Request For Swift Customer Transfer': Serial No 2021071506443292 Available Balance Time Received Signature

instruction to customers
1. This form should be filled in CAPITAL LETTERS

2. Beneficiary’s account number, name, bank and branch must be quoted
3. The beneficiary bank BIC CODE MUST be provided
4. For ALL payments to the EURO zone a valid IBAN & BIC Code MUST be provided
5. For terms and conditions overleaf
Request for ‘swift customer transfer’

Serial no 2021071506443292 Available balance Time received Signature
Kindly make the following transfer on my/our behalf. l/we have read and agree to be bound by the terms and conditions overleaf.
Remitter’s details Date 2 0 2 1 0 7 1 5
Remitter’s name Branch code

Branch name Account number
Address Telephone number
Amount details: (How much do you want to send?)
Payment currency Payment currency name (in words) Value date
Payment amount in figures amount in words
Special exchange rate (if applicable) Deal ID (if special rate is used)
Please tick as appropriate: amount to be debited to remain static / Payment a mount to remain static
Beneficiary’s details:
name Account number
Beneficiary address (For all payments to the EURO zone please quote valid IBAN)
Beneficiary country
Bank and branch ▾
Beneficiary’s bank’s country
Beneficiary bank BIC code (swift address)

Bank code County Location
(Mandatory for all payments. Add beneficiary bank code where necessary)
Purpose of payment
Remitters reference (optiona1)
Charges to be paid by: Remitter I shared I beneficiary (delete whichever is not applicable)
Remitter’s signature (s) Signature(s) verified and customer identified Branch received stamp (show date & time)
through photoviewersystem / e-box
Beneficiary’s Details:
Amount Remitted (Currecy): Call back done:
Rate applied: Call back date:
Deal ID: Call back reason:
Local equivalent: Authorised :
Commission / charges: Authorised :
Total amount : Authorised :
Group in::
Senders reference:
Activity reference:
Comments (e.g reason for decline):
Absa Bank Tanzania Limited (registered number 38557) is

Regulated by the Bank of Tanzania.
instructions to customers
1. This form should be filled in CAPITAL LETTERS

2. This form is NOT BE USED FOR PAYMENTS AGAINST SHIPPING DOCUMENTS
3. For Transfers to EURO Zone (e.g.German, France and Italy etc) please insure to quote beneficiary’s International Bank Account
Number (IBAN)
4. For payments to the Middle East please include among other details full address of remitter & beneficiary and purpose of remittance.
Charge
5. Payment of charges if specified as Remitter Shared or Beneficiary mean:

a) Remitter- Remitting customer to bear the cost of both local and overseas bank charges. Please note that we will charge correspondents
charges upfront for payments to the United states when charges are for remitter.
b) Shared - Remitting customer to pay for local bank charges while the beneficiary pays for over seas bank charges.
c) Beneficiary- Beneficiary customer to bear the cost of both localand overseas bank charges.
terms and conditions
1. Absa Bank Ltd will use discretion in deciding the method of transmission and may opt to use services of another bank to execute the payment
instructions.
2. Absa Bank Ltd will use the paying bank nominated by the customer or in absence of such nomination any bank in the country whose
currency is being remitted or of the beneficiary address.
3. Value date of the funds will be the date the funds will be available to the beneficiary’s bank and Absa Bank Ltd gives no commitment on the ability of th
will provide guidance on each particular transfer needs.
4. The Bank does not accept any responsibility for any loss caused by delays, interruption, misinterpretations or error’s in transmission
or payment which are not directly due to negligence of default of the bank’s own Officers.
5. The customer shall be bound by any hereby indemnifies the bank against all obligations and responsibilities imposed by foreign laws
or any other matters regarding the transfer over which the bank has no control.
6. The customer is required to attached supporting document for any remittance outside the country, this is per BOT circular No.6000
7. In order to make this payment,the details of the payment (including information relating to those involved in the payment) may be sent abroad, where it c
their legitimate duties (e.g.the prevention of crime) By completing this form you agree to this on behalf of yourself
and others involved in the payment.

Request For Swift Customer Transfer': Serial No 2021071506443292 Available Balance Time Received Signature

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Request For Swift Customer Transfer': Serial No 2021071506443292 Available Balance Time Received Signature

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instruction to customers

1. This form should be filled in CAPITAL LETTERS

Request for ‘swift customer transfer’

Remitter’s details Date 2 0 2 1 0 7 1 5

Remitter’s name Branch code

Payment currency Payment currency name (in words) Value date

Payment amount in figures amount in words

Beneficiary bank BIC code (swift address)

Remitters reference (optiona1)

Absa Bank Tanzania Limited (registered number 38557) is

1. This form should be filled in CAPITAL LETTERS

5. Payment of charges if specified as Remitter Shared or Beneficiary mean:

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