EFT / CHEQUE REQUEST FORM

CASA File reference : DXB/X/IF/250721/7717746

Beneficiary Bank Details for EFT (Electronic Fund Transfer)

IBAN Number:
Bank Account Number:
Bank SWIFT/BIC:
Bank Country Code:
Bank Name:
Bank Branch Name:
Bank Account Holder Name:
Bank Account Currency:
Bank Address:

Amount
Amount Payable and Currency: EUR 600.00 Note:currency must be valid for the bank branch/country
Debit CCC/Nominal/Sub-nominal: / / n/a

Payment authorised by (to be filled by Emirates authorised personnel) n/a

Name:
Title:
Date: / /

Customer Name and Signature

*Name and Signature: Mr Khalid Ehsan (sign with a pen)

*Date: / /
Emirates accepts no responsibility for the information provided herein and is entitled to assume all information
provided by you in this Emirates Electronic Fund Transfer Request Form is complete and accurate in all respects.
Emirates excludes all liability that may arise as a result of any incorrect or incomplete information provided by you
In this Emirates Electronic Fund Transfer Request Form.

BUSINESS DOCUMENT This document is intended for business use and should be distributed to intended recipients only.