4

MOKJIMO NURODYMAS Nr. ________________________________________

PAYMENT ORDER NO.

MOKJIMO DATA /
PAYMENT DATE

2016-02-03

MOKTOJO VARDAS, PAVARD / PAVADINIMAS / PAYERS NAME, SURNAME / COMPANY NAME

BRIGITA JASIONIEN

MOKTOJO SSKAITOS NR. /

MOKJIMO RIS /
TYPE OF PAYMENT

MOKTOJO KODAS / PAYERS ID

PAPRASTAS /
ORDINARY

SKUBUS /
URGENT

MOKJIMO PASKIRTIS / DETAILS OF PAYMENT

4378591625

PAYERS ACCOUNT NO.

LT117300010144586021
GAVJO VARDAS, PAVARD / PAVADINIMAS / BENEFICIARYS NAME, SURNAME / COMPANY NAME

TRUST PAY, A. S.

GAVJO SSKAITOS (IBAN) NR. /

BENEFICIARYS ACCOUNT (IBAN) NO.

LT577300010139191120

GAVJO KREDITO STAIGA / BENEFICIARYS BANK

MOKOS KODAS (NUORODA GAVJUI) / REFERENCE NO.

Swedbank AB

SUMA SKAITMENIMIS / AMOUNT IN FIGURES

VALIUTOS KODAS / CURRENCY CODE

MOKESIAI / CHARGES

6.00

EUR

0.00

UNIKALUS MOKJIMO KODAS / END TO END ID

SUMA ODIAIS / AMOUNT IN WORDS

2016020300884676
MOKTOJO VARDAS, PAVARD, PARAAS (-AI) /

KREDITO STAIGOS DARBUOTOJO PARAAS/

PAYERS NAME, SURNAME, SIGNATURE (S)

CREDIT INSTITUTION REPRESENTATIVES SIGNATURE