* NGAN HANG TMCP QUAN t>(H

.;MB
H6i sa chinh (Head Office): Toa nha Ngan hang Quan dQi - 3 Lieu Giai, Ila mnh, Ha N. i, Vitt Nam
. Tel: 84-4-266 1088/9 Fax:84-4-266 1080
Website: www.militarybank.com.l.1I - Email: info@nJiliIQr.J1lpllk.com .•..n - SWIFT Code: MSCBVNVX
NGAN HANG OUAN O(JI

GrAY DANG KY MO TAl KHoAN ellA eA NIlAN

APPLICATION FOR OPENING INDIVIDUAl-ACCOUNT
Kinh J!;m: NG'\N II,\NG TMCI' QU'\N n(>1
IISKII .
To: Military Commercial Joint Stock Bank
CIFN°.

Ten tai khoa n: .

Account Name .
110. va len chu lai khoan

Account Holder'.'1 Name

.,
:.PH.A(\J....llt -'-- Q.LJ.'1NfJ
f) f:-
-- -- -- -- .

CM ND, HI) chieu so:. __15A4-.5.6.SS.& __.. doCA .. 1uie.__..HUtL'...IlA../IL dp n~ay.. M1..O'[.I ..£m).CJ. ..
ID Cardl Passport NO. issued hy I __ issuing date
fl,a chi dan~ kj hI) kh{,u ..tfo.o.~'r.il-I,I.-:f0e. ..
:~~IYnf f1I-!;~.I lliio./
J6ine.. ---- -- -- .
Place of permanent residenc't I ()
fl,a chi lien h~:. ¥.ft~ 1£ 1.-121" fm~ 1;;..f.:{g,~ ...t.GJffi.: .. VIR.fied. .
Contact address
f)i~n Ih()~i: Nha rieng: __ Co quan:.DHola.ol..9.b.'l Di dQng.OjH:JI.S.~ :n. Email~ .
Tel. Home Tel. Office Tel. Mohile

~ Kh6ng ky h~n 0 Ti~n gi'ti co ky h~n DKhac

Current Fixed Deposit Other

[)USD IiVND DKhac

Other

Y~NI Authorized Person

CMND, He> chieu 56: __ do CA __ cap ngay l 1.. .

lD Cordi Passport No. issued by issuing date
Ph~m vi uy" ~nl Au thori zed scope .

Thai h~n u qu ~n, k~ III ng"¥ 1 ./200 __.. Mn ngay ; /200 . __.
Period of authorization,jrom to
Chung loi cam ket thuc hi~n dung cae Qu, dinh cua Ngan hang TMCP Quan dl)i va cua Phap IUat "f vi~c rna ,'a sir dung lai khoan.
lVe undertake ro comply with all Military mmercial Joint Srock Bank's regulations and the lawfor opening and using this account .

. .__" ngay/date .JJ...,hang/molltlL ..QXmim!year 2~D.....

CHa KY MAUl SPECIMEN SIGNATURE
CIIl) TAl KIIOAlI:/ '\«ounll/old"
Cua Chu Tili Khoan (Ky va ghi ro hQ ten)

~ol;;sspecimen ~~ (SiWllltun> & Fill/name)

I
Cua
prlOm
~~lfm
t" 'P1rJ.t&
d.r""
uj q~en .
2

Authorized Person's specimen of signature

_________ 2 _

Luu y: Truimg h£!p ,yEu ii'u fiii khoan diJng 50-IlIlU, de ngh! xem m!,' sa
Notes: In case-Co-holde
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DON DANG KY PHAT HANH THE 3. DANG KYDICH VU TR VAN THONG TIN

Mobile Bankin; ft] ~6 dien thoai dang ky su dyng: .OS.r.t-: .8.2..8.2..~z.. I

ACTIVE pillS Internet Banking 0 Email dang ky truy v~n: .

• Ngtm hang c6 quye1n t<jlm dUng djch vII rna khOng cAn phai th6ng bao
Kfnh gUt:
Ngan himg TMCP Quan DQi - Chi nhimh. .
tnJtk khi khach hang kh6ng tu~nthu cac y~ucAu baD m~tho(lc c6 sl/co
cua nha cung clp dfch vl,I vi6n thOng
De ngh! Ngim hang Quan f)~i:
• ThOng tin cung c5p mang tinh h6 tn;JkhtJch hang vi v~yS8 khOng co
Phill h~mhthe AcnYEplus cha tOi thea "9i dung sau day:
tnJt1ng hqp khach hang khieu k;~nkhi dich vl,l cung cap bj sf/c6 bat kha
1. THO~G TIN:KHACH HANG: , khang (th6ng tin bj giii nhi~uIAn. kh6ng giii dlJr)c do 16; tilnha cung cap
Ha va tan (chi! in hoa): ftlft.tY..1HLil.L:CfNtf . dich Vl,lvi{mth6ng .... )

Ngay sinh: .. O.910tjA.9F,6 GilJi Unh: Nam 0 I Ni! Ii T61 xi" xac nh*n:
• Nhang thong tin tren day /a dung SI/that va hoan toan ch;u trach nh;~m
56 CMNDI H(\ chieu: . As.d4-:&6...~r Ii .
1 .- vd cac th6ng tin d~ cung cap
Ngay cap:.,1./ q..eUJ)j Noi cap: .. (.It ..1:1UU' f,;,l.t& . • Da dQc. hidu rO va d6ng y voi Cacdidu ki~n,didu khoan phat hanh va su

Dia chithLJIJng lni ~f1LftP~,~nLPfUj)Jif<tJ.~ dl,lng the Ac1M pl~

• Cam ke-t thl/C hi~n dung cac quy d!nh su dl,lng rai khoan ca nhan cua
Dia chi lian lac: Pfmtg.1C L'f) C1g fL/rIf18' idli:l7. vic1f..el Ngfm hang TMCP Quan DCJi.

• Cam ket chiu hoan loan trach nhi~m ve vi~c bao quan m~t khau sa
dl,lng. tinh an toan. bao m~t th6ng tin va tuan lhu dung.quy dfnh cua
Di~ntho~inha rieng: . dfch vl,l MobileBanking, IntemetBanking.
.tlIl ..iY&:.Ngayu" thang .p.3. nam,Ul{J.! ..
Cci'g.f)f ..~ ..&M:v~1fpJ
~;;;wotan)~
Co quan. • NgLJIJidang ky

Nghe nghiap: .: .c'J{+ \ifu rrr.-J4!........ .. .

7) fl\.' O~ f\ 01Q ,>.. ~~ I, 1iW. CJ. ,,/'
CIl, 1OMSr'J'1Jii"
D!aChicoquan/.Jo(\,.I1~.~. 1..100'L.,(]', I~({).:J
Di~n thoai co quan: .. 0+' ,.tG& ...t969, . fM-HI. 1R.t' fW;jne
8iE1ln tho~idi d~ng: .09.8'!:-, .1'2..8',L .. 9,[, ..
Email: Fax: .
MfJ Khach hang:

2. YEU cAu I'HAT HANH THE Chli rai khoan: .

56 Uti khoan VND tai Ngfm hang TMCP Quan 8~i:
56 rai khoan:

H'llng the: 00000000000000000000

Chu~n (Blue) Vang (Gold) o Dilc biot (Diamond) 0 Giao dich vien Kil~mscat Giamd6c

lo~ihinh phat hanh: Nhanh o Thong thl/ang Ei

Hinh thlic Ihanh loan phi: Ghi n<.1tal khoan D N9P tien m~U D