EQUINOR

PETROLEUM AND ENERGY COMPANY

USA E&P INC, BROOKLYN, NEW YORK 11201
UNITED STATES OF AMERICA

T.T FORM
0866750 MOL DATE:..............................

TELEGRAPHIC TRANSFER PAYMENT FORM

CAREFULLY FILL APPROPRIATELY YOUR INFORMATION IN THE SPACES PROVIDED. USE CAPITAL
LETTERS THROUGHOUT

1. PARTICULARS OF BENEFICIARY

COMPANY NAME:...................................…............................................................................................

ADDRESS:...............................................................................................................................................

2. NAME OF BANK:................................................................................................................................

ADDRESS:.............................................................................................................................................

ACCOUNT NUMBER:...........................................................................................................................

SWIFT CODE::......................................................................................................................................

ACCOUNT NAME::..........................................................……..............................................................

3. AMOUNT APPLIED (IN WORDS):...................................................................................................

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I/WE DECLARE THAT ALL INFORMATION GIVEN IN THIS FORM ARE CORRECT AND AUTHENTIC TO THE
BEST OF MY KNOWLEDGE. THE AMOUNT FOR REMITTANCE IS FOR THE PURPOSE STATED IN
ACCORDANCE WITH THE EXCHANGE CONTROL ACT.

BENEFICIARY'S NAME:..................................................................................……...................
XED
BENEFICIARY'S SIGNATURE:.......................................................................................... AFFI ORT
S P
PAS GRAPH
TO
PH O
OFFICIAL USE ONLY

A. APPROVED BY:.....................................................................................................

B. CHECKED & PASSED FOR REMITTANCE BY:....................................................

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CONTRACTOR’S SIGNATURE