FUND TRANSFER APPLICATION PLEASE MARK APPLICANTS DETAILS Date Ref No. Branch DD MM Y Y Y Y TELEGRAPHIC TRANSFER Applicant Beneficiary DRAFT RTGS Name : Address : Tel No. : NIC / PP No. : Account No. : SLIPS PAY ORDER BENEFICIARY DETAILS DRAFT / PAY ORDER FOR BANK USE ONLY Name : Account No. : Purpose : Bank : Branch : Name of Bank : Branch : Name : BENEFICIARY DETAILS BENEFICIARY BANK DETAILS Address : Country : Address : Account No. : INTERMEDIARY BANK DETAILS Name of Bank : Branch : Address : Country : Please mark () where applicable Branch Approval Authorised Signature Authorised Signature Central Operaons Unit Authorised Signature Authorised Signature I/We hereby authorise the bank to debit my/our account for the purpose detailed above and agree to abide by the Terms and Condions printed overleaf. Currency : Signature of Applicant/s TRANSFER INSTRUCTIONS Amount : Amount in Words : All Bank charges outside Sri Lanka : Purpose of Remiance : DD MM Y Y Y Y Value Date : IBAN No. : SWIFT Code : Chips ID : USA Fed Wire: UK Sort Code : SWIFT Code : Chips ID : USA Fed Wire: UK Sort Code : WEB PRINT 1