Seylan Foreign Remittance Application

Please Effect / Issue: *

Telegraphic Transfer

Demand Draft

Debit our Account No *

Foreign Currency Amount (Figures) *

Currency Type *

Purpose of the Payment *

Applicant Details (Account Holder)

Full Name *

Identification Type & Number *

Address *

Contact No *

Street Name *

E-mail Address *

Town *

Sender's Business / Profession *

Country *

Postal Code *

Source of Funds *

Beneficiary Details

Name *

Address *

Street Name *

Town *

Country *

Postal Code *

Intermediary Bank

BIC of Beneficiary's Bank (8 or 11 digits) *

Name of the Beneficiary's Bank *

Address of the Beneficiary's Bank *

IBAN No / Account No *

BSB / IFSC / Routine / Transit

Foreign Bank charges to be borne by: *

Beneficiary's A/C

Applicant's A/C

Select Category (Optional):

Any other details

I/we take the full responsibility for the instructions provided above by me/us and hereby authorized to remit the funds. I/we are aware of the possibility of the instructions received from the beneficiary could be altered due to cyber fraudulent activity and have verified same and are satisfied with the accuracy of the said beneficiary details.

I/We absolve the bank or it’s correspondents from any responsibility or claims whatsoever that may arise in the event of it’s failure to properly identify the payee or any mistake or misinterpretation or any delay whether in transmission or in giving effect to this request. I/We further certify that request is made under existing local/Foreign regularity requirements and have not obtained exchange for this purpose from any other bank/authorized dealer in Sri Lanka. In respect of imports, I/we undertake to submit the Customs declaration and commercial invoice within 180 days from today.

Applicant Details (Account Holder)

Beneficiary Details

For Import Purposes

For Student Payments

For Service Payments

Seylan Foreign Remittance Application

Applicant Details (Account Holder)

Beneficiary Details

For Import Purposes

For Student Payments

For Service Payments

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