TRANSACTION NO

MONEY TRANSFER FORM 16REM

PARA TRANSFER FORMU
REFERENCE NO
NEW YORK BRANCH
122 East 42nd Street, Suite 310, New York, NY 10168
Tel: 212-792-5010, Fax 212-490-8076
info@ziraatnewyork.com
Please Print Clearly and Provide all information / Lütfen eksiksiz doldurun
Name / Adı Soyadı Telephone / Telefon numaranız

Address / Adres (No POB Addresses-Posta Kutusu adresi kabul edilmemektedir)

SENDER
Gönderen
City / İl State / Eyalet Zip / Posta kodu Social Security – Tax Id Number
Sosyal Güvenlik veya Vergi Numarası

Name / Adı Soyadı Telephone / Telefon

MİLLİ SAVUNMA BAKANLIĞI

Address / Adres
DÖVİZLİ ASKERLİK ÖDEMESİ
BENEFICIARY ATATÜRK CADDESİ, BAKANLIKLAR
Alıcı City / İl State / Eyalet Zip / Posta kodu Country / Ülke

ANKARA 06100 TR
Beneficiary’s Bank and Branch Name / Account No / IBAN / Alıcı Bankası / Hesap Numarası

T.C. MERKEZ BANKASI # 10107603

Father’s Name Babanızın Adı
Place of Birth Doğum Yeriniz
ADDITIONAL
INSTRUCTIONS Date of Birth Doğum Tarihiniz
Ek Bilgiler TR ID Number TC Kimlik Numaranız
Military Branch Askerlik Şubeniz
By placing this funds transfer order with T.C. Ziraat Bankasi A.S. New York Branch, I agree to the following terms and conditions at the front and back of this form. By signing
below, I hereby acknowledge that I have received a full and complete copy of the Terms and Conditions, and Disclosures. I certify that the above information is true and correct
as to the best of my knowledge and that I am liable for any damages resulting from the errors or information contained therein.
T.C. Ziraat Bankası A.S. New York Subesi’ne bu para transfer talimatını vererek, bu formun ön ve arka sayfasındaki, “Terms and Conditions”i kabul ettiğimi beyan ederim. Bu formun ön ve
arka sayfasındaki bilgileri okudum, “Terms and Conditions, and Disclosures” birer kopyalarını aldım ve aynen kabul ediyorum.

AMOUNT Göndereceğiniz toplam miktar ____________________ ________________________ ________________________

DATE (Tarih) SENDERS SIGNATURE (İmza)
FOR BANK USE ONLY
AMOUNT TO BE TRANSFERED
Transfer edilecek miktar US$ 1,091.60
TRANSFER FEES
Transfer ücreti US$ 225.00
COMMISSIONS / TAXES (If applicable) US$ __
Uygulanırsa, komisyon ve/veya vergi miktarı
TOTAL AMOUNT RECEIVED
Göndericiden alınan toplam miktar US$ 1,316.60
TOTAL AMOUNT PAID TO BENEFICIARY
Transfer edilen tutar US$ 1,091.60
VALUE DATE (Date funds available) Exchange rate / Foreign Currency
Valör / Ödeme tarihi (If other than US$) ____________________
Unless specified, funds will be sent in US Dollars. If the recipient has no US dollar account, it will be converted into local currency by the local bank. Recipient may receive
less due to fees (and/or commissions) charged by recipient’s bank and foreign taxes.
Aksi belirtilmediği takdirde havaleniz Amerikan Doları olarak yapılacaktır. Alıcının Dolar hesabı olmadığı takdirde, hesap para birimine, karşı banka tarafından o günün kuru üzerinden
çevrilecektir. Alıcı, kendi bankasının uygulayabilceği vergi, komisyon ve ücretler nedeni ile belirtilen miktardan daha az alabilir.
Government Issued ID; Type/Number/Issue Date/Expiry
OFFICIAL CHECK RECEIVED __________________
(Kimlik Bilgileri)
_____________________________________________
If Cash Received (denominations) __________________
INFORMATION VERIFIED BY: ____________________

