F-N CLIENT’S QUESTIONNAIRE Responsible ... - citadele.lv · Republikas laukums 2A, Rīga, LV-1010, Latvija Date..... Dear Client! According to the provisions of the law and the

CLIENT’S

QUESTIONNAIREAS „Citadele banka”, Reģ. nr. 40103303559 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 in

block letters. Thank you for your understanding!

1. Basic information about the client

1.1. Name, surname ....................................................................................................................................................................................................................................................................

1.2. Date of birth .................................................................................................... 1.3. Place of birth (country) .......................................................................................................

1.4. Address of registered residence .................................................................................................................................................................................................................................

.................................................................................................................................................................................................................................................................................................................. (street, house/building name or number, apartment/office No, city (region, inhabited place), zip code, country)

2. Contact information

2.1. Actual address (if differs from address of registered residence (1.4.)):

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


2.2. Address for the correspondence:

2.2.1. � address of registered residence 2.2.2. � actual address

2.2.3. � other ...................................................................................................................................................................................................................................................................................


2.3. Phone: 2.3.1. home .................................................................................................... 2.3.2. Name of the Country/code ...............................................

2.3.3. mobile .................................................................................................. 2.3.4. Name of the Country/code .....................................................

2.4. E-mail ....................................................................................................................................................... 2.5. Fax .............................................................................................................

2.6. Skype .................................................................................................................

3. Contact person (provided information will be used if Client could 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:

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

3.2. Name, surname ....................................................................................................................................................................................................................................................................

3.3. Identity number or date of birth .......................................................................................................................

3.4. Actual address:

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


3.5. Phone:

3.5.1. at work ................................................................ 3.5.2. at home ...................................................................... 3.5.3. mobile ...............................................................................

3.6. E-mail ............................................................................................................................................... 3.7. Fax .......................................................................................................................

PANN/AN-S-F-EN-0516.08-LV 1 of 5 Client’s signature: .....................................................................................................................................

F-N

Responsible dept ......................................................

Client number ....................................................... (To be filled in by Bank)

4. Occupation /Place of work

4.1. Occupation: 4.1.1. � hired worker 4.1.2. � entrepreneur 4.1.3. � student 4.1.4. � self-employed person

4.1.5. � house keeper 4.1.6. � retired 4.1.7. � unemployed

4.1.8. � other ....................................................................................................................................................................................................................................

4.2. Present place of work:

4.2.2. Company name .................................................................................................................................................................................................................................................................

4.2.3. Actual address ....................................................................................................................................................................................................................................................................


4.2.4. Industry ...................................................................................................................................................................................................................................................................................

4.2.5. Position: 4.2.5.1. � lawyer 4.2.5.2. � risk analyst

4.2.5.3. � position for which knowledge of financial instruments is necessary

4.2.5.4. � position related to enterprise management and finances

4.2.5.5. � loan specialist-manager 4.2.5.6. � other manager

4.2.5.7. � 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

4.2.5.8. � external accountant who opens accounts with financial institution on his/her behalf to perform financial

operations on customer's behalf

4.2.5.9. � real estate agent

4.2.5.10. � other (specify) ..........................................................................................................................................................................................................

4.2.6. Since when the position has been occupied ................... .......................

month year

4.2.7. Phone .......................................................................................... 4.2.8 Name of the Country/code .............................................................

4.2.9. E-mail ...............................................................................................................................................................

4.3. Previous place of work:

4.3.1. Company name .................................................................................................................................................................................................................................................................

4.3.2. Position: 4.3.2.1. � lawyer 4.3.2.2. � risk analyst

4.3.2.3. � position for which knowledge of financial instruments is necessary

4.3.2.4. � position related to enterprise management and finances

4.3.2.5. � loan specialist-manager 4.3.2.6. � other manager

4.3.2.7. � other (specify) ............................................................................................................................................................................................................

4.3.3. Duration of the previous work ............................ ........................ years months

5. Information about the Client’s tax residency

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).

5.1 Are you a tax resident of the Republic of Latvia? � Yes � No

5.2 Are you a citizen/tax resident of the United States (U.S.)? � Yes � No

If ‘Yes’, please submit Form W-9.

