Template of Application for service

Ministry of Foreign Affairs of the Republic of Uzbekistan

Chief
of Diplomatic Service

[insert Name].

[Date]

[№]

APPLICATION...

Your Full Name:
Email:
Below please provide information about a company which will sign the Agreement. Please note that this information is required by law for inclusion into Agreement and bank transaction purposes. We guarantee that your information will be kept confidential.
Full Name of person who will sign an Agreement:
Company Name:
Address:
City:
ZIP code/Postal Index:
Country:
Phone:
Subscription period*:
6 months	Price: $ 1080
12 months	Price: $ 1900
*We currently provide only 6 months and 12 months subscription.
Bank details:
Bank name:
Bank address:
SWIFT code:
Sort code:
Account Number:
Bank code:
Company Individual Tax Number:
Industrial Code (ОКОНХ):Mandatory for Uzbek citizens
Antibot check:

All payments currently accepted via bank transfers only. Please complete a form below to receive an Agreement for our product and invoice.