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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