To millenniumbcp.pt Área de Operações Tagus Park, Edifício 9, Piso

To millenniumbcp.pt
Área de Operações
Tagus Park, Edifício 9, Piso 1
2784-511 Porto Salvo
PORTUGAL
Dear Sirs,
I, _________________________________________________________________________,
Here by request you to send to the address of my account with the BIN indicated below, the
Multichannel Access Code.
BIN:
Date______/______/______
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Signature (signature as per account signature card)