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Subscription Application Form for Multibanking
Customer is a legal entity
Company Name
*
Legal Entity
*
Unique enterprise number (UEN) or VAT number
*
VAT System
VAT registered
Not registered
Business Activity
*
Publicly listed
Publicly listed
No
Publicly listed
Yes
Headquarter address
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
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Contact person
Name
*
Language
English
Dutch
French
Telephone Number
*
E-mail
*
*
Billing
Use the same address as headquarters
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
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Contact Person of invoices
*
Language of Invoices
English
Dutch
French
Telephone number
*
E-mail
*
*
Add a User to a Multibanking subscription
User information
Type of user
Physical person
Function user
Attention! Function cards cannot be granted signing rights.
Attention! Since we no longer provide certificates, new users will not be able to log in to e-government applications.
First and last name
*
Job title or department name
*
National Register Number
*
Identity card number
*
Date of Birth
*
Language
English
Dutch
French
The user has a Belgian eID or E(+) card and knows his/her PIN code
Delivery address and contact information of the user
Use the same address as headquarters
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
Clear lookup field
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Lookup records
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E-mail
*
*
Phone number
*
Add new user
(uncheck to remove)
User information
Type of user
Physical person
Function user
Attention! Function cards cannot be granted signing rights.
Attention! Since we no longer provide certificates, new users will not be able to log in to e-government applications.
First and last name
*
Job title or department name
*
National Register Number
*
Identity card number
*
Date of Birth
*
Language
English
Dutch
French
The user has a Belgian eID or E(+) card and knows his/her PIN code
Delivery address and contact information of the user
Use the same address as headquarters
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
Clear lookup field
Launch lookup modal
Lookup records
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E-mail
*
*
Phone number
*
Add new user
(uncheck to remove)
User information
Type of user
Physical person
Function user
Attention! Function cards cannot be granted signing rights.
Attention! Since we no longer provide certificates, new users will not be able to log in to e-government applications.
First and last name
*
Job title or department name
*
National Register Number
*
Identity card number
*
Date of Birth
*
Language
English
Dutch
French
The user has a Belgian eID or E(+) card and knows his/her PIN code
Delivery address and contact information of the user
Use the same address as headquarters
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
Clear lookup field
Launch lookup modal
Lookup records
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E-mail
*
*
Phone number
*
Add new user
(uncheck to remove)
User information
Type of user
Physical person
Function user
Attention! Function cards cannot be granted signing rights.
Attention! Since we no longer provide certificates, new users will not be able to log in to e-government applications.
First and last name
*
Job title or department name
*
National Registration Number
*
Identity card number
*
Date of Birth
*
Language
English
Dutch
French
The user has a Belgian eID or E(+) card and knows his/her PIN code
Delivery address and contact information of the user
Use the same address as headquarters
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
Clear lookup field
Launch lookup modal
Lookup records
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E-mail
*
*
Phone number
*
Add new user
(uncheck to remove)
User information
Type of user
Physical person
Function user
Attention! Function cards cannot be granted signing rights.
Attention! Since we no longer provide certificates, new users will not be able to log in to e-government applications.
First and last name
*
Job title or department name
*
National Registration Number
*
Identity card number
*
Date of Birth
*
Language
English
Dutch
French
The user has a Belgian eID or E(+) card and knows his/her PIN code
Delivery address and contact information of the user
Use the same address as headquarters
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
Clear lookup field
Launch lookup modal
Lookup records
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E-mail
*
*
Phone number
*
SEPA Direct Debit Mandate - CORE
Use the same company name and legal entity
Debtor name
*
Unique enterprise number (UEN) or VAT number
*
IBAN
*
Use the same address as headquarters
Street/number/box
*
Building/place/floor
*
City
*
Postcode
*
Country
Clear lookup field
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Information request form related to KYC/AML Legal obligations
Legal representative related information
Full Name (LR)
*
Date of Birth
*
Place Of Birth
*
Nationality(ies)
*
Country of Residence
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Street/Nr/Box
*
City
*
Postal Code
*
Unique Identifier
*
National ID or Passport Number + issuing country
Is this person also a UBO* of the company?
Is this person also a UBO* of the company?
Yes
Is this person also a UBO* of the company?
No
Is this person a Politically Exposed Person (PEP)**?
Is this person a Politically Exposed Person (PEP)**?
Yes
Is this person a Politically Exposed Person (PEP)**?
No
UBO* related information
UBO* Full Name
*
Date of Birth
*
Nationality(ies)
*
Country of Residence
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Unique Identifier
*
National ID or Passport Number + issuing country
Is this person Politically Exposed Person (PEP)**?
Is this person Politically Exposed Person (PEP)**?
Yes
Is this person Politically Exposed Person (PEP)**?
No
Check this box, if there are multiple legal representatives and UBO's within your company.
Additional UBO and or Legal Representative Information
Legal representative:
Full Name (LR)
*
Date of Birth
*
Place Of Birth
*
Nationality(ies)
*
Country of Residence
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Street/Nr/Box
*
City
*
Postal Code
*
Unique Identifier
*
National ID or Passport Number + issuing country
Is this person also a UBO of the company?
Is this person also a UBO of the company?
Yes
Is this person also a UBO of the company?
No
Is this person Politically Exposed Person (PEP)?
Is this person Politically Exposed Person (PEP)?
Yes
Is this person Politically Exposed Person (PEP)?
No
UBO:
UBO Full Name
*
Date of Birth
*
Nationality(ies)
*
Country of Residence
Clear lookup field
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Unique Identifier
*
National ID or Passport Number + issuing country
Is this person Politically Exposed Person (PEP)?
Is this person Politically Exposed Person (PEP)?
Yes
Is this person Politically Exposed Person (PEP)?
No
Legal representative:
Full Name (LR)
*
Date of Birth
*
Place Of Birth
*
Nationality(ies)
*
Country of Residence
Clear lookup field
Launch lookup modal
Lookup records
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Street/Nr/Box
*
City
*
Postal Code
*
Unique Identifier
*
National ID or Passport Number + issuing country
Is this person also a UBO of the company?
Is this person also a UBO of the company?
Yes
Is this person also a UBO of the company?
No
Is this person Politically Exposed Person (PEP)?
Is this person Politically Exposed Person (PEP)?
Yes
Is this person Politically Exposed Person (PEP)?
No
UBO:
UBO Full Name
*
Date of Birth
*
Nationality(ies)
*
Country of Residence
Clear lookup field
Launch lookup modal
Lookup records
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Unique Identifier
*
National ID or Passport Number + issuing country
Is this person Politically Exposed Person (PEP)?
Is this person Politically Exposed Person (PEP)?
Yes
Is this person Politically Exposed Person (PEP)?
No
Executed on
*
Name
*
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