5.3 Are you a tax resident of a country other than the Republic of Latvia and/or the U.S.? � Yes � No

(Please also specify if you are a tax resident of the Republic of Latvia and/or the US)

If you answer 'Yes' in Item 5.3, please specify the country (countries) and taxpayer identification number(s)

Country Taxpayer identification number

6. Income structure (specify):

6.1. � salary

6.2. � registered self-employment (specify type of activity) ...........................................................................................................................................................................

6.3. � from lease of the personal property (specify property type) .............................................................................................................................................................

6.4. � from real estate transactions (specify type of property) .......................................................................................................................................................................

6.5. � dividends / interest (specify payer) ....................................................................................................................................................................................................................

6.6. � loans (credits) 6.7. � inheritance 6.8. � gift 6.9. � scholarship

6.10. � pension 6.11. � other (specify) ...................................................................................................................................................................................................


7. Monthly income (EUR)

7.1. Client’s income: 7.1.1. � salary (net) ............................................... 7.1.2. � other income ............................................................

7.2. Total family income ...............................................

8. Services, products of the Bank, which the Customer plans to use (mark):

8.1. � current account 8.2. � savings account 8.3. � term deposit 8.4. � payment card

8.5. � loan / Leasing 8.6. � currency transactions 8.7. � transactions with financial instruments 8.8. � remote account service

8.9. � other (specify) ..............................................................................................................................................................................................................................................................

9. Reason why SC "Citadele banka" has been chosen:

9.1. � favorable tariffs 9.2. � favorable collaboration conditions

9.3. � Bank’s reputation 9.4. � other persons' recommendations

9.5. � other (specify) ...............................................................................................................................................................................................................................................................

10. Accounts in other banks:

10.1. � DON’T HAVE 10.2. � DO HAVE (specify banks and countries, in which the accounts are opened):

Bank Country

1.

2.

3.

4.

5.

6.

11. Please state if any transaction carried out with the assets on the accounts will be performed in favor of or on

behalf of other person

11.1. � No, I am the actual owner of the funds in the accounts 11.2. � Yes (fill in Statement about actual beneficiary)

12. Information regarding status of politically exposed person

12.1. Are you a politically exposed person, family member of a politically exposed person, or person closely associated to a politically

exposed person?

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, directors, deputy directors and member of the board or equivalent function of an international organization (director, deputy director), or a person

who is in a similar position in this organization.

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.

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.

12.1.1 � Yes please fill in the following information: 12.1.2 � No

12.1.1.1 � I am politically exposed person

12.1.1.1.1. The country where you are currently/were formerly holding a politically exposed position .......................................................................

12.1.1.1.2. Occupied position (please tick):

� 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


12.1.1.2. � I am a family member or a person closely associated to a politically exposed person

Name, surname of politically exposed person ............................................................................................................

12.1.1.2.1. The country where politically exposed person is currently/were formerly holding the position ................................................................

12.1.1.2.2 Occupied position (please tick):

� 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

13. Planned turnover in the accounts in the Bank

13.1. Incoming payments:

13.1.1. Purpose of payments:

13.1.1.1. � salary 13.1.1.2. � income from the personal property 13.1.1.3. � dividends / interest

13.1.1.4. � loan (credit) 13.1.1.5. � inheritance 13.1.1.6. � gift

13.1.1.7. � other (specify).............................................................................................................................................................................................................................

13.1.2. Specify countries from which payments will be made:

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

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

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

13.2. Outgoing payments:

13.2.1. Purpose and regularity of payments (if there are several options, specify the most frequent regularity – x times per month/year):

13.2.1.1. � household expenses .............. time (-s) per month / .............. time (-s) per year

13.2.1.2. � loan repayment .............. time (-s) per month / .............. time (-s) per year

13.2.1.3. � granting loan .............. time (-s) per month / .............. time (-s) per year

13.2.1.4. � term deposits .............. time (-s) per month / .............. time (-s) per year

13.2.1.5. � other (specify) ................................................................................................. .............. time (-s) per month / .............. time (-s) per year

13.2.2. Specify countries to which payments will be made

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

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

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

13.3. Monthly transactions on accounts (EUR):

Transaction type Quantity Average turnover

13.3.1. Incoming transfer

13.3.2. Cash deposit

13.3.3. Outgoing payments

13.3.4. Cash withdrawal

13.3.5. Payments with a payment card for goods or services

13.3.6. Cash withdrawal using a payment card


Account No: ........................................................................................................

