S A X O B A N K C L I E N T F U N D S T R A N S F E R REQUEST

By debiting my/our account number: _ ____________________________________________________________(Mandatory field)

Account name:_________________________________________________________________________________(Mandatory field)

I/We hereby authorise Saxo Bank A/S to execute the following transfer on my / our behalf:
Pay to: ___________________________________________________________________________________________
(Bank Name & Address)
___________________________________________________________________________________________

SWIFT ID (BIC): _________________________________ Clearing Code:___________________________________________

(Sort Code, BLZ, ABA…etc)

Branch name (or City):_______________________________________________________________________________________

Amount:_ __________________________________________Currency:________________________________________________

In favour of:_________________________________________________________________________________________________
(Intermediary bank if applicable)

Account no.:_________________________________________________________________________________________________
(or IBAN if available)

Clearing Code:_______________________________________________________________________________________________
(Sort Code, BLZ, ABA…etc)

For Further Credit to:________________________________________________________________________________________

(Ultimate beneficiary name)

Account no.:_________________________________________________________________________________________________

Additional Info:_____________________________________________________________________________________________
Information to the Beneficiary Bank about the reason of transfer or other relevant info.

Authorised Signatory Authorised Signatory (if more than one)

NOTE:
NOTE:
1. Third Party Payments are not supported. Funds will only be sent to an account held in the same
1. Thirdname
PartyasPayments arefrom
the account not supported. Funds
which the funds arewill onlywithdrawn.
being be sent to an account held in the same name as the
account from which the funds are being withdrawn.
2. If you have access to withdrawal module within Trading platform, a service fee of USD40 from your
2. trading
If you have account forwithdrawal
access to processingmodule
this withdrawal request.
within trading Currency
platform, conversion
SAXO at current
BANK will chargespot rate fee of USD
a service
plus/minus 0.5% will apply if you don’t have USD denominated trading account for deduction.
40 from your trading account for processing this withdrawal request. Currency conversion at current spot rate
plus/minus 0.5% will apply if you don’t have USD denominated trading account for deduction.
09 / 20 10

THE SPECIALIST IN TRADING AND INVESTMENT

SAXO BANK l Philip Heymans Allé 15 l DK 2900 Hellerup l Denmark l Telephone +45 39 77 40 00 Telefax
+45 39 77 47 00 l Reuters Dealing Code: SAXO l Web: www.saxobank.com