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Form. Please tick where applicable: Telegraphic Transfer Gross Settlement Real Time (GSRT) Real Time Gross Settlement (RTGS) Demand Draft Local Payment Draft for collection by (Name of Authorized Representative) Name of Remitter: Contact number of Remitter: Name of Beneficiary: Address of Beneficiary: Beneficiary s Bank: Address of Beneficiary s Bank: Beneficiary s Account No.: Intermediary Bank (if any): Instructions (if any): Purpose of remittance: Currency to be remitted Currency.

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