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IN BEHALF OF THIRD PARTY DEPOSIT APPLICATION FORM by opi20846

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									                                       ýǽÇÏ³Ï³Ý ³ÝÓ³Ýó ѳٳñ/ for individuals only
                    Ðú¶àôî ºððà𸠲ÜÒÆ ´²ÜβÚÆÜ ²ì²Ü¸Æ ¸ÆØàôØ/ ä²Úزܲ¶Æð
                        IN BEHALF OF THIRD PARTY DEPOSIT APPLICATION FORM/ AGREEMENT

ÐÇÙù ÁݹáõÝ»Éáí “ÆÝ»Ïáµ³ÝÏ” ö´À ÏáÕÙÇó ѳëï³ïí³Í §üǽÇÏ³Ï³Ý ³ÝÓ³Ýó µ³ÝϳÛÇÝ ³í³Ý¹Ç
ͳé³ÛáõÃÛáõÝÝ»ñÇ Ù³ïáõóÙ³Ý ÑÇÙÝ³Ï³Ý å³ÛÙ³ÝÝ»ñ¦-Á` ËݹñáõÙ »Ù Ý»ñùáÑÇßÛ³É ³ñÅáõÛÃáí, ïáÏáëáí ¨ ã³÷áí
ÁݹáõÝ»É ³í³Ý¹:
I hereby apply for the opening an account(s) in the following currency(s), amount and interest rate, according to the
“General Conditions of Bank Deposits Service for individuals”, approved by Inecobank CJSC.
²í³Ý¹Ç ³ñÅáõÛÃÁ
Deposit Currency
ÐÐ ¹ñ³Ù          ²ØÜ ¹áɳñ                 ºíñá                    ³ÛÉ
AMD              USD                       Euro                    other
²í³Ý¹Ç ï»ë³ÏÁ/ Deposit Type
 سÝϳϳÝ
²í³Ý¹Ç ųÙÏ»ïÁ/ Deposit Term

²í³Ý¹Ç ï³ñ»Ï³Ý å³ñ½ ïáÏáë³¹ñáõù/
Annual Rate of Simple Interest
                   ï³ñ»Ï³Ý
                   annual
²í³Ý¹Ç ·áõÙ³ñÁ (Ãí»ñáí ¨ µ³é»ñáí)/ Deposit Amount (both in figures and words)

²ÛÉ/гïáõÏ å³ÛÙ³ÝÝ»ñ
Other/Special Conditions



г׳Ëáñ¹Ç ²ÝáõÝ, ²½·³ÝáõÝ, гÛñ³ÝáõÝ (ѳۻñ»Ý)
Customer Name, Surname (Armenian)

г׳Ëáñ¹Ç ²ÝáõÝ, ²½·³ÝáõÝ (³Ý·É»ñ»Ý ٻͳï³é)
Customer Name, Surname (English block capital letters)


²ÝÓݳ·Çñ (Passport)
гٳñÁ                      îñÙ³Ý (³Ùë³ÃÇíÁ)          àõÙ ÏáÕÙÇó       êáó. ø³ñïÇ Ñ.                   ²ÚÈ
Number                      Date of Issue             Authority       Social Card No.                 Other


гßí³éÙ³Ý Ñ³ëó» (Registration Address)
öáëï Çݹ»ùë     ä»ïáõÃÛáõÝ                           سñ½                               ø³Õ³ù
Postcode         Country                             Region                              City


öáÕáó, ïáõÝ, µÝ³Ï³ñ³Ý                             лé³Ëáë(Ý»ñ)                              ´çç³ÛÇÝ
Street, House, Apartment                          Telehone                                  Mobile.



                                               ¾É-÷áëï
                                               E-Mail
´Ý³ÏáõÃÛ³Ý Ñ³ëó» (»Ã» í»ñçÇÝë ï³ñµ»ñ ¿ í»ñáÑÇßÛ³ÉÇó)
Residential Address (if different from the above)

ºñ»Ë³ÛÇ ²ÝáõÝ, ²½·³ÝáõÝ, гÛñ³ÝáõÝ (ѳۻñ»Ý)
Children’s Name, Surname (Armenian)

ºñ»Ë³ÛÇ ²ÝáõÝ, ²½·³ÝáõÝ (³Ý·É»ñ»Ý ٻͳï³é)
Children’s Name, Surname (English block capital letters)

ÌÝÝ¹Û³Ý ìϳ۳ϳÝ/ ²ÝÓݳ·Çñ (Passport)
гٳñÁ                îñÙ³Ý (³Ùë³ÃÇíÁ)                àõÙ ÏáÕÙÇó       êáó. ø³ñïÇ Ñ.                   ²ÚÈ
Number                 Date of Issue                  Authority       Social Card No.                 Other

гßí³éÙ³Ý Ñ³ëó» (Registered Address)
öáëï Çݹ»ùë     ä»ïáõÃÛáõÝ                           سñ½                               ø³Õ³ù
Postcode         Country                             Region                              City
öáÕáó, ïáõÝ, µÝ³Ï³ñ³Ý                                лé³Ëáë(Ý»ñ)                                  ´çç³ÛÇÝ
Street, House, Apartment                             Telehone                                      Mobile.



