KTT Telegraphic-Transfer-2021 Form (Original)

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APPLICANTS: Pls.

fill-out; fields with asterisk (*) are mandatory items Date Branch

Domestic KTT Telegraphic Transfer Foreign KTT Telegraphic Transfer Others (Please specify) ______________________________________________________________
USD $ (Dollar) EUR € (Euro)

*Ordering Bank Name


Remitter’s Other information
Reference No. *Source of Funds

*Remitters Account No. *Intermediary Bank Name:

*Ordering Bank Address *Ordering Bank KTT Telex Code *Intermediary Bank Adress: *Country

*Value Date (yy/mm/dd) *Intermediary Bank Swift Code:

*Amount *Purpose/Reason

*Account Holder Name: Mode of Payment


Cash Debit from Account ___________________________________
Cashier's Check TD/PA/COP No.
*Present Address (No.,St.,Subd/Dist/Town, City/Prov., Country)
TERMS AND CONDITIONS
The Bank shall not be liable for any loss or damage sustained by the Applicant or any other person by
reason of the error or delay of telegraphic or cable companies transmitting the telegraphic transfer
message directing the agencies employed by the Bank in the transfer of funds, the risk for all which
*Permanent Address (No.,St.,Subd/Dist/Town, City/Prov., Country)
are assumed by the Applicant. By filling-out this form, the Applicant authorizes the Bank to disclose
information necessary for the execution of the transaction and the Applicant agrees that the Bank
from or in
connection with the disclosure of any such information. The Applicant authorizes the Bank to
collect/debit from the above account any and all applicable fees & charges relative to the processing
*Telephone No. Fax No. and implementation of this transaction.
I/We have read and hereby authorize the Bank to carry out this instruction and agree to be governed
*Tax ID No. *SSS/GSIS No./Other ID Type and No. by the terms and conditions printed herein.

Bank Officer Name:

Bank Officer Title:


Client’s Signature
Bank Officer Telephone No.
Signature verified by:

Bank Officer Email:


For Bank’s Use Only

NOTE: FW1=Fedwire; CH2=Chips; BIC3=Bank Identifier Code


Remittance Rate Rate Pay EUR
Amount to to USD Amount Equivalent
*Beneficiary Bank: KTT No. or SWIFT Code

*Bank Name:

*Bank Address

*Country of Destination

*Beneficiary Account No.


Service Charge/Commission

Cable

*Beneficiary Name
Cash/Postage

Documentary Stamps
*Address
Others

TOTAL
*Remittance Info
Processed by

Test Key/ Code Date Tested

Verified by

*Charges for (Sha/Our)


Tested by

Sender to Receiver info


Approved by

Trans. Ref. No.

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