APPLICATION FOR MEMBERSHIP
TO THE BRICS PAY CONSORTIUM
(LEGAL FORM OF A LEGAL ENTITY)
"(NAME OF THE LEGAL ENTITY)"
TAX ID ________, ACTIVITY CODE________, REGISTRY #________
ADDRESS: ___________________________________________________,
TAX ID ________, ACTIVITY CODE________,
REGISTRY #________
ADDRESS: ________________________________________,
Represented by the (representative title) (full name) acting on the basis of the company Charter, hereby sends for consideration an application to join the BRICS PAY Consortium.

Fully and unconditionally joins the Agreement on the BRICS PAY Consortium, published on the official website of the leading Consortium at: https://consortium.brics-pay.com

Confirms consent and undertakes to comply with provisions of the Agreement on the BRICS PAY Consortium.

Informs the following of its current bank details for mutual settlements with other parties within the framework of the BRICS PAY Consortium:

Bank name _______________________________________________________________
BIC _______________________________________________________________________
SWIFT ____________________________________________________________________
Correspondent account _________________________________________________
Payment account ________________________________________________________
Full name of the authorized representative in the Consortium:
___________________________________________________________________________
E-mail address (mail): ____________________________________________________
Contact phone number: ______________

Date: ___________________

________________/__________________________________________________________
Signature of M.P. / name of the position of the signatory, transcript
Represented by the (representative title) (full name) acting on the basis of the company Charter, hereby sends for consideration an application to join the BRICS PAY Consortium.

Fully and unconditionally joins the Agreement on the BRICS PAY Consortium, published on the official website of the leading Consortium at: https://consortium.brics-pay.com

Confirms consent and undertakes to comply with provisions of the Agreement on the BRICS PAY Consortium.

Informs the following of its current bank details for mutual settlements with other parties within the framework of the BRICS PAY Consortium:

Bank name _____________________________________________
BIC _____________________________________________
SWIFT _____________________________________________
Correspondent account _____________________________________________
Payment account _____________________________________________
Full name of the authorized representative in the Consortium:
_____________________________________________
E-mail address (mail): _____________________________________________
Contact phone number: ______________

Date: ___________________

________________/____________________________
Signature of M.P. / name of the position of the signatory, transcript