7/25/2019 Remittance Application Form

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_______________ Branch.

Date:____________________

REMITTANCE APPLICATION FORM

You are requested to process the following remittance(s) by debiting my / our account no. against

cheque no. ___________________ dated____________ amounting _________________ favoring Meezan Bank Ltd.

Please markthe mode of remittance.

Payment Order Demand Draft Foreign Telegraphic Transfer

Remittance Details (* denotes mandatory fields)

Name of Beneficiary (in Block Letters)* CNIC / SNIC* orNTN number* (for corporate entities)

Amount in words*: Currency* Amount in figures*

Complete address of the beneficiary:* Contact No. of the beneficiary:*

Purpose of remittance:*

For Demand Draft, Foreign Telegraphic Transfer Use Only Please fill where applicable

Town, City and Country where Payable:

Name and Address of Beneficiary Bank:

SWIFT Code:* Beneficiarys Account number:*

Relationship between Originator & Remitter:*

Message or Instructions if any (for FCY remittances only):

Name of Applicant / Remitter (in Block Letters):*

Conditions:I / we hereby declare that information presented above is correct and verifiable. I / we further hereby agree that the above payment order / draft / remittan

to be dispatched entirely at my / our own risk; and in case of a telegraphic transfer, you are at liberty to send the same either literally or in spirit and you shhave no liability whatsoever for any delay, error, omission, which may occur in the transmission of the message or from its misinterpretation when receivedwe further agree that the bank may share with other banks/authorities including correspondent banks, as the Bank deems fit, the information about my/ou

account provided by me/us, or that the Bank may obtain as a result of transaction(s) or other activity, for among other things, the purpose of offering produand services.

I/we authori ze Mr./Mrs./Ms._______________________________________

having CNIC No. (copy enclosed)____________________ to collect the above

PO/DD/FDD on my/our behalf. His / her specimen signature is as under.

__________________ ___________________________Customers Signature Signature of Authorized Persons

(Customers signature & Company Stamp)

or Bank Use Only

PO /DD /FDD / Ref no. Checked by Authori zed signature

Remittance Amount

Conversion Rate

Account debited by amount

Remittance charges I hereby acknowledge the receipt of the above PO / DD / FDD.

Receivers signature:Date Received:

FED

Courier / SWIFT Charges

TOTAL

S.V.