Digipass No: ........................................................................................................

Key 1: K ....... .......

Key 2: ....... ....... ....... ....... ....... ....... ....... ....... ....... .......

13.4. Planned maximum amount of one transaction (EUR)

Transaction type Amount

13.4.1. Non-cash transaction, incl. using a payment card

13.4.2. Cash transaction

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 undertake to inform the Bank immediately about changes in the information provided in the Customer questionnaire.

Questionnaire is filled by: � Client � Authorized person

I hereby 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.

.................................................................................................................................................. .......................................................................................................................................................... Name, surname Signature

Date ....................................................

Fill in if the Questionnaire will be send to the Banka by FAX

(Only for the Bank’s client!)

I, .................................................................................... , the Banks’s employee (Bank’s authorized person) has accepted the Questionaire

(Name, surname)

Date ....................................................

Signature, stamp ......................................................................................................................................................................................................................................................................

PANN/AN-S-F-EN-0516.08-LV 5 of 5

PLGK/PA-S-F-EN-1117.02-LV 1 from 3

DECLARATION ABOUT BENEFICIAL OWNER

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

Name, surname ..............................................................................................................................................................................................................................................................................................

Date of birth ................................................................................................................... Personal Identity Number ..........................................................................................................

INFORMATION ABOUT BENEFICIAL OWNERS (BO)1

Name, surname .............................................................................................................................................................................................................................................................................................

Date of birth ................................................................................................................... Place of birth (country) .................................................................................................................

Personal Identity number (for Latvia’ residents²)/ Identity number (for Latvia’ non-residents3) ..................................................................................................................

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 THE BO’S TAX RESIDENCY4

Is BO a tax resident of the Republic of Latvia? � Yes � No

Is BO a citizen/tax resident of the United States (U.S.)? � Yes � No if‘Yes’, please submit Form W-9.

Is BO a tax resident of a country other than the Republic of Latvia and/or the U.S.? � Yes � No (Please also specify if you are a tax resident of the Republic of Latvia and/or the US)

If answer is “Yes” in the previous then please specify the country (countries) and taxpayer identification number(s).

Country Taxpayer Identification Number

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):

............................................................................................................................................................; ............................................................................................................................................................ .

F

........................................................................................ Signature


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 ABOUT POLITICALLY EXPOSED PERSON STATUS

Is BO a politically exposed person5, family member of a politically exposed person6 or person closely associated with a politically exposed person7?

� Yes, please fill in the following information � No

� BO is politically exposed person

� BO is a family member of a politically exposed person or a person closely associated with a politically exposed person

Name, surname of a politically exposed person Do not fill

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 � Client’s authorized person � Client

..................................................................................................................................................................................................................................................................................................................................... Name, surname Signature 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


¹ Beneficial Owner (BO) - is a natural person on whose name or for whose benefit or in whose interests a business relationship is established or a separate transaction is performed without establishing a business relationship.

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 Tax resident - a natural person 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).

5 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, directors, deputy directors and member of the board or equivalent function of an international organization (director, deputy director), or a person who is in a similar position in this organization.

6 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 stipulates 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.

7 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.

Client number .............................................

Date .............................................

CONSENT TO PERSONAL

DATA PROCESSING FOR RECEIPT OF NOTIFICATIONS AND OFFERS

By using Citadele services, clients are entitled to receive various benefits including more favourable financing conditions, higher deposit rates, special offers and discounts for purchases with a payment card, etc.

We work to offer you the best, and we care that you are informed about your possibilities. The habits of every person change over time; to inform you about important current events and the best offers available to you, we need your consent for the processing of your personal data.

