(Please Specify) : Fedwire CH Chips BIC Bank Identifier Code
(Please Specify) : Fedwire CH Chips BIC Bank Identifier Code
Application Form
APPLICANTS: Pls. fill-out; fields with asterisk (*) are mandatory items; write in bold letters Date Branch
Domestic Telegraphic Transfer Foreign Telegraphic Transfer Others (Please specify) ______________________________________________________________
PDDTS (Dollar) RTGS (Peso)
Address
For Bank’s Use Only
*Name
*Address
*Country of Destination
Cable
*Beneficiary Name
Cash/Postage
Documentary Stamps
*Address
Others
TOTAL
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