<SifraFirme>

Corporate officer code                                                       Client number

Application Form for Payment Account and Payment Services

Branch…………………………………………..
I.	Corporate payment account
☐ Initial application for payment account                                                                                                                                                                                                                 ☐ Application for additional account                      ☐ Change of account 
I kindly request you to open an account in your Bank

Payment account No

Applicant:

Contact person:

Corporate name:	

Address and office:	

URN	

TIN	

Telephone:	

Email:	

Web:	

Method of receipt daily statements	

Changes: (Please indicate in case the application refers to a change of the account)	

	
Please fined attached the following documents that the Bank will keep for its records
1.	Completed and signed Application Form for corporate  with all elements
2.	Signature card of authorized persons for disposal of funds on the account in triplicate	

II.	Cards
 Allowing           Change        	
Basic card data

MKD account number in Sparkasse Bank

FX account number in Sparkasse Bank

Basic card user
(in Latin, no more than 24 characters)
First emboss line	

I kindly request you to issue a Visa business debit card*:

Additional card data                                                     Additional card user                              Additional card user                                                                           
Name	

	

Surname	

	

Date of birth

	

Place of birth	

	

Personal identification number	

	

ID card or passport number	

	

Valid to	

	

Address from ID card 	

	

City	

	

Cell phone number	

	

Email	

	

Name and surname on the card
 (in Latin script, no more than 24 characters)	

	

Signature of the additional card applicant	

	

I kindly request you to issue a MasterCard business credit card and approve a framework credit limit in the amount of MKD_____________.

Additional card data                                                      Additional card user                             Additional card user
Name 	

	

Surname 	

	

Date of birth	

	

Place of birth	

	

Personal identification number	

	

ID card or passport number	

	

Valid to  	

	

Address from ID card 	

	

City 	

	

Cell phone number	

	

Email	

	

Name and surname on the card
 (in Latin, no more than 24 characters)	

	

Signature of the additional card applicant	

	

Please deliver the statements to:    Permanent address   Correspondence address  E-bank   Email 

Please fined attached the following documents that the Bank will keep for its records:
1.    Photocopy of ID card/passport of the additional card users
2.    Balance sheets and income statements for two previous years (only when applying for a MasterCard business card)
   3.    Trial balance for the last quarter of the current year
   4.   Analytical review by client - specification of groups 12, 22, 25 and 28 of the same date with reference to the trial balance from point 3
   5.    Giro account turnover for the last 6 months
    6.   Statement / Consent to check credit exposure (only when applying for a MasterCard business card)
    7.    Collateral 
    8.   Other documentation

To fill in when picking up the card:
Basic card number:

I received additional card number:                                             and enveloped PIN code. Date                          Signature

I received additional card number:                                             and enveloped PIN code. Date                          Signature
Basic card number:

I received additional card number:                                             and enveloped PIN code.  Date                         Signature

I received additional card number:                                              and enveloped PIN code.  Date                         Signature

III.	Digital channels
 Allowing           Change        
  Electronic banking
 Mobile banking          Privileges:    Info access  Full access
           
Certificate type:                                                                              Certificate validity period:
    KIBS:    ☐  Verba Sign PKI Token  ☐   Verba Sign Pro PKI Token
Telecom  ☐                                                                                                                                                         	
1 year  ☐         2 years ☐        

	
А. Review of accounts in electronic banking
No	
Account / Batch number	
Signature regime: Enter one of the options; 
1. Single – Single signature; 
2. Double – Double signatures; 
3. Group – Group signatures (minimum two, one of who is a mandatory signatory)   
4. Mix – Mixed signatures	

 1.	

2.	

3.	

4.	

5.	

6.	

7.	

8.	

9.	

10.	

	

B. Authorisation by account:
Authorised persons for account review, creation of payment orders with and without the right of signature* through electronic banking for corporate clients have the following level of authorization:
No	Name/
PIN	Email address**/ 
Phone number 	Account number	Authorisation (***)	Limit (****)	

Group 
(*****)	
				
INF	Creation of payment orders	
Signature			
1		 	 	 			 
		
2	 	 		 			 		
3	 	 	 	 			 		
4	 	 	 	 			 		
5	 	 	 	 			 		
6	 	 	 	 			 		
7	 	 	 	 			 		
8	 	 	 	 			 		
9	 	 	 	 			 		
10	 	 	 	 			 		
		