We will monitor the situation on a regular basis to ensure that you receive only the information that is truly essential. Should you change your mind, you will be able to opt out of receiving notifications and offers at any time.

Information on processing your personal data

To receive notifications and offers, including personalized offers and individual credit limit offers, processing of your personal data will be performed by the following Citadele Group companies: Citadele banka AS, CBL Life AAS, CBL Atklātais pensiju fonds AS, Citadele līzings un faktorings SIA, CBL Asset Management IPAS. The address of companies of the Citadele Group is Republikas laukums 2A, Riga, LV-1010.

Each company of Citadele Group as your separate personal data controller will process the following personal data:

- identification data – name, surname, identity number or date of birth, client number;

- contact information – telephone number, email address;

- personal data related to your habits of receiving personalized notifications.

We guarantee the non-disclosure and security of your personal data. You can opt out of receiving notifications and offers at any time. You may read detailed information on the rights of cancellation and processing of your personal data in the Privacy Protection Rules of any respective Citadele Group company.

Please fill in your personal details below and specify which notifications of Citadele Group companies you agree to receive.

Client’s name and surname ..............................................................................................................................................................................................................................................

Identity number * ............................................................................................................ Date of birth ** .........................................................................................................

Telephone number ............................................................................................................ Email ..............................................................................................................................

* - to be completed by residents, ** - to be completed by non-residents

RECEIPT OF NOTIFICATIONS AND OFFERS

Receive notifications and up-to-date information about services and offers provided by Citadele Group companies (including personalized offers within the client loyalty program); to find out about possibilities to participate in competitions, lotteries, promotions and other events organized by Citadele Group companies; etc. Detailed information may be found in the Privacy Protection Rules of a respective company of Citadele Group.

I CONSENT to processing of personal data for receipt of I DO NOT CONSENT to processing of personal data for notifications and offers, including personalized offers receipt of notifications and offers, including personalized offers

RECEIPT OF INDIVIDUAL OFFERS OF CREDIT LIMITS

Receive up-to-date information on individual credit limits available to you.

I CONSENT to processing of personal data for receipt of I DO NOT CONSENT to processing of personal data for individual offers of credit limits receipt of individual offers of credit limits

Special provisions.............................................................................................................................................................................................................................................................

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

Hereby I confirm that I understand all information requested and specified in this document and can verify its accuracy.

.................................................................................................................................................................................................................................................................................................................. Name, surname Signature

Notes of Citadele banka AS

L.C. Representative of the Bank ..........................................................................................................................

Branch of the Bank ..........................................................................................................................

PPDA/AL-S-F-EN-0518.02-LV

JSC „Citadele banka”, Unified reg. No. 40103303559 Republikas laukums 2A, Riga, LV-1010, Latvia

APPLICATION

FOR OPENING AND MANAGEMENT

OF CURRENT ACCOUNT

Customer No ...................................................

Date ..................................................

Customer name, surname ......................................................................................................................................................................................................................................................

Identity No* ................................................................................................................ Date of birth** ....................................................................

Type of identification Identification document document ................................................................................................................ number .....................................................................

Telephone number ......................................................................................................................................................................................................................................................

Customer card’s number/ Password .....................................................................................................................................................................................................................

*- for residents, ** - for non residents

Multicurrency Monocurrency Monocurrency Please open a current account account account account currency ............................................

Account number ..................................................................................................................................

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 am informed, that the processing of the natural person data in the Bank is carried out in accordance with the Privacy Protection Regulations approved by the Bank.

I hereby confirm that I have been provided with basic information about the protection of deposit in accordance with the Deposit Guarantee Law.

.................................................................................................................................................................................................................................................................................................................. First and last name Signature

Bank remarks

Seal The Bank officer ........................................................................................................

NKNT/IE-S-F-EN-0518.08-LV

AS „Citadele banka”, Reģ. nr. 40103303559 Republikas laukums 2A, Rīga, LV-1010, Latvija

F

APPLICATION FOR CITADELE ONLINE BANKING CONNECTION

Customer No. ................................................... JSC „Citadele banka”, Unified reg. No. 40103303559 Republikas laukums 2A, Riga, LV-1010, Latvia Date ...................................................

