Download Transfer/wire money from your account to a EUROPEAN BANK

Transfer/wire funds from client account to EUROPEAN BANK
Instructions: Complete ALL BANK DETAILS, and sign where indicated. Profile Fax # : (02)-624-2789. After sending in this form, call to
confirm 02-624-2788 or in the US toll free at 1-888-327-6179. Wire requests received after 3:00 PM (Israel time) Mon. to Thurs. will be
processed on the following business day. Fridays & holidays are not regular business days, so wire requests received will only be
processed on the following business day.
No wire request will be executed without a phone authorization from the client.
USE BLACK INK ONLY TO COMPLETE THIS FORM
Account Name
Account #
PR_______ ____ ____ ____ ____ ____ ____
What is a phone number that we can reach you at now in case there is a problem?
Details of receiving bank - This form is ONLY FOR MONEY BEING SENT TO A EUROPEAN BANK
Amount:
$
Amount in words:
Please wire money to the following account:
Account name of recipient:
Account number:
Receiving bank name:
Phone number of receiving bank:
Address of receiving bank:
For further credit to,
and/or additional reference
information:
*REQUIRED INFORMATION: THE EUROPEAN BANK MUST SUPPLY US WITH THE NAME AND WIRING INSTRUCTIONS FOR ITS "U.S. CORRESPONDENT BANK." ENTER
THE DATA HERE FOR THE U.S. CORRESPONDENT BANK. WITHOUT A U.S. CORRESPONDENT BANK, A WIRE CANNOT BE SENT. A SWIFT CODE IS NOT SUFFICIENT
TO PROCESS A WIRE, but may be supplied for reference purposes only.
Name of U.S. correspondent bank:
ABA (routing) # for U.S. correspondent
bank (nine digit number):
(Without the correspondent bank details, a wire can NOT be sent. An ABA number is NOT a SWIFT code. We do NOT use SWIFT codes to send wires.)
Account number of European Bank at the
U.S correspondent bank:
For further credit to, or any additional information,
and/or SWIFT code (for references purposes
ONLY):
I understand that I need to supply you with ALL of the bank details of the receiving bank in order to process this wire. I do not have ALL of
the details and would like your help in figuring out the wiring instructions. I understand that this research is performed on a "best efforts"
basis, and Profile Investment Services, LTD., Portfolio Resources Group, Inc., any of its owners and/or associates will NOT be responsible
for any loss caused by an error.
†
All account owners must sign here to authorize
the research. By checking this box, I authorize you X
to research the wiring instructions and debit
________________________________________________
my/our account for the research fee ($50 + VAT)
to be credited to account #PRG705900. Total:
X
________
*Required information (according to U.S. Patriot Act, further information is required before wires can be sent)
Reason for transfer of
funds:
‰Personal expenses ‰Real estate purchase ‰Mortgage payment ‰Closing a/c
‰Other (describe):
Beneficiary details (complete the following if money is being sent to someone other than the name on your account)
Address of recipient:
Recipient date of birth:
Passport # & country issued OR National ID # and country issued:
Occupation of recipient:
The bank charges a $50 transfer fee for all outgoing wires.
Signature of account owner
Date
Signature of account owner
Date
* In compliance with the US Patriot Act Money Laundering Requirements Act we may request additional documentation and/or information of the
receiver of your wire. This may include a contract or other related material or correspondence. Profile Investments, Portfolio Resources and NFS has
the discretion of refusing a money transfer if proper backup is not provided and/or if there are discrepancies with your request.
Transfer request form to European Bank.xls