SPECIAL MENTIONS FOR PAYMENTS F2 1. ORDONATOR/Payer: Nume/Denumire/Name.......................................................................................... CNP/ Cod de identificare fiscala.............................................................................. 2. DETALIILE ORDINULUI DE PLATA/Payment details Nr/No./Data/Date... Suma/Amount. Valuta/currency .................... Cod IBAN platitor /Payer IBAN account R R O Z B R BENEFICIAR/Beneficiary Nume/Denumire/Name....................................... Cod IBAN beneficiar/Beneficiary IBAN account
BANCA BENEFICIARULUI /Beneficiary Bank
3. SOLICITARE /Request: CONFIRMAREA DE EFECTUARE A PLATII mai sus mentionate. Confirmation of the payment(s) mentioned above ( ANULAREA (REVOCAREA) platii /Payment cancellation:
RECLAMAREA NEPRIMIRII DE CATRE BENEFICIAR A SUMEI dispuse prin OP/DPE/OPV mentionat
mai sus/The beneficiary claiming for not receiving the amount ordered by above mentioned OP/DPE/OPV:
URMATOARELE MODIFICARI ALE INSTRUCTIUNILOR initiale dispuse prin OP/DPE/OPV
mentionat mai sus / Following changes for original intructions above mentioned OP/DPE/OPV . ................................................................................................................................................................................ . .............................................................................................................................................................................. .. Subsemnatul Ordonator al platii, declar ca sunt de acord cu plata comisioanelor/spezelor bancare aferente rezolvarii solicitarii si autorizez Banca sa incaseze contravaloarea comisionului aferent serviciului solicitat din conturile mele, fara indeplinirea altor formalitati prealabile / Undersigned payment Ordering customer, hereby declare that I agree with banks charges for solving my request and I authorize the Bank to retain the fees for service requested from my accounts, without prior notice.
Se completeaza de catre Banca / Fill in by the Bank :
Referinta interna a platii /Payment reference............................................................................................................. Motivul revocarii /Cancellation reason................................................................. ................................... Motivul pentru care nu poate fi procesata solicitarea/The reason for not processing customer request: ............................................................................................................................................................ ..................
Client Ordonator/Ordering cutomer,
Email: .. Raiffeisen Bank S.A., Fax: ............................ Telefon/Phone:................ Semnatura/Signature.. Semnatura/Signature..