                                                ¾É-÷áëï
                                                E-Mail
´Ý³ÏáõÃÛ³Ý Ñ³ëó» (»Ã» í»ñçÇÝë ï³ñµ»ñ ¿ í»ñáÑÇßÛ³ÉÇó)
Residential Address (if different from the above)


 ò³ÝϳÝáõÙ »Ù í׳ñí»ÉÇù ïáÏáë³·áõÙ³ñÝ»ñÁ ÷áË³Ý³Ï»É ³í³Ý¹Ç ³ñÅáõÛÃÇ` ïáÏáë³·áõÙ³ñÝ»ñÇ í׳ñÙ³Ý
ûñí³ ¹ñáõÃÛ³Ùµ ÐРδ ë³ÑÙ³Ýí³Í ÷á˳ñÅ»ùáí`
 Please exchange the accrued interests to the Deposit currency by CB RA exchange rate as of the interest payment
 date.
    ²Úà/YES                                 àâ/ NO
êáõÛÝ ¸ÇÙáõÙ/å³Ûٳݳ·ñáí ë³ÑÙ³Ýí³Í ³í³Ý¹Ç ųÙÏ»ïÁ Éñ³Ý³Éáõ ûñí³ ¹ñáõÃÛ³Ùµ ÇÙ ÏáÕÙÇó ³ÛÉ
ѳÝÓݳñ³ñ³Ï³Ý ãÉÇÝ»Éáõ ¹»åùáõÙ, ËݹñáõÙ »Ù ²í³Ý¹Ç ·áõÙ³ñÁ` ѳßí³ñÏí³Í ïáÏáëÝ»ñáí/³é³Ýó
ѳßí³ñÏí³Í ïáÏáëÝ»ñÇ, ²í³Ý¹Ç ųÙÏ»ïÇ ³í³ñïÇÝ Ñ³çáñ¹áÕ ûñí³ ¹ñáõÃÛ³Ùµ ´³ÝÏÇ ÏáÕÙÇó ë³ÑÙ³Ýí³Í
î³ñ»Ï³Ý å³ñ½ ïáÏáë³¹ñáõÛùáí Ó¨³Ï»ñå»É áñå»ë §Ø³Ýϳϳݦ ³í³Ý¹` Ûáõñ³ù³ÝãÛáõñ ³Ý·³Ù ____ ³ÙÇë
ųÙÏ»ïáí, µ³Ûó áã ³í»É ù³Ý ____ ³ÙÇë ųÙÏ»ïÁ, »Ã» ³Û¹ Ó¨³Ï»ñåáõÙÝ»ñÁ ã»Ý ѳϳëÇ ³Û¹ å³ÑÇÝ ·áñÍáÕ
§ÆÝ»Ïáµ³ÝϦ ö´À-Ç §üǽÇÏ³Ï³Ý ³ÝÓ³Ýó µ³ÝϳÛÇÝ ³í³Ý¹Ç ͳé³ÛáõÃÛáõÝÝ»ñÇ Ù³ïáõóÙ³Ý ÑÇÙݳϳÝ
å³ÛÙ³ÝÝ»ñ¦ Ý»ñùÇÝ Çñ³í³Ï³Ý ³Ïïáí ë³ÑÙ³Ýí³Í ÝáñÙ»ñÇÝ:
On the deposit maturity date stipulated by the Order agreement, if there are no additional instructions made by me, I
request to reinvest the Deposit Amount as “Kids deposit” with the value date starting from the date following the Deposit
maturity date and the simple annual interest rate stipulated by the Bank with the tenor of ______months for each
reinvestment case but not exceeding ________ months and given that these terms are not in violation with the norms
stipulated by the Bank’s internal procedure on “General terms of the deposit servicing of natural persons” at that moment.
²Úà/YES                        àâ/ NO

²í³Ý¹áõÙ Ý»ñ¹ñíáÕ ÙÇçáóÝ»ñÇ Í³·Ù³Ý ³ÕµÛáõñÁ
The source of funds invested in the deposit
³ß˳ï³í³ñÓ            ÷á˳ÝóáõÙÝ»ñ          ËݳÛáÕáõÃÛáõÝÝ»ñ                              ³ÛÉ   ___________________
                  ³ñï³ë³ÑÙ³ÝÇó
     Salary     Remittances from abroad          Savings                                other   ___________________



²í³Ý¹Á Ý»ñ¹ñÙ³Ý å³ÑÇÝ Ñ³Ý¹Çë³ÝáõÙ ¿ §üǽÇÏ³Ï³Ý ³ÝÓ³Ýó μ³ÝϳÛÇÝ ³í³Ý¹Ý»ñÇ Ñ³ïáõóáõÙÁ
»ñ³ß˳íáñ»Éáõ Ù³ëÇݦ ÐÐ ûñ»Ýùáí ë³ÑÙ³Ýí³Í ã³÷áí ¨ ϳñ·áíª
The Deposit is ( by its amount and in accordance with the procedure, stipulated by the Law of the Republic of Armenia
on the Guarantee of Remuneration of Bank Deposits of Physical Entities)`
»ñ³ß˳íáñí³Í ³í³Ý¹                         ã»ñ³ß˳íáñí³Í ³í³Ý¹
insured deposit                            non-insured deposit

