Fund Transfer Application Form

Customer:

Sender Information
Gholghola Group Construction Co

Transfer Type:
International

Account No:

0510103003717510 - EURO

Domestic

Address:

Omid-e-Sabz Township, Darul Aman, 6 district, Kabul Afghanistan

Beneficiary Bank
details

Intermediary
Bank details (if
any)

Beneficiary details

Transfer
Instruction

For Individuals only:

Date of Birth

Amount(in figures)

Amount (in word)

Account name
Account number
Address

Place of Birth

Nationality

426,850.00

Currency

EURO

Four Hundred twenty six thousand, Eight hundred fifty

Euro Only

Occupation

Country

Afghanistan

Value Date

26-Jul-15

Gholghola Group Construction Company

001202EURO645634
Omid-e-Sabz Township, Darul Aman, 6 district, Kabul Afghanistan

Details of transfer

Fund Transfer from Gholghola AIB account to Gholghola AUB Account

Bank name
Account #
IBAN/Routing # SWIFT
Bank name
Address

Afghan United Bank

Shahre Naw, Kabul Afghanistan

IBAN/Routing #
SWIFT

External payment
code

Charges
Single Purpose

OUR

AIB Charges, Intermediary, & Beneficiary Bank charges to

my account

BEN

AIB Charges, Intermediary, & Beneficiary Bank charges to

Beneficiary's account

SHA

AIB charges to my account. Intermediary and Beneficiary

Bank charges to Beneficiary's account

Multiple purpose

AIB shall not be held liable if the beneficiary does not receive the transferred amount on any reasons stated by the intermediary or beneficiary bank
due to blockage or stoppage of the transfer process, or for any delay in the payment of the amount.

.

( AIB)

.
I/We authorize the bank to debit our account with above mentioned amount and associated charges. I/we also certify that the above mentioned
information is accurate and complete to the best of my/our knowledge and on a later date if AIB requires any documentry proof of purpose we
undertake to submit the same.
Sender's Signature:

Date:

For Bank Use Only

Signature Verified:

Checked by:

AML Checked:
Balance Verfied

Signature:

For Use by Payment Department

PS Booker
PS Authorizer
Flexcube Ref#
External Ref#