DELEGA}IE / DELEGATION

Denumire client / Client Name

Cod unic de \nregistrare (CUI) / Unique Registration Code (URC)*

*In cazul \n care clientul nu are alocat CUI, se va completa Codul de |nregistrare Fiscal`/ Should no URC be available,
the Fiscal Code will be provided
Deleg`m pesoanele mai jos men]ionate pentru a efectua urm`toarele opera]iuni / hereby delegate the below mentioned
persons for the following operations:
1. Preluare extrase de cont ale societ`]ii / Collect the companys account statements
2. Depunere documente bancare/Retragere documente bancare / Deposit documents to the bank/Collect
documents from the bank
3. Depunere numerar / Cash deposits
4. Retragere numerar / Cash withdrawals
Informa]ii despre delega]ii persoanei juridice/entit`]ii f`r` personalitate juridic` / Information about delegations of
legal person /non-legal entities:
Tipul
deleg`rii */
Type of
delegation *

Nume / Name

Document identitate/
Identity card
(tip,serie,nr.)/
(type,series,no.)

C.N.P. / P.N.C.

Semn`tura/
Signature

* pentru fiecare opera]iune se va completa cu DA sau NU / to be filled in with YES or NO for each operation
Persoanele desemnate ca delega]i declara c`, prin semnarea prezentului formular, \[i exprim` [i acordul de prelucrare
a datelor cu caracter personal, conform mentiunilor de pe verso / By signing the present form, delegates express their
agreement for the manipulation by the Bank of their personal data, as mentioned on the reverse page.
Prezenta delega]ie \nlocuie[te formularul depus la data/ The delegation hereby replaces the form dated __/__/____
[i este valabil` pn` la revocarea acesteia \n scris de c`tre noi/ and is valid until revoked in writing by us.

Nume [i Prenume Reprezentan]i Legali /

Legal Representatives Name and
Surname

C.N.P. / P.N.C.

Nume [i Prenume Reprezentant Banc` /

Bank Representative Name and Surname

Agen]ia / Branch:

Data /
Date

Data / Date

Semn`tura Reprezentant
Legal/
Legal Representative
Signature

Semn`tura Reprezentant
Banca/
Bank Representative
Signature

CIF:

Raiffeisen Bank S.A.  Administra]ia Central`  Pia]a Charles de Gaulle nr. 15, sector 1, Bucure[ti  Cod 011857  Romnia  Telefon +40 21 306 1000




Fax +40 21 230 0700  E-mail: centrala@raiffeisen.ro  www.raiffeisen.ro  C.U.I. 361820  Num`r de \nregistrare \n Registrul Comer]ului J40/44/1991
Num`r de \nregistrare \n Registrul Bancar RB-PJR-40-009/1999
Societate administrat` n sistem dualist

Cod de \nregistrare fiscal` RO361820

Capital Social 1.200 mil Lei

Cod BIC RZBRROBU Raiffeisen Direct: 0800 802 02 02 apel gratuit din re]eaua Romtelecom
40024542

Acord de prelucrare date cu caracter personal / consent for personal data processing
Cunoscnd dispozi]iile legale referitoare la protec]ia persoanelor cu privire la prelucrarea datelor cu caracter personal
[i libera circula]ie a acestor date, \mi manifest \n mod expres acordul cu privire la prelucrarea de c`tre Banc`, direct
sau prin intermediul mandatarilor [i/sau ter]ilor contractan]i, a datelor mele personale, \n scopul derul`rii raporturilor
juridice existente \ntre mine [i Banc`, precum [i cu privire la dezv`luirea [i transmiterea oric`rei astfel de informa]ii sau
date [i altor entit`]i membre ale grupului Raiffeisen, agen]ilor B`ncii sau ter]ilor parteneri ai B`ncii, \n scopul prest`rii
oric`rui serviciu Clientului, efectu`rii oric`rei analize [i/sau \n scopuri statistice. Declar c` am luat cuno[tin]` despre
drepturile pe care mi le confer` Legea nr. 677/2001: dreptul la informare, dreptul de acces la date, dreptul la interven]ie
asupra datelor, dreptul la opozi]ie (drepturi ce pot fi exercitate adresnd o cerere scris`, datat` [i semnat` c`tre
operatorul de date \n care se vor men]iona informa]iile prev`zute de lege; oric`rei cereri i se va ata[a o copie xerox,
lizibil`, dup` actul de identitate al solicitantului), dreptul de a nu fi supus unei decizii individuale [i dreptul de a m`
adresa justi]iei.
Datele cu caracter personal prelucrate includ urm`toarele categorii: date de identificare - numele, prenumele,
pseudonim, adresa de domiciliu/resedin]a, num`rul de telefon fix/mobil, codul numeric personal, data [i locul na[terii,
cet`]enie, reziden]`, func]ia public` de]inut`, tip/serie/num`r document de identitate, semn`tura olograf`; date
referitoare la inadverten]e (neconcordan]e) / Knowing the legal provisions regarding the protection of persons related
to the processing of personal data and free movement of such data, hereby expressly give my consent regarding the
processing by the Bank of my personal data, either directly or by representatives of contracted third parties, for the
purpose of the existing legal relations between me and the Bank, as well as regarding the disclosure and transfer of
any such information or data to other entities and members of the Raiffeisen group, the Banks agencies or Banks third
party partners, for the purpose of providing any service to the Client, making any analysis and/or for statistic purposes.
I hereby state that I am aware of the rights granted to me by Law no. 677/2001: right to information, right of access to
data, right of intervention on the data, right to opposition (rights that may be exerted after submitting a written
application, dated and signed to the data controller indicating the information provided by the law; a legible photocopy
of the applicants identity document will be attached to any application), the right not to be subject to an individual
decision and the right to go to court.
Processed personal data include the following categories: identification data first name, last name, alias,
domicile/residence address, fixed/mobile phone number, the personal identification number, dated and place of birth,
citizenship, residence, public office held, type/series/number of identity document, handwritten signature; data
regarding inadvertences (non-conformities).