FUND TRANSFER APPLICATION
PLEASE MARK
APPLICANTS DETAILS
Date
Ref No.
Branch
D D M M Y Y YY
TELEGRAPHIC TRANSFER
Applicant Beneficiary
DRAFT
RTGS
Name :
Address : Tel No. :
NIC / PP No. :Account No. :
SLIPS
PAY ORDER
BENEFICIARY DETAILS
DRAFT / PAY ORDER
FOR BANK USE ONLY
Name :
Account No. :
Purpose :
Bank :
Branch :
Name of Bank : Branch :
Name :
BENEFICIARY DETAILS
BENEFICIARY BANK DETAILS Address :
Country :
Address :
Account No. :
INTERMEDIARY BANK DETAILS
Name of Bank : Branch :
Address :
Country :
Please mark () where applicable
Branch Approval
Authorised SignatureAuthorised Signature
Central Operations Unit
Authorised SignatureAuthorised Signature
I/We hereby authorise the bank to debit my/our account for the purpose detailed above and agree to abide by the Terms and Conditions
printed overleaf.
Currency :
Signature of Applicant/s
TRANSFER INSTRUCTIONS
Amount :
Amount in Words :
All Bank charges outside Sri Lanka :
Purpose of Remittance :
D D M M Y Y YYValue Date :
IBAN No. :
SWIFT Code :
Chips ID :
USA Fed Wire:
UK Sort Code :
SWIFT Code :
Chips ID :
USA Fed Wire:
UK Sort Code :
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JOINT ACCOUNT HOLDER "B"
TERMS AND CONDITIONS
Amãna Bank PLC
Payment Order or RTGS and SLIPS without liability on the part of the Bank, if the Bank is of the opinion
a Regulatory Authority / Government Agency.
Neither the Bank nor its branches, correspondents or agents are responsible for any loss, delay, error or
country to which the payment is to be made.
All charges/ commission outside Sri Lanka are for the Beneficiary’s account unless specified.
The Bank reserves the right to send the Telegraphic Transfer from a different place other than the one
and subject to obtaining appropriate indemnity from the Customer.
all charges and expenses.
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