On Buyer’s Letterhead

PAYMENT DECLARATION
CONTRACT NO:

Date: 10 December 2019

To: ( TO BE PROVIDE AFTER RECEIVED DOA )

Attention:

I ....................., the authorised signatory of (BENEFICIARY YOUR COMPANY NAME) with (BENEFICIARY
ACCOUNT NUMBER) hereby instruct our bank (PAYING BANK NAME) to debit and transfer, VIA SWIFT MT
103 from our account details as stated below the amount of $XXX, 000 .00 (XXX Million Dollars) to the
provider’s nominated Bank Coordinates as stated in the pro forma invoice upon delivery of the Pre advice
MT799 in (AMOUNT: €XXX, 000,000).

This declaration will be executed within 24 hours after delivery of the Pre advice MT799 to the provider’s nominated
Bank Coordinates subject to the pro forma invoice.

CLIENTS PAYING BANK COORDINATES:

Bank Name :
Bank Address :
Account Name :
Account Number:
Account Signatory:
SWIFT Code :
Bank Officer :

The above mentioned instruction is irrevocable and must be honoured by (PAYING BANK NAME) on behalf and by
instruction of (BENEFICIARY NAME, COMPANY NAME AND ADDRESS) as stated above.

Approved and agreed by Signed by (SENDING BANK NAME)

-----------------------------
Legal & Authorized Signatory Bank Officer Name:
Date: Title: (Bank Seal)
Signatory Full Name: Tel Number:
Title: Email:
Nationality:
Passport #:
Date of Issuance:
Date of Expiration: