, and I possess information that is sufficient to provide data requested in this Statement. I undertake to inform the Bank immediately about changes of the information specified in the Statement Name, surname of the Client's Representative PANR/AP-S-J-EN LV 3of 3

12 and seal specimen card Customer name A B Customer representatives Name, surname Identity number* Date of birth* Position Representation rights: Individually Name, surname Jointly with: Registration number Representation limits Customer number (ID) Indentity number* Date of birth* Position Representation rights: Individually Jointly with: Representation limits C Name, surname Identity number* Date of birth* Position Representation rights: Individually Jointly with: Representation rights D Name, surname Identity number* Date of birth* Position Representation rights: Individually Jointly with: Representation Additional information Corporate seal specimen Bank / Notary confirmation I hereby certify the authenticity of the signatures of the above indicated persons. Name, surname Stamp, signature Customer Service Center Date *The Identity number field has to be filled in if it is indicated in the ID document. Otherwise, Date of birth field has to be filled in. page ( ) PPK/PV/S-J-EN LV

13 AS Citadele banka, Reģ. nr Republikas laukums 2A, Rīga, LV-1010, Latvija APPLICATION FOR OPENING AND MANAGEMENT OF CURRENT ACCOUNT Customer No... Date... J Customer name... Registration number... Telephone number... Customer card s number/ Password... Customer representative name, surname... Identity No*... Date of birth**... Type of identification Identification document document... number... *- for residents, ** - for non residents Multicurrency Monocurrency Monocurrency Please open a current account account account account currency... Account number... Receipt of regular account statements At the bank Don t need Frequency of receiving of account statements Every day Once a week Once a month Special provisions... Customer signature I hereby confirm that I have examined the Terms and Conditions of Opening and Management of Current Account, the General Terms of Business and the Pricelist of services of the Bank, and undertake to comply therewith. I am informed that the said Regulations approved by the Executive Board of the Bank are available on the Bank s website and at the structural units of client services. I hereby confirm that I have been provided with basic information about the protection of deposit in accordance with the Deposit Guarantee Law.... Name, surname Seal Bank remarks Seal The Bank officer... NKNT/IE-S-J-EN LV

14 AS Citadele banka, Reģ. nr Republikas laukums 2A, Rīga, LV-1010, Latvija APPLICATION FOR CITADELE ONLINE BANKING CONNECTION Application number... Customer No.... Date... New Application Amendments to the existing Application Customer Name... Registration number... Phone number Customer representative name, surname... Identity No*... Date of birth**... Type of identification Identification document... document number... *- for Latvian residents, **- for Latvian non residents User: Customer representative other person (to be filled in) Name, surname... Identity No*... Date of birth**... Type of identification document Identification... document number... *- for Latvian residents, **- for Latvian non residents User s: Phone number... Mobile phone number Address... Authorisation Code card Code calculator... device type (Type) Device ID Nr.... Device ID Nr.... User Login Password login name... envelope number... Telephone password question... Telephone password... Online banking usage mode: Full-scale operation mode View-only operation mode Special conditions (Limitations) Other MobileSCAN Customer signature I hereby confirm that I have examined the Terms of Citadele Online Banking use and servicing, the General Terms of Business and the Pricelist of services of the Bank, and undertake to comply therewith. I am informed that the said Regulations approved by the Executive Board of the Bank are available on the Bank's website and at the structural units of client services. I am informed and confirm that loan (credit) agreements and amendments thereto can be concluded between the Client and the Bank via Citadele Online Banking, as well as that via Citadele Online Banking between the Client and the Bank can be concluded agreements, amendments thereto and transactions regarding investment services and ancillary investment services.... Name, surname User signature Hereby I confirm that I have received the Authorisation Device specified in the Application.... Name, surname Bank Representative of the Bank... Seal Branch of the Bank... PINB/IE-S-J-EN LV

