Foreign Funds Transfer Request Form

For individual accounts only

Day Month Year

Name of Ordering Customer________________________________________________________________________________
Nature of Business_______________________________________________________________________________________
Customers e-mail Address _______________________________________ Phone Number _________________________
Kindly effect the following transfer on my/our behalf
Amount____________________________ (In words) ____________________________________________________________
___________________________________________________________________________________ (Please specify currency)

Name of beneficiary: ______________________________________________________________________________________

Nature of Business: ___________________________________________Relationship with beneficiary_______________________
Beneficiary Address: _______________________________________________________________________________________
Beneficiary’s Website__________________________________ (Mandatory if beneficiary is a corporate body)

Beneficiary’s Bank: ______________________________________________ Swift Code/Bank BIC_________________________

Beneficiary’s Bank Address: _________________________________________________________________________________
Beneficiary’s Account Number/IBAN __________________________________________________________________________
(For the IBAN, UK/European Banks are optional while Dubai, Lebanon and Jordan Banks are compulsory)
Routing Number: _______________________Sort Code: _________________Transit Number___________________________
(For American Banks) (For UK Banks) (For Canadian Banks)
Intermediary Bank (If any) _________________________________________________________________________________
Purpose of Payment “payment for goods not acceptable” (Please be specific) _______________________________________

Would this be a regular occurrence or a one-off ________________________________________________________

Please Debit
My/Our (Dom. A/C) Account Number: For Principal and Charges

Local Charges Only Offshore & Local Charges

_________________________________________ ______________________________________
Customer’s Signature Customer’s Signature

Official Use
ACCOUNT OFFICER: (Name & Signature) ________________________________________________________________________

Source of funds: Cash Deposit Inflow RTB _________________________________

Originating Branch: __________________________________ HOP (Name & Signature): ________________________________

Confirming Officer: Name, Signature and Date: _________________________________________________________________