Download Application Form Retail Bonds 2016 (File Size: 260,84Kb)

APPLICATION FORM
BONDS OF THE REPUBLIC OF CYPRUS FOR NATURAL PERSONS
ISSUE 2016 MATURITY 2022
To: Cyprus Stock Exchange
Lord Byron Avenue 71-73 P.O. box 25427
Nicosia 1096, Cyprus
(for official use)
Application no:………..……………………………
1. APPLICATION THROUGH AN
AUTHORISED
REPRESENTATIVE
………………………………………………………..
(mark Χ if applicable)
(please place seal)
2. APPLICANT DATA (please complete in capital letters)
Name (please complete name and then surname):
……………………………………………………………………………………………………………………….
Correspondence Address:……………………………………………………………………………………………
……………………………………………………………………………………………………………………….
Identity Card no.: …………………………………………………………………………………………………….
Passport no. and country of issuance :……………………………… ……………………………………………..
Passport date of issuance:………………………….Passport date of expiry:……………………………………..
Investors share a/c at CSE (OBLIGATORY FIELD):……………………………….............................................
Securities a/c at CSE (OBLIGATORY FIELD ):…………………………………………………………………
Date of birth: ………………………………… Place of birth (city):………………………………………………
Country of residency:……………………………... Tel. no.:..…………………………………………………….
3.
NOMINAL VALUE OF APPLICATION AMOUNT (in words)
………………………………………………………………………………
€
………………………………………………………………………………
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4.
REPAYMENT/ RETURNED FUNDS INSTRUCTIONS
I hereby authorise the execution of the repayment of the bonds that will be allocated to me or, in case of a rejection of
my application, the return of funds as follows:
By bank transfer to the following account:
Name of account holder………….……………………………………………………………………………………..
Credit Institution. ……………………………………………………………………………………………………...
BIC Code………………………………………………………………………………………………………………..
Account Number IΒΑΝ
Date ………………………………..
Signature(s) ………………………………………
(in words)
………………………………………
………………………………………
(in words)
………………………………………
Note: the above payment instructions are valid only for the specific bonds that will be allocated on the basis of this application
and will supersede any general payment instructions to the Cyprus Stock Exchange by the investor.
5.
INTEREST PAYMENT INSTRUCTIONS
I hereby authorize you to execute the payment of interest of the bonds that will be allocated as follows:
By bank transfer to the following account:
Name of account holder………….……………………………………………………………………………………..
Credit Institution. ……………………………………………………………………………………………………...
BIC Code………………………………………………………………………………………………………………..
Account Number IΒΑΝ
Date ………………………………..
Signature(s) ………………………………………
(in words)
………………………………………
………………………………………
(in words)
………………………………………
Note: the above payment instructions are valid only for the specific bonds that will be allocated on the basis of this application
and will supersede any general payment instructions to the Cyprus Stock Exchange by the investor.
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6.
APPLICANT STATEMENT
1. The present application for the purchase of bonds is submitted according to the general terms of
issuance of government bonds for natural persons and the specific terms for issuance of government
bonds to natural persons as they were published in the Official Gazette of the Republic on 30 November
2015.
2. I hereby state that I am / I am not a permanent resident of the Republic of Cyprus (strike accordingly)
IMPORTANT CLARIFICATION
This document does not constitute or form part of, and should not be construed as, an offer to sell or issue or the solicitation of an
offer to buy or acquire securities of the Republic of Cyprus (Issuer) in any jurisdiction or an inducement to enter into investment
activity in any jurisdiction. Neither this document nor any part thereof, nor the fact of its publication, shall form the basis of, or
be relied on in connection with, any contract or commitment or investment decision whatsoever.
Interested investors are encouraged to perform an independent review of the financial situation of the Issuer and the main
characteristics/risks of the bonds. For this purpose advice may be sought from a registered/licensed expert (eg. Investment Firms)
as to whether this investment is suitable for them before taking any final decision as regards the Bonds .
Date ………………………………
Signature(s) ………………………………………
(in words)
………………………………………
………………………………………
(in words)
………………………………………
AUTHENTICATION
Note.: If this document is submitted by a person other than the investor or his/hers authorized representative, the signature on the document
needs to be authenticated by a certifying officer, responsible for certification on the basis of article 19A of the Securities and Cyprus Securities
Exchange (Central Securities Depository and Central Registry) Law or from a corresponding authority abroad.
NOTES
1.
2.
3.
The applicant data must be the same as recorded at the Central Securities Depository and Central Registry
(CSDCR) of the Cyprus Stock Exchange. In case a modification is needed the relevant procedure of the CSDCR
will be followed and fees will be charged accordingly.
For underage applicants the application must be signed by the person(s) which hold parental care
For the application to be considered full the following documents must be included:
 Payment (personal cheque or bank draft which is accompanied by proof on which the applicant's name and the
account number , from which the bank draft was issued, appear or bank transfer on which the name of the applicant
appear)
 Copy of Identity card/passport
 Copy of a recent utility account (e.g. CYTA, Electricity Authority of Cyprus)
 Bank statement or other bank document on which the IBAN and BIC codes of the applicant’s bank account
are clearly indicated.
 Where applicable: Application for the creation of an Investor’s share a/c at the Cyprus Stock Exchange along
with the necessary accompanying documents such as a copy of the identity card and a recent utility bill.
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(for official use)
Receipt:………………………………………
Date:…………...
Signature:………………………...
Checked :……………………………………...
Date :…………...
Signature :………………………...
Entered:…………………………………...
Date :…………...
Signature :………………………...
Entry check:………………………...
Date :…………...
Signature :………………………...
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