Directly Registered Share Account Agreement Sample Contracts
INCOMPLETE APPLICATION PACKAGES CANNOT BE PROCESSEDDirectly Registered Share Account Agreement • February 1st, 2021
INDIVIDUAL ACCOUNT or JOINT ACCOUNT (complete the information below) Mr. Ms.Last name Maiden name _____________________________________Birthdate ___________________Birthplace ______ Country ___________________________________________Address (place of taxation) _________________________Postal code _ _ _ _ _ _ _ _ City Mobile tel. (1) E-mail(2) Minor Adult under protection (complete this agreement and the attached account form) _ _ First name ________________________________________________________________________ _ _ _ _ _ Dept/State/Etc. ____ _ _____________________________________________________________________________________________ _ _ _ _ _ _ __ Country _________________________________________________________(guardianship - trusteeship - judicial protection, etc.)
ACCOUNT AGREEMENTDirectly Registered Share Account Agreement • February 1st, 2021
Complete and sign this form and return it preferably online at contact.actionnaires.airliquide.com or to the mailing address at the bottom of the page along with the supporting documents specified on the back.