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Ordre de Transfert Local /Local Transfer Order
Instructions du client / Customer Instructions
Jour Mois Année
‘Agence / Agency Day Month “Year
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[Nom et adresse du donneur ordre
Name and address of applicant
1N"de compte / Account N° Motit/ Reason
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Pay tothe debit of my account indicated above
Montant en chiffres / Amount in fgures Montant en lettres / Amount in words
"Nom adresse et domilation bancalve du béndliciire
Namo / Address of beneficiary and receiving bank
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La banque n't pas responsable ni ge la perte ni c'un préjusie qui proviendalt une erreur
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