The Commercial Bank (P.S.Q.C.) (.‫ق‬.‫ع‬.‫م‬.

‫اﻟﺒﻨﻚ اﻟﺘﺠﺎري )ش‬

PO Box 3232, Doha, State of Qatar
Tel: +974 4449 0000
Fax: +974 4449 0070
www.cbq.qa

‫اﺳﺘﻤﺎرة ﻃﻠﺐ ﺗﺤﻮﻳﻞ اﻷﻣﻮال‬

Fund Transfer Application Form
Remitter account details
‫ﻃﺮﻳﻘﺔ ﺗﺤﻮﻳﻞ اﻷﻣﻮال‬ ‫ﺣﻮاﻟﺔ دوﻟﻴﺔ‬
Transfer mode International transfer
‫اﺳﻢ اﻟﻌﻤﻴﻞ‬
Customer name AHMED ALNASARI
‫رﻗﻢ اﻟﺠﻮال‬
Mobile no. +5 9
0 73 43 6 1 1 1
Beneficiary details
‫اﺳﻢ ﺣﺴﺎب اﻟﻤﺴﺘﻔﻴﺪ‬
Beneficiary account name
‫ رﻗﻢ اﻟﺤﺴﺎب اﻟﻤﺼﺮﻓﻲ اﻟﺪوﻟﻲ ﻟﻠﻤﺴﺘﻔﻴﺪ‬/‫*رﻗﻢ اﻟﺤﺴﺎب‬
*Beneficiary account no./ IBAN
‫ﻋﻨﻮان اﻟﻤﺴﺘﻔﻴﺪ‬
Beneficiary address
‫ ﻫﺎﺗﻒ اﻟﻤﺴﺘﻔﻴﺪ‬/‫رﻗﻢ ﺟﻮال‬
Beneficiary mobile/ phone no.
‫اﻟﻌﻼﻗﺔ ﺑﺎﻟﻤﺴﺘﻔﻴﺪ‬
Beneficiary Relationship
‫اﺳﻢ اﻟﺒﻨﻚ اﻟﻤﺴﺘﻔﻴﺪ‬
Beneficiary bank name
‫ﻋﻨﻮان اﻟﺒﻨﻚ اﻟﻤﺴﺘﻔﻴﺪ‬
Beneficiary bank address
‫ﺑﻠﺪ ﺑﻨﻚ اﻟﻤﺴﺘﻔﻴﺪ‬
Beneficiary bank country
‫ ﻟﻠﺘﺤﻮﻳﻞ‬SORT/BSB/IFSC/FW/Transit ‫رﻣﺰ‬
Remitting /SORT/BSB/IFSC/FW/Transit
‫رﻣﺰ ﺳﻮﻳﻔﺖ اﻟﺨﺎص ﺑﺒﻨﻚ اﻟﻤﺴﺘﻔﻴﺪ‬
Beneficiary bank SWIFT code
‫اﻟﺘﺎرﻳﺦ‬
Date 1 0 / 0 4 / 2 3
‫ﺗﻔﺎﺻﻴﻞ ﺣﺴﺎب ﻣﺮﺳﻞ اﻟﺤﻮاﻟﺔ‬
‫ﺣﻮاﻟﺔ ﻣﺼﺮﻓﻴﺔ ﻣﺤﻠﻴﺔ‬ ‫ﺣﻮاﻟﺔ إﻟﻰ ﺣﺴﺎب ﻟﺪى اﻟﺒﻨﻚ اﻟﺘﺠﺎري‬ ‫ﺳﺪاد ﺑﻄﺎﻗﺔ اﻻﺋﺘﻤﺎن‬ ‫ﺣﻮاﻟﺔ ﻋﻨﺪ اﻟﻄﻠﺐ‬ ‫ﺷﻴﻚ اﻟﻤﺪﻳﺮ‬
Local bank transfer Commercial Bank account transfer Credit card payment Demand draft Manager’s cheque
(‫رﻗﻢ اﻟﺤﺴﺎب )اﻟﺬي ﺳﻴﺘﻢ اﻟﺨﺼﻢ ﻣﻨﻪ‬
Account no. (to be debited) 4 5 0 1 0 9 1 6 5 1 2 3 2
‫ﻋﻨﻮان اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬
Email address ahmd.qtr1@gmail.com
‫ﺑﻴﺎﻧﺎت اﻟﻤﺴﺘﻔﻴﺪ‬
SHAH ZEB
PK46FAYS3093301000007609
PAKISTAN
+92 3343843322
‫اﻟﺘﺤﻮﻳﻞ ﺑﻴﻦ اﻟﺤﺴﺎﺑﺎت اﻟﺨﺎﺻﺔ‬ ‫ﻓﺮد ﻣﻦ اﻟﻌﺎﺋﻠﺔ‬ ‫اﻟﻌﻼﻗﺎت اﻻﺟﺘﻤﺎﻋﻴﺔ‬ ‫ﻋﻼﻗﺔ اﻻﺳﺘﻬﻼك‬ ‫ﻋﻼﻗﺔ ﻋﻤﻞ أو اﺳﺘﺜﻤﺎر‬
Transfer between own accounts Family Member Social Relationship Consumer Relationship Business or investment relationship
FAYSAL BANK LIMITED
Karachi , PAKISTAN
PAKISTAN
(‫اﻟﺒﻨﻚ اﻟﻮﺳﻴﻂ )إن وﺟﺪ‬
FAYS Intermediary bank (if any)
‫ﺑﻠﺪ اﻟﺴﺪاد‬
FAYSPKKA112 Draft payable in country

