FORMULAR DE ACTUALIZARE DATE PERSONALE PERSOANE JURIDICE

Subsemnatul/a (nume si prenume) __________________________________________________, avand CNP

_/_/_/_/_/_/_/_/_/_/_/_/_/, in calitate de reprezentant al __________________________________________ client al BRD
Sogelease IFN S.A (Finantator), solicit prin prezenta actualizarea datelor conform optiunilor de mai jos:

Denumirea firmei ____________________________________________________________ (Client) Forma juridica

____________________________________ Adresa sediu social Str. ___________________________________ Nr. ______
Bl. _____ Sc _____ Et. _____ Apt. ______ Localitate _______________________________ Judet ____________________
Sector _______ Cod Postal ___________ Tara __________________________ Rezident Nerezident UE Nerezident
din afara UE Telefon mobil 1 __________________ Telefon mobil 2 ________________ Fax ____________________
E-mail _________________________________________________ web __________________________________________

Date de identificare

CUI _/_/_/_/_/_/_/_/_/_/_/_/_/, Cod de inregistrare fiscal _/_/_/_/_/_/_/_/_/_/_/_/_/, Cod inregistrare Reg.

Comertului/Registru public de ordin profesional/Numar autorizatie _/_/_/_/_/_/_/_/_/_/_/_/_/, CAEN
_/_/_/_/_/_/_/_/_/_/_/_/_/, Tipul /natura activitatii desfasurate _______________________________________________

Asociati persoane fizice

Nume ____________________________________ Prenume __________________________ Participatie (%) _______

Nume ____________________________________ Prenume __________________________ Participatie (%) _______
Nume _____________________________________ Prenume ____________________________ Participatie (%) _______

Asociati persoane juridice

Denumire _________________________________________ CUI _____________________ Participatie (%) _____

Denumire _________________________________________ CUI _____________________ Participatie (%) _____
Denumire ____________________________________________ CUI _______________________ Participatie (%) _____

Administrator/reprezentanti legali

Nume ____________________________________ Prenume ________________________ Telefon ________________

Nume ____________________________________ Prenume ________________________ Telefon ________________
Nume ____________________________________ Prenume ________________________ Telefon ________________

Numele beneficiarului/beneficiarilor real(i): _________________________________________________________________

Documente ce atesta modificarea (daca e cazul): ___________________________________________________

Formularul completat se transmite la adresa BRD Sogelease IFN SA din Bucuresti, str. Ion Mihalache, nr.1-7, bloc Turn
BRD, sector 1.

Data (zz/ll/aaaa): _/_/_/_/_/_/_/_/ Nume si prenume: ________________________________

Semnatura: ______________________________________

BRD SOGELEASE IFN S.A. Operator de date cu caracter personal nr. 3290
Bd. Ion Mihalache nr. 1-7, Turn BRD, etaj 12, sector 1- Bucuresti RG-PJR-41-110036/30.11.2006
Nr. inreg. Reg. Com. J40/6764/31.07.2001 RS-PJR-41-110006/30.11.2006
CIF/CUI: RO14080565 l: +40 21 301 41 88; Fax: +40 21 301 41 04/05
Capital social: 9.000.000 LEI www.brdleasing.ro; e-mail:brd.sogelease@brd.ro