Foreign Funds Transfer Request Form
Zenith
(Not applicable for corporate accounts)
Day
Month
Year
Name of Ordering Customer:
Address:
Kindly effect the following transfer on my/our behalf
(In Words)
Amount:
(Please specify (currency)
Name of Beneficiary:
Beneficiary Address:
Beneficiarys Bank:
Beneficiarys Bank Address:
Beneficiarys Account No:
BIC/ROUTING NO: (for USD transfers)
IBAN No/BIC (Mandatory for EURO transfers):
Sort Code (Mandatory for POUND transfers):
Intermediary Bank (If any):
Purpose of Payment payment for goods not acceptable (Please be specific)
Please Debit
My/Our (Dom. A/C) Account No.:
For Principal
My/Our Account No:
Withdrawal Charges Only
Local Charges Only
Offshore & Local Charges
Customers
e-mail Address:
Phone No:
Customers Signature
Customers Signature
Official Use
ACCOUNT OFFICER: (Name & Signature)
Source of funds:
Cash Deposit
Inflow
Originating Branch:
Confirming Officer: Name Signature/Date:
RTB
HOP (Name & Signature)