APPLICATION FOR SWIFT FUNDS TRANSFER
DOMESTIC RTGS OVERSEAS
TICK APPLICABLE OPTION FROM THE ABOVE & FILL THE FORM IN BLOCK LETTERS ONLY
TERMS AND CONDITIONS APPLY
BRANCH DATE BANK REF
APPLICANT INFORMATION
Account name
Remittance currency Remittance amount
Deal reference (if any, please also specify the foreign currency) Rate
Debit account number Debit amount
Charge account number (if different from above)
Local charges to be paid by remitter and overseas charges to VALUE DATE FOR OVERSEAS TRANSFERS
be paid by beneficiary (SHA) Same day value date: USD, GBP, EUR, ZAR,INR,TZS & RWF
All local and overseas charges to be paid by remitter (OUR) Extra charges apply for same day value requests
Spot value date (Two days from the transaction date)
Local and overseas charges to be borne by beneficiary (BEN) Currencies; CAD, AUD, JPY, AED, CNY, UGX
TRANSFER DETAILS
Beneficiary full name(s)
Beneficiary account no
(IBAN for payments to EU & UAE)
Beneficiary physical address
Incl. telephone contact for ZAR payments (Mandatory)
Beneficiary bank name
Beneficiary bank SWIFT code Beneficiary bank branch
USA Fed Wire / ABA; UK Sort Code; AUD BSB; ZAR Branch
Code; INR NEFT / IFSC Code; CNY CNAPS Code
Payment instructions/Narration
Purpose of remittance (for remittances equivalent to
USD 10,000 & above, attach supporting documentation)
INTERMEDIARY BANK DETAILS
Bank name
SWIFT code Address / Country
TERMS & CONDITIONS
I confirm that all the above details are correct and that I have read, understood and agree to be bound by the Outward Swift (RTGS and Overseas) Remittances
Terms and Conditions and General Terms and Conditions as amended from time to time and available at https://www.imbankgroup.com/ke/terms-and-conditions/
I also agree to indemnify and hold I&M Bank Limited harmless from and against all claims arising from any information that I have provided herein.
PRIVACY NOTICE
I hereby acknowledge that I have read and understood how the information that I have provided in this form will be used by the Bank as outlined in the Privacy
Notice available at https://www.imbankgroup.com/ke/information-security/privacy-notice/ and I consent to usage of this data as stipulated therein.
Tick both to confirm acceptance
Terms & Privacy
Conditions Notice
1st Signatory name Signature Date
2nd Signatory name Signature Date
3rd Signatory name Signature Date
Delivered by Signature ID Number
FOR BANK'S USE ONLY
Signature Verified Position Verified Approved
Confirmed by/with Confirmation Contact
Processed by Verified by Authorized by
I&M is regulated by the Central Bank of Kenya
