Registration Form of the Bank Annex No. 3

Annex no. 3
Registration form
REGISTRATION FORM
OF THE BANK ______________________ Name of the bank Address Telex Fax Chairman of Bank’s Board Telephone Position, place of employment and address President of the bank Telephone Vice President of the bank Telephone Chief accountant Telephone Number of registration of the bank Date of registration Number of branches, representative offices and secondary offices Type of the bank Code Number of the Loro account opened with the National Bank of Moldova License number and series: ______________________________ Number of founding-stockholders: ______________________________ Capital of the bank: ______________________________ Founding￾stockholders that hold significant shares in the bank’s capital Share Thousands, lei % Chairman of the bank’s Board ______________________________ (Annex no.3 amended by the Decision of the NBM no.171 of September 11, 2008) (Annex no.3 amended by the Decision of the NBM no.197 of August 23, 2012)