INPUT BY ____________________ VERIFIED BY ______________________

Revised 2016/03
 TERMS AND CONDITIONS, AND DISCLOSURES
You have presented us with a cashier’s check, bank check, or cash. We will make
a transfer of these funds promptly after we have received good and available funds
in accordance with the information that you have provided on the Money Transfer
Form. By signing this form, you have confirmed that you are responsible for the
correctness of the information provided. T.C. Ziraat Bankasi A.S. New York Branch.
is not liable for any errors made on the form, including, but not limited to, insufficient
funds to cover the full transfer amount and fees, the recipient’s name, address, and
bank information, and any other information relevant to making the transfer.
Further, you accept liability for a cancel of transfer, should the funds provided prove
to be subject to legal process or other claim restricting such transfer.
For purposes of these disclosures, our business days are Monday through Friday.
Excluding bank Holidays in New York NY or in the jurisdiction that the Beneficiary
receives the funds.
Transfer to Another Bank Other than T.C. Ziraat Bankasi A.S.;
You may request either that the funds be deposited to a particular account at the
other bank. The other bank will be responsible for following your instructions and of
notifying the recipient that the funds are available. If you identify a recipient by name
and account number, the recipient’s bank may pay the funds to the person identified
by the account number, and your payment will be final even if the account number
provided does not correspond to your recipient. Once the funds are transferred to
the other bank, the funds become the property of the other bank, and the other bank
is responsible to locate, identify and make payment to your recipient.
Means of Transfer; T.C. Ziraat Bankasi A.S. New York Branch uses a variety of
banking channels and facilities, but will ordinarily use electronic means. You agree
that we may choose any conventional means that we deem suitable to transfer your
funds to your recipient. Because we do not maintain banking relations with every
bank, it may be necessary for us to use one or more intermediary banks before your
funds are transferred to the other bank. Once we transmit your order to an
intermediary bank, it will be that bank’s responsibility to ensure that your order is
completed. Recipient may receive less due to fees charged by the recipient’s bank
and foreign taxes.
Limitations; There may be a period after T.C. Ziraat Bankasi A.S. New York
Branch. processes your request for a money transfer, subject to our policy on
clearing checks for remittance purposes, during which the transfer funds may be
unavailable.
Documentation; You are entitled to a receipt at the time you make any money
transfer.
Stop payment; You have irrevocably instructed us to use the funds provided to us
to make an electronic transfer. As such you may not stop payment of electronic
funds transfers. You should not employ electronic fund transfers unless you are
satisfied that you will not need to stop payment.
Recalls; You may request that we recall your funds transfer order, which request
may be made only if we receive such request at a time that provides us a
reasonable opportunity to act upon your request and if the funds have not already
been made available to your recipient or the bank otherwise agrees to recall or
amend your funds transfer order. If you decide that you do not want the funds
transferred, T.C. Ziraat Bankasi A.S. New York Branch will first have to check with
the other bank to determine whether the other bank can return your funds. If the
other bank confirms that the funds are returnable and the funds are returned to T.C.
Ziraat Bankasi A.S. New York Branch by the other bank, T.C. Ziraat Bankasi A.S.
New York Branch will return the funds to you.
Any amount returned to you for the recalled funds transfer order that is permitted
will be made within 3 business days. The amount that is returned will be subject to
service charges of the other bank and/or a fee of US$ 45.00 by T.C. Ziraat Bankasi
A.S. New York Branch.
There is no assurance that your request to return your funds will be permitted.
What to do if you want to cancel a remittance transfer; If you request that we
cancel your funds, then you must contact us at our phone number or e-mail address
provided above within 30 minutes of your request for the money transfer.
When you contact us, you must provide us with the information to help us identify
the transfer you wish to cancel, including the amount and location where the funds
were sent.
Cash Transaction Reporting; Federal regulations issued by the U.S. Department
of the Treasury mandate that financial institutions file with the IRS a complete and
accurate report on each customer transaction involving cash in excess of $10,000.
The regulations also require financial institutions to maintain a log of their sales of
certain negotiable instruments, which involve cash in the range of $3,000 to
$10,000 inclusive. To comply with the regulations, our financial institution must
record certain details for each of these types of transactions, as well as obtain and
record certain information about the individuals who conduct the transactions, and
the persons or entities on whose behalf the transactions are conducted.
Rejection of an order; We reserve the right to reject your funds transfer order. We
may reject your order if you have not provided to us sufficient funds for your
