Application for Deferred Exchange of Damaged Euro Banknotes

Ordinance No 18 of the BNB
Appendix No 1
to Article 9, paragraph 1, item 1
APPLICATION for requesting deferred exchange of damaged euro banknotes
I. Natural person:
I, the undersigned, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Personal registration number / foreigner’s personal number. . . . . . . . . . . , ID card/Passport No . . . . . . . . . . . . . , Date of issue . . . . . . . . . . . . . . Current address: . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . , Postal code . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . . . . , . . . . . , Telephone. . . . . . . . . . . . . . . . . . , Email address . . . . . . . . . . . . . . . . . . . . . . . .
II. Legal person:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BULSTAT/UIC . . . . . . . . . . . . . . . . , Represented by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Position . . . . . . . . . . . . . . . . . , Personal registration number/foreigner’s personal number . . . . . . . ………………………………………. . . . ……………………………………………………………………. ID card/Passport No . . . . . . . . . . . . . , Date of issue . . . . . . . . . . . . . . . . . . , Correspondence address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Postal code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Telephone . . . . . . . . . . . . . , Email address . . . . . . . . . . . . . . . . . . . . .
III. I request the exchange of damaged banknotes:
on my own behalf and for my own account on behalf and for the account of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Current address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., Postal code . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Telephone. . . . . . . . . . , Email address . . . . . . . . . . . . .
IV. How the banknotes were damaged: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
V. Enclosed documents: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
VI. The value of the exchanged banknotes, net of any fees due, will be:
paid in cash at a BNB counter in Sofia transferred in favour of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBAN/BG/ . . . . . . . . . . . . . . . . . . . . . . .. . . . . , Bank code . . . . . . . . . . . . . . . . . . . . . .
at bank .....................................................................branch.................................................................
postal money transfer (the costs are borne by the applicant) I would like to receive an evaluation report (please mark the selected field with an X) By signing the application, I declare that I have read the information in Article 13 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (General Data Protection Regulation), published by the Bulgarian National Bank on its website www.bnb.bg, in connection with the submission of this application. Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . (signature)

APPLICATION COMPLETION NOTES
Data on the person claiming the mutilated or damaged euro banknotes for a deferred ex￾change on his own behalf and for his own account are filled under item I. In this case, under item III, the person should cross out the field ☐ on behalf of myself and for my own account. Where damaged or mutilated banknotes are claimed on behalf and for the account of another person, the data of the authorised person are filled under item I. In this case, under item III, the field ☐ on behalf and for the account of shall be crossed out completing the principal’s data on behalf of whom banknotes are claimed for a deferred exchange. ‘Current address’ shall mean the address which the person has registered as residence at the time of submitting the application and where he/she receives his/her correspondence. The current address may not coincide with the permanent address of the person given in his/her identity document. Under item II, where damaged or mutilated banknotes are claimed on behalf and for the account of a legal entity, the data thereof shall be provided, as well as the data of the authorised representative of the legal entity. In this case, item I should not be completed, and under item III, in the field ☐ on behalf and for the account of only the name of the legal entity shall be written down. Under item IV, a description of the circumstances under which the banknotes have been damaged or mutilated shall be provided. All documents attached to the application shall be listed under item V (a notary certified power of attorney, where the mutilated or damaged banknotes are claimed on behalf and for the account of another person; a document issued by a municipal council, a city-hall, a body of the Ministry of Interior or other competent authority about the reasons and circumstances under which the banknote has been damaged or mutilated, if such document can be issued; where banknotes have been damaged or mutilated by activated anti-theft devices, the competent authorities shall issue a document stating the causes and circumstances under which the respective anti-theft devices have been activated; a financial standing certificate). Under item VI, the selected field ☐ shall be marked with X by the claimant or the authorised person to specify the way in which he/she would like to receive the amount of the exchanged banknotes. When crossing the field ☐ transferred in favour of ........................... (account titleholder), IBAN/BG/ ............................., bank code .................. bank ..................., branch ............... data of the account titleholder should coincide with the data under item I or item III about the person on whose behalf and for whose account the mutilated or damaged banknotes have been claimed. Note: Upon claiming mutilated or damaged banknotes for a deferred exchange, the banknotes shall be packed in a parcel (envelope) protecting its content from further physical and chemical effects, and together with the
accompanying documents (the application and the documents listed under item V of the application form) shall be placed in the same parcel (envelope). The parcel (envelope) shall be addressed to: Commission on Evaluation of Mutilated or Damaged Banknotes, BNB Cash Centre, 10, Mihail Tenev Str., 1784 Sofia. The parcel (envelope) may be submitted at a designated BNB cash desk in Sofia, as well as by parcel postage with advice delivery or by courier