Application for Escrow Account Transaction parties information

							JSC “Aizkraukles banka”, registration No. 50003149401
23 Elizabetes Str., Riga, LV-1010, Latvia; tel.: +371 6777 5222; fax: +371 6777 5200
Client line: +371 6777 5555 | http://www.ab.lv | e-mail: bank@ab.lv | S.W.I.F.T.: AIZK LV 22




Application for Escrow Account

 Transaction parties information

 Party to the transaction
                                     name, surname or company name



 Personal data
                                     Identity No./ passport data for non residents of LR or company registration No.

 Transaction
 particiapant                                Buyer                            Seller                          Other

 Authorized
 representative
                                     name, surname



 Personal data
                                     Identity No./ passport data for non residents of LR



 Contact information
                                     phone numbers, e-mail address




 Party to the transaction
                                     name, surname or company name



 Personal data
                                     Identity No./ passport data for non residents of LR or company registration No.

 Transaction
 particiapant                                Buyer                            Seller                          Other

 Authorized
 representative
                                     name, surname



 Personal data
                                     Identity No./ passport data for non residents of LR



 Contact information
                                     phone numbers, e-mail address




 Party to the transaction
                                     name, surname or company name



 Personal data
                                     Identity No./ passport data for non residents of LR or company registration No.

 Transaction
 particiapant                                Buyer                            Seller                          Other

 Authorized
 representative
                                     name, surname



 Personal data
                                     Identity No./ passport data for non residents of LR



 Contact information
                                     phone numbers, e-mail address




                                                                            VEI.279        Versija: 01     K4          Apstiprināts: 11.12.2008.   Spēkā no: 15.12.2008.   1/2
Application for Escrow Account


Transaction information
Subject of the
transaction




Amount and currency
of the transaction


Term

The commission
fee for escrow                Buyer
account opening is
to be covered by              Seller

                              Buyer and Seller in equal parts

                              Other option

To be completed by the bank

Escrow account No.

Confirmation

I have read the JSC “Aizkraukles banka” General Business Terms and Conditions, consent thereto, and agree to be bound thereby.


Date
                        day        month      year                           (signature, seal)




                                                     VEI.279   Versija: 01      K4        Apstiprināts: 11.12.2008.   Spēkā no: 15.12.2008.   2/2