Payment details ‫ﺑﻴﺎﻧﺎت اﻟﺴﺪاد‬

‫اﻟﻤﺒﻠﻎ ﺑﺎﻷرﻗﺎم‬ ‫اﻟﻌﻤﻠﺔ‬
Amount in figures 2000 Currency Qatari Riyal
‫أو‬ ‫ﻣﺒﻠﻎ اﻟﺤﻮاﻟﺔ ﺑﻌﻤﻠﺔ اﻟﺤﺴﺎب اﻟﺬي ﺳﻴﺘﻢ اﻟﺨﺼﻢ ﻣﻨﻪ ﺑﺎﻷرﻗﺎم‬ ‫اﻟﻌﻤﻠﺔ‬
Or Transfer amount to the equivalent of Debit Account currency in figures 2000 Currency Qatari Riyal
‫ﻣﺒﻠﻎ اﻟﺤﻮاﻟﺔ ﺑﺎﻟﻜﻠﻤﺎت‬
Amount in words of transfer amount Five hundred Qatari riyals
‫ﺑﻴﺎﻧﺎت اﻟﺮﺳﻮم‬ **OUR **OUR ‫اﻟﻤﺴﺘﻔﻴﺪ‬ Beneficiary ‫ﻣﺸﺘﺮك‬ Shared
‫)ﻳﺘﺤﻤﻞ اﻟﻤُﺮﺳﻞ ﻛﺎﻓﺔ‬ (All bank charges ‫)ﻳﺘﻢ ﺧﺼﻢ ﻛﺎﻓﺔ اﻟﺮﺳﻮم‬ (All bank charges to be ،‫)ﻳﺘﺤﻤﻞ اﻟﻤُﺮﺳﻞ اﻟﺮﺳﻮم اﻟﺨﺎﺻﺔ ﺑﺎﻟﺒﻨﻚ اﻟﺘﺠﺎري‬ (Commercial Bank charges by remitter and
Details of charge (‫اﻟﺮﺳﻮم اﻟﺨﺎﺻﺔ ﺑﺎﻟﺒﻨﻚ‬ borne by remitter) (‫اﻟﺨﺎﺻﺔ ﺑﺎﻟﺒﻨﻚ ﻣﻦ ﻣﺒﻠﻎ اﻟﺤﻮاﻟﺔ‬ debited from transfer amount) (‫وﻳﺘﻢ ﺧﺼﻢ رﺳﻮم اﻟﺒﻨﻚ اﻟﻤُﺮاﺳﻞ ﻣﻦ ﻣﺒﻠﻎ اﻟﺤﻮاﻟﺔ‬ correspondent bank charges from transfer amount)
‫اﻟﻤﺒﻠﻎ ﺑﺎﻟﻌﻤﻠﺔ اﻷﺟﻨﺒﻴﺔ‬ ‫اﻟﺴﻌﺮ‬ ‫ﻣﺎ ﻳﻌﺎدل ﺑﺎﻟﻌﻤﻠﺔ اﻟﺘﻲ ﺳﻴﺘﻢ ﻓﻴﻬﺎ اﻟﺨﺼﻢ‬ ‫رﺳﻮم اﻟﺒﻨﻚ اﻟ ُﻤﺮاﺳﻞ‬ ‫رﺳﻮم اﻟﻤﻌﺎﻣﻠﺔ‬
FCY amount 154 557 Rate 0.013 Equivalent debit account currency 2000 Corresponding bank charges %0.2 Transaction charges 17
‫اﻟﻐﺮض ﻣﻦ ﺗﺤﻮﻳﻞ اﻷﻣﻮال‬ ‫اﻟﻤﺠﻤﻮع‬
Purpose of transfer To friend Total 2017
(‫إﻋﺎدة اﻟﺘﻤﻮﻳﻞ )ﻟﻠﺸﺮﻛﺎت ﻓﻘﻂ‬ ‫ﻧﻌﻢ‬ ‫ﻻ‬ (‫رﻣﺰ اﻟﺘﺤﻮﻳﻞ )ﺑﺪون ﺗﻔﻮﻳﺾ ﻟﻠﻌﻤﻼء اﻷﻓﺮاد‬
Refinances (only for corporate) Yes No Remittance code as
(Non-mandate for individual customers)
‫ﺗﻢ ﺗﻘﺪﻳﻤﻪ ﻣﻦ ﻗﺒﻞ اﻟﻌﻤﻴﻞ‬ ‫ﺗﻢ ﺗﻘﺪﻳﻤﻪ ﻣﻦ ﻗﺒﻞ ﻣﻨﺪوب‬ ‫ ﻗﺎم ﺑﺎﻟﺘﺴﻠﻴﻢ‬/‫اﺳﻢ ﻣﻦ ﻗﺎم ﺑﺎﻹﺟﺮاء‬
