Remittance Application

Amount (GBP) † *
In Words *
   
† This is the total amount payable, commision will be deducted from this and convert the amount remaining to BDT at the rate on the day of payment clearance (in case of cheque payments).
 
 
Sender Details
   
ID Card Number

If you do not have an ID number please leave this field blank and fill out all of the fields below.

If you do have an ID number you only need to fill in the forename, surname and post code fields for verification purposes.

   
Forename *
Surname *
DOB
Address
 
 
 
Post Code *
Telephone
Mobile
   
   
Beneficairy Details
   
Reference

If you have a Beneficiary Reference please enter it above and verify this by entering the name below.

If you do not have a Beneficiary Reference please leave the reference field blank and fill out all of the fields below.

   
Name *
Bank
A/c No.
Branch
District
Telephone
Mobile

 
Payment Options
 
Method
   
If paying by cheque please fill out the following, otherwise, please leave blank and we will contact you to verify the card details.
   
Cheque Number
Drawn on
 
   

I/WE HEREBY DECLARE THAT MONEY PAID TO YOU BY me/us was/is not derived or obtained by me or us by any illegal means or transactions including but not limited to any unlawful drug dealings.

I understand that telegraphic transfer/bank draft once issued cannot be cancelled without prior approval of regulatory bank of recipient country.

NOTE: Once the order is placed, any amendments you wish to make will incur extra fees.

   
   
 

 

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