New Application Amendments to the existing Application

Customer

Name, surname ......................................................................................................................................................................................................................................................

Identity No* ................................................................................................................ Date of birth** ................................................................................. Type of identification Identification document ................................................................................................................ document number .................................................................................

Phone number ................................................................................................................ e-mail ................................................................................................................... *- for Latvian residents, **- for Latvian non residents

User: Customer Other person (to be filled in )

Name, surname ......................................................................................................................................................................................................................................................

Identity No* ................................................................................................................ Date of birth** ................................................................................. Type of identification Identification document ................................................................................................................ document number .................................................................................

Phone Mobile phone number .............................................................. number ................................................... e-mail ...................................................................................................................

Address ............................................................................................................................................................................................................................................................................................. *- for Latvian residents, **- for Latvian non residents

Authorisation Code card Code calculator ................................. MobileSCAN device type (Type)

Device ID No .................................. Device ID No .................................. Licence No ..................................

MobileSCAN licence will be used with DIGIPASS 780 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)

Special provisions

1..................................................................................................................................................................................................................................................

2..................................................................................................................................................................................................................................................

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. I am informed, that the processing of the natural person data in the Bank is carried out in accordance with the Privacy Protection Regulations approved by the Bank.

.................................................................................................................................................................................................................................................................................................... Seal Name, surname Signature

User signature Hereby I confirm that I have received the Authorisation Device specified in the Application.

................................................................................................................................................................................................................................................................................................................. Name, surname Signature

Bank Representative of the Bank ..............................................................................................................

Branch of Seal the Bank .............................................................................................................

PINB/IE-S-F-EN-0518.08-LV

Application number ..................................................

ANNEX TO THE APPLICATION FOR CITADELE ONLINE BANKING

CONNECTION Customer No .............................................

AS „Citadele banka”, Reģ. nr. 40103303559 Republikas laukums 2A, Rīga, LV-1010, Latvija Date .............................................

Customer

Name, surname ..................................................................................................................................................................................................................................................................

Identity No .......................................................................................................................... Date of birth ..............................................................................................

User: � Customer

� 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:

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Usage mode for other accounts .........................................................................................

User special limits (EUR):

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 Signature

Bank Representative

of the Bank ..............................................................................................................

Branch of

Seal the Bank .............................................................................................................

IBSP/IE-S-F-EN-0415.03-LV

Application number ..............................................

Annex to be filled in if online banking usage mode is “Special conditions (Limitations)”.

Customer number .................................................... Date .....................................................

APPLICATION FOR CITADELE SMS BANK

SERVICE AS „Citadele banka”, Reģ. nr. 40103303559 Republikas laukums 2A, Rīga, LV-1010, Latvija New application Changes of existing contract

Customer name, surname ......................................................................................................................................................................................................................................................

Identity No* ................................................................................................................ Date of birth** ........................................................................................

Type of identification Identification document ................................................................................................................ document number ........................................................................................

Phone number ................................................................................................................ e-mail ..................................................................................................................... *- 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 outgoing amounts

Short message on incoming amounts Account balance

on request

Always include account balance

and available balance

Send Minimum amount Send Minimum amount

Short message on transactions on Customer payment card Payment card number Successful

authorisation Failed authorisation Transaction reversal

Available balance on

request

Always include

balance on request

Send Minimum amount

Send Minimum amount

Send Minimum 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 ...........................................................................................................................................................................................................................................................................

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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. I am informed, that the processing of the natural person data in the Bank is carried out in accordance with the Privacy Protection Regulations approved by the Bank.

.................................................................................................................................................................................................................................................................................................................. Name, surname Signature

Bank remarks

Seal The Bank officer ..................................................................................................................................

SMSB/IE-S-F-ENG-0518.05-LV

F

Documents

F-N CLIENT’S QUESTIONNAIRE Responsible ... - citadele.lv · Republikas laukums 2A, Rīga, LV-1010, Latvija Date..... Dear Client! According to the provisions of the law and the