PARTICULARS

The information requested below is essential for processing your payments.

Name of Personnel

Email Address

Telephone Number

BANK DETAILS
(all details must be filled in as this is a requirement to process payment)

Bank Name

Branch Country Location

Branch Address

Branch Sort/Swift Code/IFIS/Routing#

Account Number

IBAN Number/if not applicable use N/A

Account Currency

Account/Beneficiary Name

Beneficiary Address

Beneficiary City

Postal Code

Country/State/Province

Intermediary Bank Name (if applicable)

Intermediary Bank Account Number (if

applicable)

I hereby declare that all the details mentioned above are in accordance with the truth and fact as per my knowledge
and I hold the responsibility for the correctness of the above-mentioned particulars