Ordinul de plat` se va completa cu majuscule, corect [i lizibil / The form shall be filled in with capitals, correctly and legibly.

ORDIN DE PLAT~ |N VALUT~ / PAYMENT ORDER IN FOREIGN CURRENCY

Reu[im \mpreun`.

Nr. / No.

Suma / Amount

Valuta / Currency

PL~TITOR / Payer
IBAN/Payer's IBAN

R O

BIC banc` / Payer's bank BIC

R Z B R
R Z B R R O B U

BENEFICIAR / Beneficiary
IBAN/Beneficiarys account

sau

BIC banc` / Beneficiarys bank BIC

Numele b`ncii / Bank name

Adresa b`ncii / Bank address
}ara b`ncii / Bank country
Detalii de plat` / Payment details
Comisioane / Charges
p SHA p OUR p BEN

Prioritate / Priority
p standard p urgent

Semn`tura pl`titorului / Payer's signature

Cod rat` negociat` / Curs schimb

Negociated rate ID / Exchange rate

__________________________________________

Se va completa de c`tre banc` / To be filled in by the bank:

Semn`turi verificate (semn`tura [i [tampila unit`]ii bancare)
___________________________________________________________

Data emiterii / Issuing date

Data recep]iei / Reception date

Prin semnarea acestui document, certific c` am luat la cuno[tin]` de informa]iile men]ionate pe verso / Signing this form I certify that I am aware of the information on the back-side.

2100017245

Op]ional Banca intermediar` / Correspondent bank

Ordinul de plat` se va completa cu majuscule, corect [i lizibil / The form shall be filled in with capitals, correctly and legibly.

ORDIN DE PLAT~ |N VALUT~ / PAYMENT ORDER IN FOREIGN CURRENCY

Reu[im \mpreun`.

Nr. / No.

Suma / Amount

Valuta / Currency

PL~TITOR / Payer
IBAN/Payer's IBAN

R O

BIC banc` / Payer's bank BIC

R Z B R
R Z B R R O B U

BENEFICIAR / Beneficiary
IBAN/Beneficiarys account

sau

BIC banc` / Beneficiarys bank BIC

Numele b`ncii / Bank name

Adresa b`ncii / Bank address
}ara b`ncii / Bank country
Detalii de plat` / Payment details
Comisioane / Charges
p SHA p OUR p BEN

Prioritate / Priority
p standard p urgent

Semn`tura pl`titorului / Payer's signature

Cod rat` negociat` / Curs schimb

Negociated rate ID / Exchange rate

__________________________________________

Se va completa de c`tre banc` / To be filled in by the bank:

Semn`turi verificate (semn`tura [i [tampila unit`]ii bancare)
___________________________________________________________

Data emiterii / Issuing date

Data recep]iei / Reception date

Prin semnarea acestui document, certific c` am luat la cuno[tin]` de informa]iile men]ionate pe verso / Signing this form I certify that I am aware of the information on the back-side.

2100017245

Op]ional Banca intermediar` / Correspondent bank

Subsemnatul declar pe propria r`spundere, avnd deplin` cuno[tin]` despre

prevederile legale privind falsul \n declara]ii, c` fondurile transferate au origine
licit` [i au ca suport tranzac]ii reale. Prezenta opera]iune respect` prevederile
legale \n vigoare, nu are drept scop sp`larea banilor sau finan]area de acte de
terorism [i se circumscrie activit`]ii mele statutare. Totodat`, m` oblig ca \n termen
de 2 zile s` prezint orice documente justificative solicitate de banc`, cunoscnd
faptul c` banca \[i rezerv` dreptul de a nu efectua opera]iunea \n cazul
neprezent`rii acestor documente.

