Sagicor Bank Jamaica Limited
Transfer service arrangement – Wire transfer eForm 0044 (04/2014)
Date: Branch: Account No.: Account Currency: Reference No.: Account Holder: Address:
PAYMENT DETAILS Type of Transaction:
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Amount:
Intermediary Institution Name:
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Address:
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Bank ID.:
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Paying Bank Name:
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Address:
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Bank ID.:
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Beneficiary Details Name:
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Address:
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Account No.:
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Receiver Bank Name:
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Charges For:
Additional Payment Information:
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Sender to Receiver Information:
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TRANSACTION DETAILS The Bank is hereby authorised to debit the account inserted below with the amount indicated. ………………………………………………………………………………………………………………………….
Effective Date: Value Date:
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Selling Rate:
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Commission (included in amount debited):
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Amount Debited:
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Account Debited:
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Declaration In the event that the remittance is, for any reason whatsoever not completed, the Bank shall not be required to make any refund until it shall have received advice of cancellation from its agent or correspondent together with the relative funds freely available. In case of refund, all expenses and losses occasioned by the remittance or attempted remittance and the refund shall be borne by the customer who assumes as well all risks of exchange rate fluctuations. The Customer understands that the Bank is obliged to effect wire transfers on its behalf in accordance with the laws and terms and conditions of the Correspondent Bank and the Paying Bank. The Customer hereby authorizes the Bank to provide such information that it may have on record regarding the Customer, to such institutions; and agrees that the Bank shall not be liable for any loss direct or indirect, whether it has been notified of such loss or otherwise, including expense suffered by the Customer, as a result of the provision by the Bank of such information, or as a result of the failure or inability of the Bank to provide current information, or to provide same on a timely basis. The Customer also agrees to free, release and discharge and indemnify the Bank against any and all costs, or expense incurred in relation to the above. Account Holder Signature
Date:
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In witness whereof: Witness: …………………………………………………………………………… (Name in Block Letters)
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Occupation: Bank Officer
…………………………………………….………………… Signature of Witness
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