Submitted by customer Submitted by representative Name of initiator/ submitted by Ali Mundir
‫اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ اﻟﻘﻄﺮﻳﺔ‬ ‫رﻗﻢ اﻟﺠﻮال‬
QID 2 1 1 3 0 2 0 1 2 1 1 Mobile no. ++ 99 77 44 5 0 8 8 9 8 8 8
.‫ ﻧﻘﺮ ﺑﺪون ﻧﻘﺾ ودون ﻗﻴ ٍﺪ أو ﺷﺮط ﺑﺎﻻﻃﻼع ﻋﻠﻰ وﻓﻬﻢ وﻗﺒﻮل ﻛﺎﻓﺔ اﻟﺸﺮوط واﻷﺣﻜﺎم اﻟﺨﺎﺻﺔ ﺑﺄواﻣﺮ اﻟﺪﻓﻊ وأواﻣﺮ اﻟﺘﺤﻮﻳﻞ اﻟﻤﻨﺸﻮرة ﻓﻲ ﻣﻮﻗﻊ اﻟﺒﻨﻚ‬/‫أﻗﺮ‬ ‫ﺗﻮﻗﻴﻊ اﻟﻌﻤﻴﻞ‬
I/ We irrevocably and unconditionally acknowledge having read, understood and accepted all the terms and conditions of Customer signature
payment/ transfer published on the Bank’s website.
.‫**ﻗﺪ ﻳﺨﻀﻊ اﻟﻤﺒﻠﻎ اﻟﻨﻬﺎﺋﻲ اﻟﺬي ﻳﺴﺘﻠﻤﻪ اﻟﻤﺴﺘﻔﻴﺪ إﻟﻰ اﻟﺘﺨﻔﻴﺾ ﺑﺴﺒﺐ اﻟﺮﺳﻮم اﻟﻤﺴﺘﺤﻘﺔ ﻟﻠﺒﻨﻚ اﻟﻤﺴﺘﻔﻴﺪ أو اﻟﺒﻨﻚ اﻟ ُﻤﺮاﺳﻞ‬
**The final amount received by the Beneficiary may be subject to a reduction in amount due to the Beneficiary or Correspondent bank fees (or charges) involved.

FOR BANK USE ONLY ‫ﻻﺳﺘﺨﺪام اﻟﺒﻨﻚ ﻓﻘﻂ‬

‫ﺗﻢ اﻟﺘﺤﻘﻖ ﻣﻦ اﻟﺘﻮﻗﻴﻊ ﻣﻦ ﻗﺒﻞ‬ ‫ﻣﺸﺮف اﻟﻔﺮع‬
Signature verified by Branch supervisor

‫أُﻋ ّﺪ ﻣﻦ ِﻗﺒﻞ‬ ‫ﺗﻢ ﺳﺪاد ﻣﺒﻠﻎ اﻟﺘﺤﻮﻳﻞ‬ ‫اﻟﺘﺴﻠﺴﻞ‬

Prepared by Funds settled Sequence

‫ﻣﺪﻳﺮ اﻟﻔﺮع‬ ‫اﻟﻤﺮﺟﻊ‬

Branch manager Reference

* Mandatory field ‫*ﺧﺎﻧﺔ إﺟﺒﺎرﻳﺔ‬ Nov 2021

‫)‪The Commercial Bank (P.S.Q.C.‬‬ ‫اﻟﺒﻨﻚ اﻟﺘﺠﺎري )ش‪.‬م‪.‬ع‪.‬ق‪(.‬‬
‫‪PO Box 3232, Doha, State of Qatar‬‬
‫‪Tel: +974 4449 0000‬‬
‫‪Fax: +974 4449 0070‬‬
‫‪www.cbq.qa‬‬

