Application for Membership

Bundesverband Vermögensanlagen

im Zweitmarkt Lebensversicherungen e.V. – Vorstand –

Ridlerstraße 33

80339 München

1. Your data

Company: Contact:

Street:

Postal code / place: Phone:

Fax: E-Mail:

I hereby apply for membership in the „Bundesverband Vermögensanlagen im Zweitmarkt Lebensversicherungen e.V.“

Full member (EUR 5,000 net / year) q Sustaining member (EUR 4,000 net / year) q I acknowledge the Statutes and accept the amount of membership fee q

q Direct debit

Account No.: Bank:

Bank routing code:

Bundesverband Vermögensanlagen

im Zweitmarkt Lebensversicherungen (BVZL) e.V. Ridlerstraße 33 · 80339 München

q Invoice

Place/date: Signature:

Phone +49 (0) 89 24 20 37 – 08 Fax +49 (0) 89 24 20 37 – 09 info@bvzl.de

www.bvzl.de

Chairman Christian Seidl Ingo Wichelhaus

Banking Account

HypoVereinsbank AG München

Account 660 533 34 · Bank code 700 202 70 IBAN: DE 6670 0202 7000 6605 3334 SWIFT/BIC: HYVEDEMMXXX

Tax number: 143 / 842 / 38112

VAT: DE23 6913 413

2. Company description

Object of the company: Partner/Owner of the company: Business activities:

Date of company formation:

month

Company history:

Number of staff members:

Turnover shown in EUR (or comparable ratio): Main business partner(s)/References:

Statutory representatives:

Contact for BVZL membership:

Value added tax identification number (VAT):

Please attach a brief Curriculum Vitae of your representative in the Association to this questionnaire!

Place/date: Signature:

year

LOG

Geschützter Bereich/
Protected Area