ГОСТ ISO/1EC 7812-2—2014
Приложение А
(справочное)
Заявка на присвоение идентификационного номера эмитента1:
PLEASE TYPE OR USE BLOCK LETTERS
This application Is submitted m accordance with ISO/IEC 7812-1. Identification cards — Identification of issuers — P arti
Numbering system.
A. TO BE COMPLETED BY THE APPLICANT
Complete Legal Name of Applicant Organization:
Physical Address of Applicant Organization:
Mailing Address of Applicant/Agent Organization (if different from physical address):
Main Contact (Include first and last name):
Phone number:Fax Number:
E-mail address:
Please identify the main industry of the applicant organization (check v only one box).
Airline
Healthcare
Telecommunications
Other
Banklng/Fmanctal
Merchandizing, e. g. Retail
Travel
Entertainment
Petroleum
Please
provide description
of rOther*
Anticipated Date of First Use of this IIN:
(Please select all that apply) The IIN will be used in an:
International Interchange Environment
Intra-Industry Interchange Environment
Please provide a brief description of how the IIN will be used.
Inter-industry Interchange Environment
National Use ONLY
Will applicant organization be Issuing a
card?
YesNo
By signing this application, you are agreeing to abide by alt of the terms and conditions set forth In ISO/IEC 7812-1
and ISO/IEC 7812-2. You are also certifying that the information provided on this applicantlon Is correct.
Print Name:
Signature:Date:
1’ Форма заявки на русском языке приведена в дополнительном приложении ДА.
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