‫*ﻗﺎﺋﻤﺔ ﺗﺤﻘﻖ ﻟﺘﺤﻮﻳﻞ اﻷﻣﻮال‬

‫‪*Funds Transfer Checklist Form‬‬
‫)‪Draft/ Fund transfer (Signature verification is mandatory‬‬ ‫ﺣﻮاﻟﺔ ﻣﺎﻟﻴﺔ‪ /‬ﺗﺤﻮﻳﻞ أﻣﻮال )اﻟﺘﺤﻘﻖ ﻣﻦ اﻟﺘﻮﻗﻴﻊ إﻟﺰاﻣﻲ(‬
‫ﺿﻊ ﻋﻼﻣﺔ إذا ﻛﺎن ﻓﻲ اﻟﺤﺴﺎب رﺻﻴﺪ ﻛﺎف ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﺮﺳﻮم‬
‫‪Check if account has sufficient balance including charges‬‬

‫ﺿﻊ ﻋﻼﻣﺔ إذا ﻛﺎﻧﺖ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ اﻟﻘﻄﺮﻳﺔ ﻟﻠﻌﻤﻴﻞ ﺳﺎرﻳﺔ اﻟﻤﻔﻌﻮل‬
‫‪Check if customer’s QID is valid‬‬
‫ﺗﺄﻛّﺪ ﻣﻦ وﺟﻮد رﻗﻢ اﻟﺠﻮال‪ ،‬وﻋﻨﻮان اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ ورﻗﻢ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﻴﺔ اﻟﺨﺎﺻﺔ ﺑﺎﻟﻤﺴﺘﻔﻴﺪ ﻟﻜﻞ ﻣﻦ اﻟﻌﻤﻼت اﻟﺘﺎﻟﻴﺔ‪:‬‬
‫‪Ensure the beneficiary mobile and email address is provided for the following currencies:‬‬
‫‪1. CNY – Chinese Yuan‬‬ ‫‪ -ô‬اﻟﻴﻮان اﻟﺼﻴﻨﻲ‬
‫‪2. KRW – Korean Won‬‬ ‫‪ -Ç‬اﻟﻮون اﻟﻜﻮري‬
‫‪3. HUF – Hungarian Forint‬‬ ‫‪ -õ‬اﻟﻔﻮرﻧﺖ اﻟﻬﻨﻐﺎري‬
‫‪4. IDR – Indonesian Rupiah‬‬ ‫÷‪ -‬اﻟﺮوﺑﻴﺔ اﻷﻧﺪوﻧﻴﺴﻴﺔ‬
‫‪5. TRY – Turkish Lira‬‬ ‫‪ -ø‬اﻟﻠﻴﺮة اﻟﺘﺮﻛﻴﺔ‬
‫‪6. KES – Kenyan Shilling‬‬ ‫‪ -ù‬اﻟﺸﻠﻦ اﻟﻜﻴﻨﻲ‬
‫‪7. THB – Thai Baht‬‬ ‫‪ -ú‬اﻟﺒﺎت اﻟﺘﺎﻳﻠﻨﺪي‬
‫‪8. RON – Romanian Leu‬‬ ‫‪ -û‬اﻟﻠﻴﻮ اﻟﺮوﻣﺎﻧﻲ‬

‫ﺗﺄﻛﺪ ﻣﻦ إرﻓﺎق ﻧﺴﺨﺔ ﻋﻦ ﺟﻮاز اﻟﺴﻔﺮ اﻟﺨﺎص ﺑﺎﻟ ُﻤﺮﺳﻞ ﻟﻠﺤﻮاﻻت ﺑﻤﺒﻠﻎ ‪ ÇÈÈÈ‬ﻟﻴﺮة ﺗﺮﻛﻴﺔ أو أﻛﺜﺮ‬
‫‪Ensure to attach remitter passport copy for a TRY transfer above TRY 2000.‬‬

‫‪#‬رﻣﺰ اﻟﻨﻈﺎم اﻟﻤﺎﻟﻲ اﻟﻬﻨﺪي إﻟﺰاﻣﻲ ﻟﻠﺤﻮاﻻت ﺑﺎﻟﺮوﺑﻴﺔ اﻟﻬﻨﺪﻳﺔ‬

‫‪#IFSC code mandatory for any INR fund transfer.‬‬

‫ﺗﺄﻛّﺪ ﻣﻦ أن اﻟﻄﻠﺐ ﻳُﻠ ّﺒﻲ ﺟﻤﻴﻊ اﻟﺸﺮوط اﻟﺘﺎﻟﻴﺔ‪:‬‬

‫‪Ensure the form is satisfying all of the below conditions:‬‬

‫أ‪ -‬ﺗﻮﻗﻴﻊ اﻟﻌﻤﻴﻞ )ﺑﻌﺪ ﻣﻄﺎﺑﻘﺔ اﻟﺘﻮﻗﻴﻊ( ‪ +‬اﻟﺘﻮﻗﻴﻊ اﻟﻤﻌﺘﻤﺪ ‪a. Customer Signature (SV Verified) + approved signature‬‬
‫‪b. Prepared by + approved signature‬‬ ‫ب‪ -‬أُﻋ ّﺪ ﻣﻦ ِﻗﺒﻞ ‪ +‬اﻟﺘﻮﻗﻴﻊ اﻟﻤﻌﺘﻤﺪ‬
‫‪c. Customer informed of the charges‬‬ ‫ج‪ -‬ﺗﻢ إﻋﻼم اﻟﻌﻤﻴﻞ ﺑﺎﻟﺮﺳﻮم‬
‫‪d. Clear purpose of transfer is mentioned‬‬ ‫د‪ِ -‬ذﻛﺮ اﻟﻐﺮض ﻣﻦ اﻟﺘﺤﻮﻳﻞ‬
‫‪Exotic CCY List‬‬ ‫ﻗﺎﺋﻤﺔ اﻟﻌﻤﻼت ﻏﻴﺮ اﻟﻤﺘﺪاوﻟﺔ ﻓﻲ أﺳﻮاق اﻟﺼﺮف‬
‫‪BDT‬‬ ‫اﻟﺘﺎﻛﺎ اﻟﺒﻨﺠﻼدﻳﺸﻴﺔ‬
‫‪CNY‬‬ ‫اﻟﻴﻮان اﻟﺼﻴﻨﻲ‬
‫‪HUF‬‬ ‫اﻟﻔﻮرﻧﺖ اﻟﻤﺠﺮي‬
‫‪IDR‬‬ ‫اﻟﺮوﺑﻴﺔ اﻷﻧﺪوﻧﻴﺴﻴﺔ‬
‫‪KES‬‬ ‫اﻟﺸﻠﻦ اﻟﻜﻴﻨﻲ‬
‫‪KRW‬‬ ‫اﻟﻮون اﻟﻜﻮري‬
‫‪LBP‬‬ ‫اﻟﻠﻴﺮة اﻟﻠﺒﻨﺎﻧﻴﺔ‬
‫‪LKR‬‬ ‫اﻟﺮوﺑﻴﺔ اﻟﺴﺮﻳﻼﻧﻜﻴﺔ‬
‫‪MAD‬‬ ‫اﻟﺪرﻫﻢ اﻟﻤﻐﺮﺑﻲ‬
‫‪NPR‬‬ ‫اﻟﺮوﺑﻴﺔ اﻟﻨﻴﺒﺎﻟﻴﺔ‬
‫‪RON‬‬ ‫اﻟﻠﻴﻮ اﻟﺮوﻣﺎﻧﻲ‬
‫‪SCR‬‬ ‫اﻟﺮوﺑﻴﺔ اﻟﺴﻴﺸﻴﻠﻴﺔ‬
‫‪THB‬‬ ‫اﻟﺒﺎت اﻟﺘﺎﻳﻠﻨﺪي‬
‫‪TND‬‬ ‫اﻟﺪﻳﻨﺎر اﻟﺘﻮﻧﺴﻲ‬

‫ﺗﺄﻛّﺪ ﻣﻦ أن اﻟﻄﻠﺐ ﻳُﻠ ّﺒﻲ ﺟﻤﻴﻊ اﻟﺸﺮوط اﻟﺘﺎﻟﻴﺔ‪:‬‬

‫‪IBAN check validation‬‬

‫‪* Mandatory field‬‬ ‫*ﺧﺎﻧﺔ إﺟﺒﺎرﻳﺔ‬ ‫‪Nov 2021‬‬