1	In case of account with a double signature, there must be at least two "signatories" for that account	
2	In case of account with group signatures, there must be at least one "mandatory signatory"	
3	In case of account with mix signatures, signatory groups and limits per account per user must be set	

 (*) Persons authorized for account review, creation of payment orders with and without the right of signature through electronic banking should submit ID cards for identification.
 (**)  If a certificate issued by KIBS and/or Makedonski Telekom is used, a valid email address linked to the digital certificate must be filled in.
 (***)  If the authorised person has the mandate to sign and create orders, "Signature" and "Creation of orders" must be marked.
(****) The limit is defined in the account currency.
(*****)  Only group and mixed signatures are filled in. In case of accounts with group and mixed signatures there are: Group 1 and Group 2. The detailed authorisation level by limits is defined in the registration form for electronic banking for corporate clients.

C. Additional information for Mix signatory regime
  (To be only completed in case of mix signatures)
No	Account	Lower limit	Upper limit	
Number of signatures of any group	Number of signatures in Group 1	Number of signatures in Group 2	
1.	
						
2.	
						
3.	
						
4.	
						
The User or the Authorised Person hereby freely and explicitly represents and agrees that their data, balance, operations and other data relating to the account including their PIN that are considered business secrecy are delivered to the relevant processing centre in the country and abroad for the purpose of fulfilling the tasks of the Bank under the Agreement for the Regulation of Mutual Rights and Obligations for Using the Electronic Banking Service for Corporate Clients.
The entire responsibility or possible damage related to all transactions executed and messages sent by the User through the electronic banking system shall be borne by the User, i.e. the Bank shall debit the User's accounts.
IV.	SMS notification
 Allowing           Change        Closing
SMS notification language:                     Macedonian            English
No	
Account number	
Cell phone number	
Message sending and receiving period (1)	

Inflow	
Outflow                                        	
Balance 	
Statement in short format	

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You can choose to receive one or both types of SMS notifications: per event or periodic SMS notifications. For periodic notifications there is a choice of daily or weekly receipts in three defined periods at 09:00 am, 12:00 pm and 06:00 pm.	

Client’s consent
I hereby acknowledge that:
◘ The data given above are correct and in case of changes (including address data) I shall notify the Bank within 3 working days as of the change. Otherwise, any delivery by the Bank to the Client shall be deemed to have been duly made to the address specified in this Application Form;
◘ I agree that my personal data presented in this Application Form are registered, processed, updated by the Bank or by hiring a data processor and to transfer the personal data to other countries in accordance with laws and regulations and internal acts of the Bank within the banking operations, as well as to make them available to authorized persons in the Bank or to third parties, in all cases provided for by the Law; 
◘  I am aware of and agree that the data collected and processed by the Bank, which relate to the provision of the service obtained by filling out this Application Form of the Bank, may be transferred to other members of Erste and Steiermärkische Sparkasse Group;
◘ Before providing my personal data, I was familiar with my rights arising from the Law on the Personal Data Protection provided in the Privacy Policy published on the Bank's website;
◘ We are informed on the fees and commissions defined in the Bank's Tariffs for the products and services that are part of the requested package and we accept all costs and debts incurred by using the products in the package;
◘ We are familiar with and I fully accept all rights and obligations arising from the General Terms and Conditions for Electronic Banking of Sparkasse Bank AD Skopje, user instructions and other documents that are an integral part of the General Terms and Conditions;
◘ We are familiar with and I fully accept all rights and obligations arising from the General Terms and Conditions for Issuing and Using Visa Debit Cards, the Agreement for Issuing and Using MasterCard® credit cards as well as the Bank's Tariffs and we accept all costs and debts incurred with the use of the card;
◘ We are familiar with and I fully accept all rights and obligations arising from the Agreement for the Use of the SMS Notification Service;
◘ We agree to receive other types of SMS notifications from the Bank for which no fee is charged;
◘ I am aware that the data listed above is a business secret according to the Banking Law and other applicable regulations;
◘ The bank reserves the right to request other client’s data for the purposes of the business relationship established;
◘ The bank reserves the right to terminate the business relationship with the client at any time;
◘ I am familiar with the requirements for establishing a business relationship with the Bank and I fully accept them.	

<BaranjeDatum>

Place and date                                                              Signature of authorised person and stamp

<ImeReferenta>

To be completed by the Bank
Received and checked                                                            Signature of authorised person and stamp
Completeness of 

Application Form by: 
Date: