I. Account Holder’s Data
Account Holder’s Name
Address for correspondence
Contact person1
Telephone number / Email
II. Approval scheme
Accounts / Authorization 2 / Release3 / Limit 4
1 – one level / 2– two levels
1
2
3
4
5
6
III. User entitlements 5
Full Name / SafeWord Card Number / Add rights / emove rights / Remove user from the system / Accounts 5 / Create / Authorization 1 / Authorization 2 / FX for WorldLink / Release / Limit4 / Account Information / PDF Statements
1
2
3
4
5
6
Instructions for completing the application:
1 Contact person who Bank will contact with in case of doubts regarding the correctness of filling hereby application. The Account Owner gives the above mentioned person the power of attorney to confirm the correctness of the hereby application or to introduce essential changes necessary for its implementation providing that the changes in question do not alter its content in a significant way (including adding new users).
2 Authorization is verification of instructions made by other user. A person entitled toinput and authorize will NOT be able to authorize paymentsmadeby himself. Alsouser with entitlements for authorization at both levels will be able to authorize only on one of the levels.
3Authorization scheme order for WordLink always requires release of the transaction.
4 Limit refers to the option CREATE/AUTHORIZATION/RELEASE.
5 Users with entitlements for authorization are requested to fill „Personal data of persons authorized to make transactions in the name of the Account Holder” form. In a situation when authorization process is not activated the form should be filled by the users with entitlements for processing transactions.
6 Please specify the Accounts with the corresponding numbers from section II.
IV. Cancel previous configuration
Configuration settings shown on hereby application will cancel all previous system settings (for people not listed on this application entitlements will be cancelled with regards to the accounts covered by the application).
V. Account Holder’s sign
Date, stamp / Signature(s) of authorized persons consistent with company legal representation / power of attorney.
The form should be sent at the following address:
Zespół Obsługi Dokumentacji Rachunków Korporacyjnych
Ul. Goleszowska 6, Bud. I p. 5
01-260 Warszawa