15 ANNEX TO THE APPLICATION FOR CITADELE ONLINE BANKING CONNECTION Annex to be filled in if online banking Customer No... AS Citadele banka, Reģ. nr usage mode is Special conditions Republikas laukums 2A, Rīga, LV-1010, Latvija (Limitations). Date... Customer Name... Registration number... Customer representative name, surname... Identity No... Date of birth... User: Customer representative Other person (to be filled in) Name, surname... Identity No... Date of birth... Usage mode special conditions (Limitations) Products and services: Customer Free format order... questionnaire... Loans... Deposits... Direct debit... Standing orders... Account/payment card opening... SMS bank... Other services... Accounts: Usage mode for other accounts... User special limits (EUR): Application number... One transaction... Daily... Monthly... Customer signature The present Appendix is an integral part of Application for Citadele Online Banking connection. I hereby confirm that I have examined the Terms of Citadele Online Banking use and servicing, the General Terms of Business and the Pricelist of services of the Bank, and undertake to comply therewith. I am informed that the said Regulations approved by the Executive Board of the Bank are available on the Bank's website and at the structural units of client services.... Name, surname Bank Representative of the Bank... Branch of Seal the Bank... IBSP/IE-S-J-EN LV

16 APPLICATION for FAX Payment System Connection, Use and Servicing AS Citadele banka, Reģ. nr Customer No... Republikas laukums 2A, Rīga, LV-1010, Latvija Date... New Application Customer: (to be filled by Customer natural person) Amendments to the existing Application Name, surname... Identity No*... Date of birth**... Type of identification Identification document... document number... Phone number *- for Latvian residents, **- for Latvian non residents Customer: (to be filled by Customer legal entities) Company name... Registration number... Phone number Customer representative name, surname... Identity No*... Date of birth **... Phone number *- for Latvian residents, **- for Latvian non residents Authorisation tool Code calculator model... Code calculator ID No... FAX Payment System usage mode: Full mode Account mode Please FAX Payment System attached to the Customer s Account (-s) in the Bank (to be filled if Customer uses Account mode): No No No No No No Special provisions... Customer signature/ Customer s representative signature (by Customer - legal entities) I hereby confirm that I have examined the Conditions for the Use and Service of FAX Payment System, the General Terms of Business and the pricelist of services of the Bank, consents thereto in full and undertake to comply therewith. I am informed that the said regulations are available on the Bank s website and at the structural units of customer services. Hereby I confirm that I have received the Authorisation tool specified in the Application Seal Name, surname Bank Representative of the Bank... Branch of the Bank... Seal FAXN/IE-S-JF-EN LV

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19 APPLICATION FOR CITADELE SMS BANK SERVICE AS Citadele banka, Reģ. nr Republikas laukums 2A, Rīga, LV-1010, Latvija New application Changes of existing contract Customer number... Date... Customer name... Registration number... Phone number Customer representative name, surname... Identity No*... Date of birth**... Type of identification Identification document... document number... *- for Latvian residents, **- for Latvian non residents Mobile telephone Mobile communication Short message number with country code... operator... language: Latvian Russian English Charge the commission Account from account number... currency... Activation code (4 digits) Secret question*... Answer*... Short message on transaction on Customer account Account number Account currency Short message on transactions on Customer payment card Payment card number Successful authorisation Minimum Send amount Short message on Short message on outgoing amounts incoming amounts Account balance on request Send Minimum amount Send Minimum amount Always include account balance, available balance Failed authorisation Transaction reversal Available balance on request Always include balance on request Send Minimum Minimum Send amount amount * This field should be filled if the customer or customers representative is not registered as Citadele Online Banking user. But, if he is registered, then fields are filled in with the same question and answer as in Citadele Internet bank agreement. Other conditions... Customer signature I hereby confirm that I have examined the Terms of Citadele SMS Bank Use and Servicing, the Terms of Opening and Maintenance of a Current Account, the General Terms of Business and the Pricelist of services of the Bank, and undertake to comply therewith. I am informed that the said Regulations approved by the Executive Board of the Bank are available on the Bank s website and at the structural units of client services. Name, surname Seal Bank remarks J Seal The Bank officer... SMSB/IE-S-J-EN LV