вֲÊàð¸Æ вêî²îàôØÀ
CUSTOMER’s CONFIRMATION
êáõÛÝáí »ë ³ÙμáÕç å³ï³ë˳ݳïíáõÃÛ³Ùμ ѳëï³ïáõÙ »Ù, áñ μáÉáñ ýÇݳÝë³Ï³Ý ÙÇçáóÝ»ñÁ, áñáÝù
Ï÷á˳Ýóí»Ý §ÆÝ»Ïáμ³ÝϦ ö´À–áõÙ μ³óí³Í Ç٠ѳßÇíÝ»ñÇÝ, ëï³óí³Í »Ý ûñÇÝ³Ï³Ý ×³Ý³å³ñÑáí ¨ áã ÙÇ
Ï»ñå ϳåí³Í ã»Ý ÷áÕ»ñÇ Éí³óÙ³Ý, ³Ñ³μ»ÏãáõÃÛ³Ý, ÃÙñ³ÝÛáõûñÇ í³×³éùÇ, Ù³ñ¹Ï³Ýó í³×³éùÇ, ѳñÏ»ñÇ
í׳ñáõÙÇó Ëáõë³÷»Éáõ ¨ ³ÛÉ Ñ³Ýó³íáñ ·áñÍáÕáõÃÛáõÝÝ»ñÇ Ñ»ï:
гëï³ïáõÙ »Ù ÇÙ ÏáÕÙÇó ïñí³Í ï»Õ»ÏáõÃÛáõÝÝ»ñÇ ³ñųݳѳí³ïáõÃÛáõÝÁ ¨ å³ñï³íáñ »Ù ųٳݳÏÇÝ
ï»Õ»Ï³óÝ»É §ÆÝ»Ïáμ³ÝϦ ö´À-ÇÝ ïñí³Í ïíÛ³ÉÝ»ñÇ ó³Ýϳó³Í ÷á÷áËáõÃÛáõÝÝ»ñÇ Ù³ëÇÝ:
̳Ýáà »Ù ëáõÛÝ ¸ÇÙáõÙ/å³Ûٳݳ·ñÇ ³Ýμ³Å³Ý»ÉÇ Ù³ëÁ ѳݹÇë³óáÕ §ÆÝ»Ïáμ³ÝϦ ö´À §üǽÇÏ³Ï³Ý ³ÝÓ³Ýó
μ³ÝϳÛÇÝ ³í³Ý¹Ç ͳé³ÛáõÃÛáõÝÝ»ñÇ Ù³ïáõóÙ³Ý ÑÇÙÝ³Ï³Ý å³ÛÙ³ÝÝ»ñÇݦ áõ ê³Ï³·Ý»ñÇÝ ¨ å³ñï³íáñíáõÙ
»Ù ³Ýí»ñ³å³Ñáñ»Ý Ñ»ï¨»É ¹ñ³Ýó:
I herewith confirm that all credits to accounts opened in my name will have legitimate source and will not be related to
any tipe of criminal activities, such as terrorism, trafficking, drug circulation, tax evasion and other activities proceeds of
which is forbidden by the Law of RA on Prevention of Money Laundering and Terrorism Finanacing.
I hereby confirm the accuracy and completeness of data stated in the present application/agreement and undertakes to
timely inform the Bank on any changes to it.
By signing this application/agreement I accept the “General Conditions of the Bank Deposits for individuals” of
Inecobank CJSC and the Fees and Charges of Inecobank CJSC and undertake to comply with them.

___________________________                ___/___/200_
(ëïáñ³·ñáõÃÛáõÝ)
(Signiture)
´²ÜÎÆ ÜÞàôØܺðÆ Ð²Ø²ð
FOR BANK’S NOTES ONLY
´³ÝϳÛÇÝ Ñ³ßíÇ (»ñÇ) μ³óáõÙÁ ѳëï³ïáõÙ »Ù ¨ μ³ÝϳÛÇÝ Ñ³ßíÇ å³Ûٳݳ·ÇñÁ ÏÝùáõÙ »Ùª
I hereby permit the opening of the account(s) by signing this agreement:

¶áñͳ¹Çñ ïÝûñ»Ý           ²í»ïÇë ´³ÉáÛ³Ý
CEO                       AVETIS BALOYAN

г׳Ëáñ¹Ç ѳßíÇ Ñ³Ù³ñÁ ÆܺÎà´²ÜÎ ö´À-áõÙ
Account number in INECOBANK CJSC
ÆܺÎà´²ÜÎ ö´À
INECOBANK CJSC
ÐìÐÐ
Tax code
Ã/Ñ ÐРδ
Account number in the Central Bank of RA
гëó»
Adress
лé³Ëáë
Telephone.
¾É. ÷áëï
E-mail
www.inecobank.am
ä³ï³ë˳ݳïáõ ³ß˳ï³ÏÇó
Responsible officer

								
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