▌REMITTANCE APPLICATION FORM ▌ (*) Indicates mandatory information to be provided. Please "" where applicable. PLEASE ENSURE TO SAVE THE FORM BEFORE PRINTING Branch Date* Customer's Information (Sender) Name of Sender* Address Application submitted by Customer in person Transfer Instructions Debit A/C No.* Currency Account Yes No ID/ Passport No. Please enter Currency of Remittance and amount to be remitted or equivalent currency amount to be converted Currency Curency of Remittance * Charges Debit A/C No.* Currency Account Amount to be Remitted* Currency Amount 32A Value Date In Words 56A Intermediary Bank Name Optional – for routing payment to Beneficiary Bank Address Country Bank Code 57 Beneficiary's Bank Name* Address* Country* Bank Code 59 Beneficiary Name*/ Address Country* Account No*/ IBAN 70 Details of Payment Transaction Type Code (Mandatory for AED remittances) 71 All local and overseas charges borne All local and overseas charges borne SCB UAE charges borne by remitter & all OR OR by beneficiary (BEN) by remitter (OUR) other charges by beneficiary (SHA) Contract Details (If Applicable) Forward Contract/ Treasury Deal No: Customer's Signature(s) FX rate Dealer's Name: Do not write on this area I/ We authorise the Bank to debit the above monies for the lawful purpose detailed above and agree to abide by the Terms and Conditions printed overleaf and as updated on the Bank’s web site. OTT ver Apr 12 Customer's Signature(s) 7c1fd77f-1419-4d72-ab5f-7ee3573e448f
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