I, the undersigned customer, having complete knowledge about the legal provisions
in making false statements, I hereby declare under full responsibility that the
transfered funds have legal origins and are related to real transactions. This
transaction conforms to the law in force, does not represent money laundering or
financing terrorism activities and conforms to my lstatutory activity. Also, I hereby
engage that within 2 days to present at your counters any documents required by
the bank, being already informed that the bank reserves the right not to process this
operation in case of non-presentation by me of the required documents.

|n cazul acestei cereri se vor aplica Condi]iile generale de derulare a opera]iunilor

bancare (CGB), Cererea de deschidere cont curent Persoane Fizice [i/sau orice alte
\n]elegeri \n vigoare semnate de client.
Instruc]iuni de completare
a. Acest ordin de plat` se va completa \n cazul:
- pl`]ilor \n valut` sub 50.000 EUR sau echivalent
- pl`]ilor \n valut` egale sau mai mari de 50.000 EUR sau echivalent pentru care
nu este necesar` raportarea statistic` de c`tre client
- pl`]ilor \n lei externe.
b. Comisioane: pentru pl`]ile externe \n lei v` rug`m s` bifa]i comisioane "SHA";
c. Prioritate Standard \nseamn` D+1 sau D+2, iar Urgent \nseamn` D sau D+1 \n
func]ie de valuta tranzac]iei [i/sau sediul prestatorului de servicii de plat` al
beneficiarului pl`]ii. Pentru a alege corect prioritatea care corespunde intereselor
Dvs, v` rug`m s` consulta]i \n prealabil informa]iile referitoare la aceste aspecte,
afi[ate \n Agen]ie (tabel "Ore Limit`").
d. Cod rat` negociat`/curs schimb este cmp op]ional [i se va completa \n cazul
pl`]ilor efectuate \ntr-o valut` diferit` de valuta contului, \n baza informa]iilor primite
de la Departamentul de Trezorerie al b`ncii, dup` negocierea ratei de schimb
aplicat`; \n cazul necomplet`rii acestui cmp, banca va aplica cursul de schimb
conform CGB.
e. Banca intermediar` este cmp op]ional [i se va completa cu numele b`ncii/codul
BIC prin care se dore[te transmiterea pl`]ii la banca beneficiar`. Banca va folosi
intermediarul indicat \n m`sura \n care exist` o rela]ie de corespondent cu acesta;
|n cazul necomplet`rii cmpului, banca va stabili unilateral traseul bancar pe baza
rela]iilor proprii de corespondent.
f. |n cazul complet`rii BIC-ului b`ncii beneficiare, Numele b`ncii [i Adresa devin
cmpuri op]ionale. Dac` ambele informa]ii sunt completate, banca va transmite
plata c`tre beneficiar folosind BIC-ul indicat.
g. Comisionul Repara]ii cod IBAN va fi suportat de ordonatorul pl`]ii, indiferent de
op]iunea de comisionare selectat` (BEN, OUR, SHA).

This order is subject to the General Conditions for banking operations (CGB),
Application for client enrollment and current account opening - individuals and/or
any other agreements signed by the client.
Instructions for filling in:
a. This form will be used for:
- foreign currency payments up to EUR 50.000 or equivalent
- foreign currency payments equal or above EUR 50.000 or equivalent, which do
not require statistical reporting by client
- external payments in Lei.
b. Charging options: in case of external payments in Lei, SHA option should be used.
c. Standard priority means D+1 or D+2 and Urgent priority means D or D+1
depending on the transaction currency and/or the payee's service provider location.
To choose the correct priority to meet your interests, please check in advance
the information related to this subject displayed in the Branch (see "Limit hours"
table).
d. Negociated rate ID/ exchange rate is an optional field and should be filled in in
case of payments which involves two different currencies, based on the information
received from Treasury Department of the bank, after the negotiation of the
exchange rate applied; in case this field is not provided than the bank will apply
the exchange rate according to CGB.
e. Correspondent bank is an optional field and should be filled in with the name/BIC
of the bank intended to be used for sending the payment to the beneficiary bank.
The bank will use the correspondent indicated as long as there is a billateral
relationship with it; In case the field is not provided, the bank will establish the
banking route based on own correspondent relationships.
f. Bank name and address are optional fields if Beneficiary's bank BIC is provided.
In case both details are filled in, the bank will use the indicated BIC to send out the
payment.
g. Commission IBAN code repair will be supported by the originator, regardless
of the selected commission option (BEN, OUR, SHA)