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Foreign Currency Telegraphic Transfer/Demand Draft

Dubai Date 1 6 1 8 7
Branch

Please select Foreign Currency Telegraphic Transfer OR Issue a Demand Draft

Ordering Customer Details (Complete in Block Letters) ( )

Inherited Transfer from Late Mr. Richard Burson
Applicants Name

Debit Account Number 8 0 2 1 6 4 2 Debit Currency $ Remittance Currency

( )
Transaction Amount and Currency (Select)

Debit Currency OR Remittance Currency Amount in Figures 3 8 2 3 1 0 0 0 . 0 0
Thirty Eight Million Two Hundred and Thirty one Thousand US Dollars Only
Amount in Words

Contact Number

Beneficiary Details (Complete in Block Letters) ( )

Fernando Graziano Ferrari

Beneficiarys Name
Via Ganne di fuori 5, 6721 Ludiano Switzerland
Beneficiarys Address

Beneficiarys Account Number 9 1 3 5 2 8 3 6

Beneficiarys IBAN 4 7 0 9 0 0 0 0 0 0 9 1 0 3 5 2 8 3 6
Swisspost PostFinance
Name and Address of Beneficiarys Bank
Via Ganne di fuori 5, 6721 Ludiano - Switzerland
/ Swift Code:POFICHBEXXX
SWIFT/Routing Code of Beneficiary Bank
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Correspondent/Intermediary Bank Details
( ) /
Correspondent Bank Routing Code/Account Number (for TT only)
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Details of Payment/Purpose of Remittance (Mandatory)
Inheritance from Late Relations Deposit with this
( ) This payment has been cleared of all money Laundering /Terrorism Activities.
Special Instructions (if any)

( )
Charges (Select)
( )
Beneficiary (Please charge beneficiary for your charges and correspondent banks charges from the TT amount)
( )
Ours (Please debit my account for your charges and correspondent banks charges)
( )

Shared (Please debit my account for your charges, beneficiary will bear the charges of your correspondent banks from the TT amount)

Demand Draft Bearer Delivery Instruction (Applicable for 3rd Party Delivery Only)

)
(
Please deliver the Demand Draft to the bearer, as per the signature appended Demand Draft Received

Bearers Signature Applicants Signature(s)

Signature Verified
Applicants Signature(s)

I/We have read, understood and accepted the Banks terms and conditions / / /
governing this application as stated in the Business Accounts General . /
Terms and Conditions a copy of which I/we have received.
EIBTTI0000000000000001

Bank Use Only

Select One: (only in case of Special FX Deal)

IBTRY Deal Number
Branch Rate
Special FX Deal Normal FX Deal Transaction Ref. Number*
Client Rate*

Signatures Teller: Head Teller: BOO/BOM/BSSM:

Emirates Islamic is a registered brand name of Emirates Islamic Bank PJSC EIB U 300 02D NI06FRM0049