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Lotus Group Ent. Sdn. Bhd.

Unit 20-09, Semua House, Jalan Bunus 6 Kuala Lumpur, Malaysia 50100 Ph: 603-2694 0014 Fax: 603-2694 0084 Email: isend.my@lotusforex.com Website: www.lotusforex.com
Please complete this form either by: 1. Keying in details online (tab between the fields), print and sign. 2. Print, handwrite in CAPITAL LETTERS and sign.
DD TT

Date:

Ref. No.: _____________

Money Transfer Details

Beneficiary Name Account No Bank SWIFT / IFSC Code Bank Branch Address : : : : :

Payment Info
Destination Ccy Amount in MYR Charges in MYR Total in MYR

INR

Purpose of Transfer
Personal Needs / Family Needs Trade / Import Investment in Financial Markets

Country Zip / Pin Code

: :

INDIA

Investment in Real Estate Others

Draft Delivery Details

Please delivery the draft to : Receiver / Consignee Name : Full Address (Complete postal Address including visible landmark) Office Home Bank Others

Source of Income
Salary Business Savings Others

For Office Use Only

Bank Code Branch Code

Postal Code:

Telephone No:

Destination Payment Info

Amount Exchange Rate

Regulatory Requirements
ID No.:
Passport National ID ID Type: Driving License Others Payment Mode Place of Issue Date of Expiry Cash Cheque Online Transfer

Signature of Cashier & Stamp

This transaction is executed by Lotus Group Ent. Sdn. Bhd. subject to the condition that it will not be held liable for delay / nonpayment / underpayment / non-delivery due to reasons beyond its control and disruption of communication systems. Payment at destination is subject to rules and regulations of that country. The Company is also not responsible if the information provided by the customer is inadequate or incorrect. Transactions shall be subject to all applicable laws including notifications, rules, bye-laws, regulations, procedures and guidelines issued by the Government and other relevant regulatory authorities.

Applicants Details: I hereby declare that the above information is true and correct. I abide by the terms and conditions.
Full Name: Address: Applicants Signature:______________________ Fax/Email/Telephone: