-------------+-----------+-------------+-------------+-------------- ¦ Âðåìÿ ¦ Ñåðèÿ, ¦ Âèä (êîä) ¦ Êîëè÷åñòâî, ¦ Ñóììà ¦ ¦ ñîâåðøåíèÿ ¦ íîìåð ¦ èíîñòðàííîé ¦ øòóê ¦ èíîñòðàííîé ¦ ¦ îïåðàöèè ¦ îáëèãàöèè ¦ âàëþòû ¦ ¦ âàëþòû ¦ +------------+-----------+-------------+-------------+-------------+ ¦ X ¦ X ¦ X ¦ X ¦ X ¦ +------------+-----------+-------------+-------------+-------------+ ¦ X ¦ X ¦ X ¦ X ¦ X ¦ +------------+-----------+-------------+-------------+-------------+ ¦ X ¦ X ¦ X ¦ X ¦ X ¦ +------------+-----------+-------------+-------------+-------------+ ¦ X ¦ X ¦ X ¦ X ¦ X ¦ +------------+-----------+-------------+-------------+-------------+ ¦ ÈÒÎÃÎ¦ ¦ X (øò.) ¦ X ¦ X ¦ ¦------------+-----------+-------------+-------------+-------------- Èòîãî ïîãàøåíî _______________ (___________________________________) (öèôðàìè) (ïðîïèñüþ) îáëèãàöèé íà ñóììó _________ (____________) ________________________ (öèôðàìè) (ïðîïèñüþ) (âèä èíîñòðàííîé âàëþòû) Êàññèð _____________ _________________ (ïîäïèñü) (È.Î.Ôàìèëèÿ) Çàâåäóþùèé îáîðîòíîé (îïåðàöèîííîé) êàññîé <*> _____________ _________________ (ïîäïèñü) (È.Î.Ôàìèëèÿ) ------------------------------- <*> Ïðèìåíÿåòñÿ ïðè ïðîâåäåíèè îïåðàöèé ÷åðåç êàññû.
Äàòà è âðåìÿ ïîäà÷è çàÿâêè _______________ ____________ __________________________________ _______________________________ (íàèìåíîâàíèå äîëæíîñòè (íàèìåíîâàíèå äîëæíîñòè óïîëíîìî÷åííîãî ïðåäñòàâèòåëÿ óïîëíîìî÷åííîãî ïðåäñòàâèòåëÿ Ãëàâíîãî (Ñïåöèàëèçèðîâàííîãî) Íàöèîíàëüíîãî áàíêà óïðàâëåíèÿ Íàöèîíàëüíîãî Ðåñïóáëèêè Áåëàðóñü) áàíêà Ðåñïóáëèêè Áåëàðóñü (óïîëíîìî÷åííîãî áàíêà) ___________ ________________ __________ _________________ (ïîäïèñü) (È.Î.Ôàìèëèÿ) (ïîäïèñü) (È.Î.Ôàìèëèÿ) Ì.Ï. Ì.Ï. __________ __________ (äàòà) (äàòà)