Appendix No. 2
AUTHORIZED PERSON INFORMATION SHEET
Personal data collected through this Questionnaire will be processed for the purpose of customer due
dilligence, in accordance with the Law on the Prevention of Money Laundering and the Financing of
Terrorism and referent regulations.
Note: The Account Holder shall complete other type of the questionnaire.
INFORMATION ON THE AUTHORIZED PERSON:
First name, Last name: ______________________________________________________________
Personal ID Number:
_____________________
Date of birth:
_____________________
Place of birth:
_____________________
Country of birth:
_____________________
Citizenship:
_____________________
Sex:
_____________________
Residence (from the ID Document):

Address:
____________________________________________________________

Town:
____________________________________________________________

Postal code:
_________________

Country: __________________________
Domicile (if different from residence):

Address:
____________________________________________________________

Town:
____________________________________________________________

Postal code:
_________________

Country: __________________________
ID Document:

Type:
_________________________

Issuer:

Number: _________________________

Date of release: ____________________
__________________________
Activity:

Employee

Freelancer

Unemployed

Retired

Entrepreneur

Self-employed

Student

Other
Additional information on the authorized person:
Have you or your close relative held at any time during last 12 months a public office, or have you
been close associate of such person:

In Serbia:
YES
NO

In a foreign country or international organization:
YES
NO
Country where the main business is carried out: __________________________________________
Code: BIB.1060.P.005-OBR.01
Version: V/11.02.2015
Page 1 / 3
Appendix No. 2
INFORMATION ON THE ACCOUNT HOLDER:
Note: Person authorized for account disposal shall complete only name and personal ID number of the
Account Holder.
First name, Last name: ______________________________________________________________
Personal ID Number:
_____________________
Date of birth:
_____________________
Place of birth:
_____________________
Country of birth:
_____________________
Citizenship:
_____________________
Sex:
_____________________
Residence (from the ID Document):

Address:
____________________________________________________________

Town:
____________________________________________________________

Postal code:
____________________________________________________________

Country:
____________________________________________________________
Domicile (if different from residence):

Address:
____________________________________________________________

Town:
____________________________________________________________

Postal code:
_________________

Country: __________________________
ID Document:

Type:
_________________________

Issuer:

Number: _________________________

Date of release: ____________________
__________________________
Activity:

Employee

Freelancer

Unemployed

Retired

Entrepreneur

Self-employed

Student

Other
Additional information on the Account Holder:
Has the Account Holder or his/her close relative held at any time during last 12 months a public office, or
has he/she been close associate of such person:

In Serbia:
YES
NO

In a foreign country or international organization:
YES
NO
Country where the main business is carried out: __________________________________________
Type of transactions that will be processed through the account:

Cash transactions

Wire transactions

Cross-border transactions

Savings and investments

Other: _____________________________________________________________________
Code: BIB.1060.P.005-OBR.02
Version: V/11.02.2015
Page 2 / 3
Appendix No. 1
Will the turnover on the account mostly refer to cash transactions? If YES, please explain the reasons
and specify the expected average amounts (roughly):
_________________________________________________________________________________
Please specify the expected average level of in-payments to the account:

Up to 1,000 Euros monthly

Up to 10,000 Euros monthly

Up to 2,000 Euros monthly

Over 10,000 Euros monthly

Up to 4,000 Euros monthly
What are the expected sources of funds:

Regular salary

Other (please specify): ________________________________________________________
Annual amount of expected other income: ________________________________________
Will the transactions on behalf of third persons be carried out through the account?
YES
NO
Hereby I confirm that all data given in this document are true and I am in full agreement with the Bank's
right to check them. I will promptly inform the Bank on any change regarding the data given above.
Hereby I confirm that the bank has informed me of the following:



That processing of the personal data contained in this questionnaire is based on the law;
My rights and obligations of the Bank in connection with the processing of the personal data –
by insight to "Notification on the conditions of collection and processing of personal data" and
evidence in register collection named "Database on basic data of natural persons for all Bank
products - No.1";
The possibility to check the details on mentioned processing of data in the Central Data File
Register maintained by the Commissioner for Information of Public Importance and Personal
Data Protection, available at Web address: http://registar.poverenik.rs , in collection
named "Database on basic data of natural persons for all Bank products - No.1 ".
___________________, ______________
Place and date
Code: BIB.1060.P.005-OBR.01
Version: V/11.02.2015
_________________________________
Authorized Person's signature
Page 3 / 3