A B N 1 5 1 1 1 7 4 3 7 5 0

1 4 7 H a l d o n S t r e e t Lakemba NSW 2195

P O B o x 1 7 5 7 L a n e C o v e N S W 2 0 6 6

Tel 1 3 0 0 7 3 3 9 8 3 Fax 1 3 0 0 7 3 3 7 0 2

sydney fo rex . com.au

R e m i t t a n c e A p p l i c a t i o n F o r m TO ENSURE FAST PROCESSING OF YOUR APPLICATION COMPLETE THE FOLLOWING DETAIL USING BLOCK LETTERS

S F X SENDER ID

SENDER DETAILS

Street Address

Email Address

Profession / Occupation

Purpose of Remittance

BENEFICIARY DETAILS

Beneficiary Street Address

BENEFICIARY ACCOUNT DETAILS

Bank Name

Branch Name/ Address

Deposit Slip

/ /

DATE

Authorization Signature: _____________________

Currency Destination

Rate Exchange

Home Phone Mobile Phone

/ / (Please Provide detail of your current residential address)

Donot Emai l Do not SMS

POBOX ADDRESS IS NOT ACCEPTABLE

YYYY DD MMYYYY MM DD

Beneficiary Account Name/Title

( )

Please visit sydneyforex.com.au or call 1300 733 983 for Current Exchange Rate

Only for Remittance to Pakistan

Beneficiary Account Number / IBAN Number

Home delivery (Chaque Only)

Bank Deposit

/ / SIGNATURE

Photo ID Number Expiry Date Date of Birth

I read all the terms and condition and I hereby declare that the information given on

transmission of message and the remittance is being made at the sole risk and responsibilityof the Remitter.

Privacy Preference

selected third parties that may be of interest to you. However if your do not wish us to communicate these other offers to you.

this form is true and correct.Sydney Forex Pty Ltd and Its Emplyees do not accept any

Branch Code Swift Code

Country City

Please Tick here and re-signature if you would like to authorized Sydney Forex Pty Ltd to use above application form for my future transactions

C.N.I.C Number (Computrized ID Card Number)

Suburb/Town State Postcode

Home Phone Mobile

Country City

Suburb/Town State Postcode

We may keep you informed above other products, services and special offers from Sydney Forex P/L and Rabitah International and

liability for loss or damage which any person may suffer arising from mutilation, delay or wrong

( )

Transaction Number (for Office Use Only)

Full Name Last Name

Full Name Last Name

Sydney Forex Pty Ltd

NAB Bank

BSB: 082254

A/C: 742738901

TRANSACTION DETAILSAmount in Foreign Currency

Amount in AU$

Administration Charges

Total Amount in AU$

Cash Pickup upto Rs 500,000/=