SKNANB Payment Order Form

SKNANB Payment Order Form
Customer Information
(STAFF USE ONLY)
Account Number*
Branch
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Payment Information
Transfer Amount*
Currency*
Requested Charges*
Payment Category*
Commercial Reason for Payment*
Beneficiary Bank Information
Beneficiary Bank SWIFT Code / ABA / Routing / Sort Code / Transit*
Beneficiary Bank Name*
Beneficiary Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Intermediary Bank Information
Intermediary Bank SWIFT Code / ABA / Routing / Sort Code / Transit
Intermediary Bank Name
Intermediary Bank Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Beneficiary Customer Information
Beneficiary Account Number*
IBAN
Beneficiary Customer Name*

First NameLast Name
Beneficiary Customer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supporting Documents
Invoice or Sales Order Estimate Required
Invoice with type of consultancy clearly listed
PSA and/or Certificate of Title
Invoice

Cancelof
Sales Order Estimate

Cancelof
Purchase and Sales Agreement (PSA)

Cancelof
Certificate of Title

Cancelof
PEP Declaration
*Politically Exposed Person (PEP) A PEP is a natural person who holds or has held an important public office locally, regionally, or internationally,such as Head of State, Government or Member of Parliament. Immediate family members (the spouse or partner who is regarded under individual nationallaw as the equivalent of a spouse, the children and their spouses or partners, and parents) as well as other close associates are also treated as PEPs.
I declare that I am not a PEPI declare that I am a PEP
Beneficial Owner Declaration
*Beneficial owner” refers to the natural person(s) who ultimately owns or controls a business/entity and/or the person on whose behalf a transaction is being conducted.
YesNo
Please verify that you are human*
By signing this form, I confirm that I am duly authorized to perform this request. I authorize SKNANB to debit the above-mentioned account for amount transferred, plus charges. I understand that the message will be sent in cipher or otherwise at my/our risk in every respect and that neither you nor your correspondents will be liable for the consequences of any delay, mistake or omission in transmission or payment or any interception of the said message. I understand that if all items marked with an asterisk (*) are not properly completed the transaction will not be completed.*

Clear
Please use your mouse or touch device to draw your signature.
By signing this form, I confirm that I am duly authorized to perform this request. I authorize SKNANB to debit the above-mentioned account for amount transferred, plus charges. I understand that the message will be sent in cipher or otherwise at my/our risk in every respect and that neither you nor your correspondents will be liable for the consequences of any delay, mistake or omission in transmission or payment or any interception of the said message. I understand that if all items marked with an asterisk (*) are not properly completed the transaction will not be completed.

Signature*
Should be Empty:

SKNANB Payment Order Form

Customer Information

Payment Information

Beneficiary Bank Information

Intermediary Bank Information

Beneficiary Customer Information

Supporting Documents

PEP Declaration

Beneficial Owner Declaration