FUNDS TRANSFER FORM FOR WHOLESALE BANKING CUSTOMERS ONLY

(*) Indicates mandatory information to be provided

PLEASE ENSURE TO SAVE THE FORM BEFORE PRINTING

Form Reference:
I/We wish to request for
Transfer Type:*

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TRANSFER FUNDS OUTSIDE OF UAE

Date:

05-AUG-2016

Debit Account Details

Debit Account Name:* 073623310001

Debit A/c Number or IBAN:*

Customer Reference:* DEBIT OUR ACCT

Debit A/c Currency:*

Payment Details
Please Enter either Debit Amount or Payment Amount
Debit Amount
Payment Amount
3,367,456.25

Debit Amount:

EUR

Payment Currency:*

EUR

Payment Amount: *

3,367,456.25

Amount in words: EUR THREE MILLION THREE HUNDRED SIXTY SEVEN THOUSAND FOUR HUNDRED FIFTY SIX AND TWENTY FIVE CENTS ONLY
Debit Value Date: * 11-AUG-2016
Applicable for Cross Currency

(Date your account to be debited. Enter date in the format DD-MM-YYYY or select a date from the calendar)

Note: For cross-currency transfers outside of UAE, all payments will be credited to the beneficiary's bank two working days after your account has been debited. However,
if you would like beneficiary's account to be credited on a different day, please make the appropriate selection from below. Note: if the following options are selected
additional charges and different FX rates may apply. All transactions are subject to currency cut off times and additional conditions as applicable. FGB will process such
payments on a best effort basis and does not guarantee the payments will be effective on the option selected below.

Payment to be Effected :
Same Day as Debit Value Date Next Business Day after Debit Value Date

Beneficiary Details
IBAN or Account Number: * 2600014033455
Beneficiary Name: *
SLL 'EOL LTD'
Beneficiary's Address: *

FX Contract No/Rate/Dealer Name : CHRISTIAN MOGHALU

If you have received FX Contract No or the Rate and Dealer Name from FGB, please enter it above
FXcontract number received from FGB

Beneficiary Bank Name: *

RAIFFEISEN BANK AVAL

Beneficiary Bank Address: *

9 LESKOVA STREET,KIEV CITY

Beneficiary Bank Country: *

UKRAINE

8 LUXEMBURG STR.,04-15 CHERKASSY CITY

Beneficiary Bank Routing Type: * SWIFT

Beneficiary Country: *

UKRAINE

Payment Details *
(will be sent to
beneficiary) :

CONTRACT NO:
FGN/FMNDVC762BBS/80/ARC/2014

Beneficiary Bank Routing Code: * AVALUAUK

Optional

Intermediary Bank Name:

STANDARD CHARTERED BANK N.Y

Intermediary Routing Type: *

SWIFT

Intermediary Routing Code: *

SCBLUS33

Purpose of Payment : *
(For Regulatory Purposes)

CONTRACT NO:FGN/FMNDVC762BBS/80/ARC/2014 EXECUTED BY THE BENEFICIARY FOR THE NIGERIA GOVERNMENT

Txn Type Code: *

REMITTANCE-REM

Authorization
I/We confirm that the above transfer details

are correct and that I/We am/are authorised to

make this transfer. I/We understand that FGB will
make the transfer to the account number specified
above and will not verify the beneficiarys details.
I/We acknowledge that this transaction is governed
by FGBs General Terms

Bank Use Only-Do not write on this area

CMU CALL VERIFICATION DONE

Bank Contact No:
Client Contact Name:
Client Contact No:
Date & Time:
Staff Initials & Id:
No. of Transactions:
FGB_FUNDS TRANSFER FORM_V2.0

Charge Code(BEN/SHA/OUR): *

Signature 1

Company Stamp

BEN

Signature 2