CIMPA BANK INFORMATION FORM

To fill and send to admin@cimpa.info

We will need the following information in order to have your CIMPA funding sent to
you. Please complete all items carefully, as incomplete or inaccurate information will
lead to delays in getting the funding to you.
Funds will be sent to you in EURO.

Electronic transfer information

RECEIVER BANK NAME: _____

RECEIVER BANK ADDRESS:

Indicate the complete address:

_______________________________________________________________

_______________________________________________________________

________________________________________________________________

________________________________________________________________

SWIFT CODE ( BIC ) OF RECEIVER BANK: _________________________

IFS code (only for Indian bank account): __________________________________

BENEFICIARY ACCOUNT INFORMATION

(THE FIRST 3 FIELDS BELOW MUST BE COMPLETED)

FULL NAME OF BENEFICIARY: _________________________________

(This must be the name of the account holder)

BENEFICIARY's ACCOUNT NUMBER ( IBAN or CLABE for bank account in

Mexico):
_______________________________________________________________

BENEFICIARY's ADDRESS:
(This must be the account holder’s address, as registered with the bank)
______________________________________________________________
______________________________________________________________

_________________________________________________________________

______________________________________________________________

BENEFICIARY's E-MAIL ADDRESS:____

CELL PHONE NUMBER: