Customer Specimen Signature Form

Customer Specimen Signature Form
We, the undersigned, representing,
Registered Company name (in full)
City
Country
hereby confirm that this specimen signature form is valid (please tick one box only):
for all the accounts opened or to be opened in our name at the above location in
the books of Clearstream Banking AG (“CBF”);
only for the following account number(s):
Name of the authorised signatory
Specimen signature1
(please print in BLOCK CAPITALS)
Scope of Authority
General commercial Power of Attorney
(“Prokura” under German law), Commercial
power, type A/B (“Handelsvollmacht”)
1
2
3
4
5
1. Please sign only in the specimen box to enable scanning of the signatures.
3199e/12.2012
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Clearstream Banking AG
Customer Specimen Signature Form
Individual or joint signatories
The persons listed
(please tick the appropriate box(es))
from number: ____ to number: ____ may act as individual signatories.
2
One person listed
from number: ____ to number: ____ together with one person listed
from number: ____ to number: ____ may act as joint signatories.
Any two of the persons listed as authorised may act as joint signatories.
Supplement or replacement
The submission of this form supersedes the previous specimen signature form
dated
(please tick one box only)
OR
This specimen signature form supplements the previous customer specimen
signature form dated
We agree to provide written notification of deletions or modifications to signatures
without delay and to submit an up-to-date specimen signature form once a year. It
is assured that the authorised signatories notified to CBF will remain authorised
until CBF has received written notification that such authority has been revoked.
Authorised signature(s)
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Signature
Signature
Name
Name
Title
Title
Place
Place
Date
Date
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Clearstream Banking AG
Customer Specimen Signature Form
Name of the authorised signatory
Specimen signature
(please print in BLOCK CAPITALS)
3
Scope of Authority
General commercial Power of Attorney
(“Prokura” under German law), Commercial
power, type A/B (“Handelsvollmacht”)
6
7
8
9
10
11
12
13
Authorised signature(s)
3199e/12.2012
Signature
Signature
Name
Name
Title
Title
Place
Place
Date
Date
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Clearstream Banking AG
Customer Specimen Signature Form
Guidelines
4
SignatureNet
If your company has confirmed that CBF should only use the web-based platform
SignatureNet to check your company's signatures, this form does not have to be
provided.
Account numbers
– First box
Mark the first box only if all of your accounts are managed by the same office.
– Second box
Mark the second box only if all the accounts listed are covered by the signatures
on this form. Please ensure that you have listed all relevant account numbers.
Note: Please use (an)other copy/copies of this form for accounts not covered by
the signatures on this form.
Name of the authorised signatory
At least one signatory name is mandatory if he/she is authorised to sign alone. At
least two signatories are mandatory if they are authorised to sign jointly. If
completing by hand, please write names in BLOCK CAPITALS.
Scope of authority
An updated official list of authorised signatures with specimen signatures refers to
the company itself. Whereas the specimen signature form for CBF only requires
the indication of authorised signatories for the concerned CBF account(s), CBF
uses this condensed standardised form to feed an internal electronic signature
management system. This system enables a decentralised, simple and fast
verification of signatures directly within all operational departments.
Individual or joint signatories
Please enter any individual signatories first. If no box is marked, we will assume
that each signatory is authorised to sign alone.
Legally binding signing
This form and all following pages must be numbered, dated and signed by a
company director or another officer (two if acting jointly) authorised to appoint
signatories. The specimen signature(s) used to sign the form must be included in
the official company list of authorised signatures.
Please return the completed form to:
Clearstream Banking AG
Attn: Client Due Diligence & Admission
D-60485 Frankfurt am Main
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Clearstream Banking AG