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This document is a remittance form for transferring funds from Bank of Baroda in New Zealand to India. It requests details of the beneficiary such as name, account number, bank and branch details. It also requires details of the remittance such as the amount, purpose, and charges. The declarant needs to provide their details and sign agreeing to terms and conditions regarding anti-money laundering compliance, data processing, delays or losses outside of the bank's control, and indemnifying the bank. Proof of identity and address are also required to be provided.

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97 views

Notice

This document is a remittance form for transferring funds from Bank of Baroda in New Zealand to India. It requests details of the beneficiary such as name, account number, bank and branch details. It also requires details of the remittance such as the amount, purpose, and charges. The declarant needs to provide their details and sign agreeing to terms and conditions regarding anti-money laundering compliance, data processing, delays or losses outside of the bank's control, and indemnifying the bank. Proof of identity and address are also required to be provided.

Uploaded by

rajat20101998
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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For Office Use

In NZ Finacle
Bank of Baroda (New Zealand) Ltd. _____________________________________________

REMITTANCE FORM Done by: _____________________________________


Request for Transfer of Funds / SWIFT Transfer /
Verified by: ___________________________________
Rapid Fund to India
In Domestic Finacle

____________________________________________
The Branch Manager
114, Dominion Road, Mt. Eden Done by: ____________________________________
AUCKLAND
Email: [email protected] Verified by: __________________________________
Phone: +64 9 632 1020 Fax: +64 9 638 5082

BENEFICIARY DETAILS

Name: ____________________________________ Today’s Date: D D M M Y Y Y Y


__________________________________________ Beneficiary
A/C.No.:
Beneficiary’s Bank : _____________________________
Beneficiary Bank’s IFSC Code (if applicable): If through Swift than
Branch Name : _________________________________ Swift Code
_________________________________________
Branch Address:_________________________________
Correspondent/Intermediary Bank’s BIC/Swift Code
_____________________________________________ (if applicable):
_____________________________________________ _________________________________________

REMITTANCE DETAILS
Purpose of Remittance (Pl. tick):
Amount to be remitted $ _______________________ Savings/Investment Charity
Commission $ _______________________ Family Maintenance Others (Pl specify):
Business Remittance
Cash handling charges $ _______________________ (Attach Contract Details)

Swift/postal charges $ _______________________ Special Instructions (if any):


Total Amount recieved:
Total Teller Signature
(amount in figures) $ _______________________
& Seal:
Exchange Rate: _______________________________

Foreign Currency Amount : ______________________

DECLARATION & REMITTER DETAILS


Please debit my/our Account number for the total amount, or I/We tender cash/enclose cheque/bankers draft which may be collected
by you as my authorised agent at my / our risk and responsibilities. I/We undertake to pay any additional charge that maybe incurred
by you on my/our behalf for any subsequent correspondence relating thereto.
I have read and agree to the term and conditions mentioned overleaf.
Date of Birth : D D M M Y Y Y Y
Name: ___________________________________________
Address: __________________________________________
Phone No: ________________________________________
__________________________________________________
Email: ___________________________________________ Postcode: _________________________________________
SOURCE OF FUNDS: Withdrawal from another Bank OTHER SOURCE
(Proof enclosed) (Pl. specify):
If you don’t have the A/c with us please provide:
IDENTITY PROOF (Any 1,Original required for verification) Signature : ___________________________________________
Current valid passport
Full NZ photo card driving license A/c no.
& for ADDRESS PROOF (Any 1,not older than 3 months, Original required for validation)
Utility bill (mobile bill not accepted)
Bank statement

REMITTER’S RECEIPT

Date: __________________________ Amount in NZ Dollars


Commission / Others
Beneficiary Name: ______________________________ Total
Beneficiary A/c No: ______________________________ Exchange Rate
Foreign Currency Amt.
Bank: ________________________________________ to be remmitted
Signature of Sender: Signature of Teller:
Term & Conditions:

I/we declare that the details given by me/us are true and correct. I/we am/are using this remittance facility
for bonafide transactions and this transaction does not in any way relate illegal activities, and/or
does it constitute a money laundering offence under Anti-Money Laundering and Counterterrorism Act
2009. I/we have no objection in the data being processed at a back office centre in NZ or elsewhere.
I/we understand that the bank may validate name, address and other personal information supplied by
me/us during the process against appropriate third party databases and in performing these checks,
personal information provided by me/us may be disclosed to a registered credit reference
agency which may keep a record of that information and that such disclosure does not constitute a
breach of privacy principles under the Privacy Act 1993.

In the event of the Bank acting upon instructions to remit as requested above I consent and undertake
that the I/we will make no claim of any kind in any jurisdiction against the Bank or its successors/
agents in respect of any delay/loss damage cost or expense you may suffer incur or sustain directly
or indirectly as a consequence our failure to carry out instructions/obligations if, the bank reasonably
believe that there may be fraudulent activity or other financial crime affecting the transaction or the
bank is required not to comply with the instructions by any law, regulation or court order or due (directly
or indirectly) to circumstances beyond your reasonable control preventing the bank from offering a
normal service (such as the failure of any machine, data processing system or transmission link
or due to industrial dispute, terrorist threat etc).

I/we further understand that any monies deposited by me/us in Indian branches be it in fixed deposit
accounts or other savings bank/current accounts etc are subject to rules and regulations applicable in
India for such accounts and are acceptable to me/us. I/we further declare that the funds being remitted
under RAPIDFUNDS2INDIA scheme does not related to trade related activities. I/we agree to indemnify
and to keep indemnified the Bank and its agents against all actions, proceedings, liabilities, demands,
claims, damages, costs and expenses which the Bank or its agent may suffer, incur or sustain directly
or indirectly as a consequence thereof.

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