Private Individual
Legal Entity
Name of the Company
Legal Form
Legal Address
Actual Address
Identification Code
Information About Contact Person
Position
First Name
Last Name
Personal Number/ID
Email
Legal Address
Actual Address
Mobile Number
Home Phone
CitizenShip
Date of birth
December 2001
Sun
Mon
Tue
Wed
Thu
Fri
Sat
48
25
26
27
28
29
30
1
49
2
3
4
5
6
7
8
50
9
10
11
12
13
14
15
51
16
17
18
19
20
21
22
52
23
24
25
26
27
28
29
01
30
31
1
2
3
4
5
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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Maturity
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Information About Client's Income
Income From Business
Activity
Monthly Income
GEL
USD
EUR
Income
Work Place
Position
Salary
Bank
GEL
USD
EUR
Procredit Bank
TBC Bank
Bank Of Georgia
Liberty Bank
VTB Bank
Basis Bank
Kor Standard Bank
Repoblic Bank
Cartu Bank
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Rental Income
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Income Per Month
GEL
USD
EUR
Information About Current Obligation
Installment Per Month
GEL
USD
EUR
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I do hereby give my consent and authorize JSC ProCredit Bank to process my banking and personal information according to the law for the purposes of reviewing this application and providing any banking service.
I am fully aware of the rights under the legislation of Georgia implying that the Bank shall be obliged, upon request, to correct, update, add, block, delete or destroy data if they are incomplete, inaccurate, not updated, or if they have been collected and processed contrary to law.
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