DECLARATION OF A REQUEST TO FORGO CONVERSION INTO HUF AND THE ADJUSTMENT
OF INTEREST IN CONNECTION WITH THE LOAN AGREEMENT
To whom it may concern:
I hereby declare, in the interest of exercising my rights stipulated in Article 12 of Act LXXVII of
2014,
that I do not wish to take the option of conversion into HUF, as offered by the financial institution,
and of the application of the interest regulations determined in relation thereto.
Loan agreement number/credit account number:
Postal address:
Contact information (phone number):
I fulfill at least one of the requirements below (please mark the appropriate box with an x):
the term of my consumer mortgage loan contract expires no later than on 31 December 2020,
the initial interest rate applied to my loan contract following the conversion into HUF exceeds the
originally charged interest or interest margin rate.
I have regular income in an amount exceeding the anticipated repayment instalment in one of the
currencies quoted by the MNB as an official exchange rate (which income, in the case of co-debtors, shall
be understood as joint income)
according to the decree on the regulation of the income-proportionate repayment instalment and loan
collateral ratios, I would be eligible to take out a foreign currency-based loan (appropriate income,
mortgage collateral). Please find attached the documents necessary for verifying this.
In the case of loan contracts affected by the Exchange Rate Cap Act:
By signing this document I acknowledge that in accordance with the provisions of act LXXVII of 2014, as
of the anniversary date, the financial institution will not offer the option of loan repayment at a set
exchange rate.
Attached documents (e.g. income certificate, bank account statement, other):
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(This is to inform you that in the case of co-debtors, the initiation defined in this declaration is possible
subject to the joint and unanimous declaration of the co-debtors, therefore, the completion and
submission of this declaration is mandatory in the case of co-debtors as well)
Dated, …………………………….…., month …… Day, 201……
Data of debtor, co-debtor
Name at birth
Place and date of birth
Mother's maiden name
Permanent residence
Type and number of identification document
Signature of debtor, co-debtor*
Data of debtor, co-debtor
Name at birth
Place and date of birth
Mother's maiden name
Permanent residence
Type and number of identification document
Signature of debtor, co-debtor*
Data of debtor, co-debtor
Name at birth
Place and date of birth
Mother's maiden name
Permanent residence
Type and number of identification document
Signature of debtor, co-debtor*
Data of debtor, co-debtor
Name at birth
Place and date of birth
Mother's maiden name
Permanent residence
Type and number of identification document
Signature of debtor, co-debtor*
In the case of administration in person certification of receipt (to be completed by financial institution):
Date of the receipt of document for further administration: ……………………. ………………………
Signature receiving party
*Underline appropriate part
We would like to call your attention that the content of the forms used by the different financial institutions
may vary, therefore, we recommend that you use the forms available on the website of your own financial
service provider!