0A1

221460
THE TRUE BENEFICIARY IS TO COMPLETE THIS FORM ACCURATELY AND FAX/EMAIL ALONG WITH A
VALUABLE PHOTOCOPY OF HIS/HER(e.g.driver’s license,passport,bith certificate, e.t.c) TO YOUR CLAIMS AGENT,
THE FOREIGN SERVICE MANAGER, MR.ASTRID PEDERSEN OF THE MAANDOI SECURITY SERVICES.

MR. ASTRID PEDERSEN

TEL Nº: 0060-162 936-194
FAX Nº:0060-321-784-731

Release Order Form ( HSBC)

Please complete and return by fax or email.

REF Nº: AS/09/13/57/009/KL BATCH Nº: SLTO/7916/KL/AS ADVICE NOTES

Name of organisation ( if any ) SOHELHASAN

Name of main contact: SOHELHASAN This can be the beneficiary

of the lottery fund or
anyone.
How would you want your money to be Transferred to you?
Note: For a certified cheque, only address of beneficiary is required. Account coordinates
(Details of the account
Certified cheque bank transfer where you want your funds
transferred) else, take the
Bank name: …………………………………. Account Nº: …………………………………. certified cheque option.

BSB Nº: …………………………. ………….. Swift Code: …………………………………

Bank Address: ………………………………………. City: ………………………………….

State: ………………………….Post Code …………

Beneficiary’s Name: SOHEL HASAN

Address: Al Jaber L.E.G.T. Engineering & Contracting (ALEC)/PO BOX NO-27639 /DTCD
PROJECT /EMP NO-89221 /DUBAI (U.A.E) Please give the applicant’s
full postal address.
City:DUBAI State: DUBAI Post Code:27639

Telephone. Nº: Mobile:+97155706063 Fax Nº:

Email:sohelhasan92@yahoo.com Date Of Birth:07 Nationality: bangladesh Occupation:privet

Oct1985
Incase of unpredicted
Relatives (next of kin) occurrences, your next of
kin can make claim on your
behalf.
Name: Relationship:

Telephone: Mobile: Fax:

Address:

City: State: Post Code:

Declaration

I (MR/MRS/MISS) sohelhasan HEREBY DECLARE THAT THE ABOVE DATA ARE TRUE AND INCASE OF
FALSIFICATION, I SHALL LOSE CLAIMS TO MY TOTAL FUND. INCASE OF UNFORSEEN CIRCUMSTANCES MY NEXT
OF KIN HAS THE RIGHT TO CLAIMS OF THE TOTAL FUND.

DATE : 23 Nov2009 SIGNATURE:………………………………….