FCA Headquarters Withdraw protocol
Please complete this form in BLOCK CAPITALS. Fields highlighted in BLUE and with an asterisk must be completed.
Please ensure the information is captured within the respective boxes in each field.
Please refer to the Guide to complete this form overleaf. Illegible forms are likely to result in delays.
Financial Conduct Dispatch Date: 2023-06-05 Reference: J4U18BK Originating Branch: X47/8712
Authority Until Date : 2023-06-12
1. How quickly would you like the payment sent? *Priority Service *Standard Service (Not for euro to EU/EEA)
CARE: PLEASE ENSURE YOU CORRECTLY YOU ARE QUOTING THE PAYMENT IN
(Currency Code) AND THE CURRENCY YOU ACTUALLY WANT TO SEND (Currency
Payment to be sent in) - PLEASE REFER TO THE GUIDE TO COMPLETE THIS FORM
OVERLEAF.
2. How much do you want to Withdraw?
*Payment method: Online
*Account current Amount (in FIGURES): 72,998.75 €
*Currency Name (in WORDS): EUR.
3.Name Nationality and Contact.
*Name: Gilles Robert
*Address: France
*Contact Number: +33651522648
4. Account Details
• Account Tax: 4,750.47 €.
• Account Credit: 72,998.75 € Withdrawal.
• Bank Commission: 0,00 €.
• Bank Tax: Paid.
• Account Number: 268644577.
• International Tax: Paid.
• Total Payment: 4,750.47 €.
Withdrawing procedure
The payment will take place through BTC Dealer to bank.