Formular actualizare date de identificare

[Pages:1]S.A .I . S TA R AS SE T MANAGE ME NT S.A .

Reg. Com. J40 / 1381 / 31.01.2006

Autorizat prin Decizia CNVM: D 730/23.03.2006

C.U.I. 18331767 Capital Social: 500.000 RON Nr. Registru CNVM: PJR05SAIR/400021

FORMULAR ACTUALIZARE DATE PERSONALE

Nume: _________________________Prenume _____________________________ Pseudonim_____________________ Act identitate: ___Serie___Nr ______Eliberat de________La data ____________________ CNP:____________________ Data Nasterii _________Locul Nasterii____________________Cetatenia __________Tara de origine ________________ Nationalitate____________ Rezident/Nerezident _____Functie publica detinuta_________________________________ Ocupatia________________________Angajator_____________________________Beneficiar real__________________ Adresa de domiciliu: Localitate___________Str._____________________________Numar___Bloc___Scara__________ Et.___Ap.___Judet/Sector_________________________Cod postal_____________Tara___________________________ Telefon____________________________Fax__________________Adresa de email______________________________ Cont Bancar nr. _________________________________________Banca_______________________________________ Scopul si natura operatiunilor derulate cu entitatea reglementata: ___________________________________________

Imputernicit:

Nume: _________________________Prenume _____________________________ Pseudonim_____________________

Act identitate: ___Serie___Nr ______Eliberat de________La data ____________________ CNP:____________________

Data Nasterii

Locul Nasterii____________________Cetatenia __________Tara de origine ________________

Nationalitate____________ Rezident/Nerezident _____Functie publica detinuta_________________________________

Ocupatia________________________Angajator_____________________________

Adresa de domiciliu: Localitate___________Str._____________________________Numar___Bloc___Scara__________

Et.___Ap.___Judet/Sector_________________________Cod postal_____________Tara___________________________

Telefon____________________________Fax__________________Adresa de email______________________________

Cont Bancar nr. _________________________________________Banca_______________________________________

Imputernicit:

Nume: _________________________Prenume _____________________________ Pseudonim_____________________

Act identitate: ___Serie___Nr ______Eliberat de________La data ____________________ CNP:____________________

Data Nasterii

Locul Nasterii____________________Cetatenia __________Tara de origine ________________

Nationalitate____________ Rezident/Nerezident _____Functie publica detinuta_________________________________

Ocupatia________________________Angajator_____________________________

Adresa de domiciliu: Localitate___________Str._____________________________Numar___Bloc___Scara__________

Et.___Ap.___Judet/Sector_________________________Cod postal_____________Tara___________________________

Telefon____________________________Fax__________________Adresa de email______________________________

Cont Bancar nr. _________________________________________Banca_______________________________________

______________________________ Numele si prenumele clientului

______________________________

Semnatura client

____________________ Data

Bucureti, Calea Floreasca nr.91-111, bl.F1, tronson 5, et.1, ap.41, sect.1 Tel./Fax: 021 3161766 / 021 3161778 sai-star.ro office@sai-star.ro

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download