requested money transfer, if your order is incomplete or unclear or if we are unable
to fulfill your order for any other reason.
Delays, Non-Execution of Funds Transfer Order; While we will handle your funds
transfer order as expeditiously as possible, you agree that T.C. Ziraat Bankasi A.S.
New York Branch will not be responsible for any delay, failure to execute or
misexecution of your order due to circumstances beyond T.C. Ziraat Bankasi A.S. New
York Branch reasonable control, including without limitation any inaccuracy,
interruption, delay in transmission, or failure in the means of transmission, whether
caused by strikes, power failures, equipment malfunctions, or acts or omissions of any
intermediary or other bank. T.C. ZIRAAT BANKASI A.S. NEW YORK BRANCH
MAKES NO WARRANTIES, EXPRESS OF IMPLIED, WITH RESPECT TO ANY
MATTER.
Liability of institution; If we do not complete a transfer on time or in the correct
amount according to our agreement with you, we will be liable for your losses or
damages. T.C. Ziraat Bankasi AS New York Branch will not be liable, however, if
circumstances beyond our control (such as fire or flood) prevent the transfer, despite
reasonable precautions that we have taken; or any other exceptions stated in our
agreement with you.
Claims; T.C. Ziraat Bankasi A.S. New York Branch sole obligation to you, is to pay or
refund such amounts as may be required by applicable law. In no event shall T.C.
Ziraat Bankasi A.S. New York Branch be responsible for any consequential or
incidental damages or expenses in connection with your order. Any claim for interest
payable by T.C. Ziraat Bankasi A.S. New York Branch shall be at T.C. Ziraat Bankasi
A.S. New York Branch prevailing deposit rate. In any event, if you fail to notify us of
any claim concerning your funds transfer order within one year from the date that you
receive notification that your order has been executed, any claim by you will be barred
under applicable law. This Agreement will be governed by the laws of the state of New
York and United States federal law, as applicable.
You have a right to dispute errors in your transaction. If you think there is an error,
contact us within 180 days at 212-792-5010 or www.ziraatnewyork.com.
You can also contact us for a written explanation of your rights. If you believe a transfer
has been made using your information without your permission, call: (212) 792-5010,
or write: T.C. Ziraat Bankasi A.Ş.
122 E 42nd Street #310
New York, NY 10168
For questions or complaints about T.C. Ziraat Bankasi A.S. New York Branch, contact:
State Regulatory Agency
800-111-2222 www.stateregulatoryagency.gov
Consumer Financial Protection Bureau
855-411-2372, 855-729-2372 (TTY/TDD)
www.consumerfinance.gov
We will determine whether an error occurred within 90 days after you contact us and
we will correct any error promptly. We will tell you the results within three business
days after completing our investigation. If we decide that there was no error, we will
send you a written explanation. You may ask for copies of any documents we used in
our investigation.
Confidentiality; We will disclose information to third parties about your account or the
transfers you make:
(i) Where it is necessary for completing transfers, or (ii) In order to verify the existence
and condition of your account for a third party, such as a credit bureau or merchant,
or (iii) In order to comply with government agency or court orders, (iv) If you give us
your written permission, or (v) In order to assert any rights or claims we may have
against you.
Error resolution; In case of errors or questions about your money transfer, if you
think your statement or receipt is wrong, or if you need more information about a
transfer listed on the statement, telephone us at (212) 792-5010, write us at T.C. Ziraat
Bankasi A.S. New York Branch, 122 East 42nd Street, Suite 310, New York, NY
10168, or e-mail us at info@ziraatnewyork.com as soon as possible. We must hear
from you no later than 60 days after we sent the FIRST statement on which the
problem or error appeared. You must:
(1) Tell us your name and account number (if any).
(2) Describe the error or the transfer you are unsure about, and explain as clearly as
you can why you believe it is an error or why you need more information.
(3) Tell us the dollar amount of the suspected error.
If you tell us orally, we may require that you send us your complaint or question in
writing within 10 business days. We will determine whether an error occurred within
10 business days after we hear from you and will correct any error promptly. If we
need more time, however, we may take up to 45 days to investigate your complaint or
question. If we decide to do this, we will credit your account within 10 business days
for the amount you think is in error, so that you will have the use of the money during
the time it takes us to complete our investigation. If we ask you to put your complaint
or question in writing and we do not receive it within 10 business days, we may not
credit your account.
For errors involving foreign-initiated transactions, we may take up to 90 days to
investigate your complaint or question. For new accounts, we may take up to 20
business days to credit your account for the amount you think is in error. We will tell
you the results within three business days after completing our investigation. If we
decide that there was no error, we will send you a written explanation. You may ask
for copies of the documents that we used in our investigation.
Revised 2016/03