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Submission: On July 31 via manual from SA — Scanned from DE
Submission: On July 31 via manual from SA — Scanned from DE
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Print feature is not supported yet. WorFNHONUVMd SYWONMNGOVHSTLIGRnBRHBZWLFlERYJKRIMiMUHHMKSWnQLUXZYLCe is not yet available on mobile devices. Please use a desktop or laptop computer to access, view or edit the content. WorLOCUJEJEd OnNVUUYXXDlKWZTXGLCiXSBBVROGneNCXIKWOG is not yet available on your device, as .NET Framework Web Applets are not yet available on Linux. Please use a Windows desktop or laptop computer to access, view or edit the content. P A Y M E N T T O B A N K ( F O R B A N K U S E O N L Y ) Refer to page 3 fo r instructions and definitions necessary for completion o f this request. Pl e ase complete all mandatory fields to a v oid processing delays. Enter Type of Request: Company I D : Customer Name: Completed By: T e mplate I D : Payment T y pe: Payment Currency: Payment Destination: N O N - T D A C C O U N T ( O T H E R B A N K ) I N T E R N A T I O N A L T R A N S F E R S Beneficiary Name: Benefic iary Account No: Street Address: Street Address: Country: Country: Bank Name: City: City: Prov/State: Prov/State: Prov/State: Prov/State: Foreign Foreign Payment amount: Bank I D : Date: Phone No: ext: MM / DD / YYYY A D D 66190 T R U E S I G H T P T E . L TD . Charlie Song +14242489328 Mandatory fields are denoted with an asterisk "*" when a Request Type is chosen on the form. PL E ASE B E A W ARE THAT PROCESS I NG TIM E IS 5 BUS I NE S S DA Y S . C U S T O M E R I N F O R M A T I O N B E N E F I C I A R Y D E T A I L S B E N E F I C I A R Y B A N K D E T A I L S Page 1 of 5 14686 (0520) CUSTOMER INFORMATION Company ID : Template ID : INTERNATIONAL TRANSFERS 66190 None Payment for advertising services Truesight V e ntures Limi t ed will cover all S W I F T paym e nt fees F o r B e n e fi c i a r y : F o r T D B a n k : R e a s o n f o r P a y m e n t : B r a n c h C o n t a c t N a m e B r a n c h S i g n a t u r e T h e P a y m e n t T y p e fi e l d i f i t h a s b e e n i n c o r r e c t l y p o p u l a t e d a n d t h e P a y m e n t T y p e s h o u l d b e a P a y m e n t t o B e n e fi c i a r y o r a P a y m e n t t o B a n k T h e P a y m e n t D e s t i n a t i o n fi e l d i f P a y m e n t D e s t i n a t i o n s h o u l d b e t o a N o n T D a c c o u n t o r a n o t h e r T D A c c o u n t , d e t e r m i n e d b a s e d o n t h e B e n e fi c i a r y B a n k D e t a i l s T h e B a n k I D fi e l d , i f t h e B a n k I D fi e l d i s i n v a l i d o r i n c o m p l e t e b a s e d o n t h e B e n e fi c i a r y B a n k D e t a i l s ; T D w i l l r e j e c t a n y fi x e d t e m p l a t e r e c e i v e d i f i t d o e s n o t c o n t a i n a l l o f t h e i n f o r m a t i o n r e q u i r e d b y T D . N o t w i t h s t a n d i n g t h e f o r e g o i n g , i f T D i s a b l e t o p o p u l a t e / c o r r e c t t h e fi x e d t e m p l a t e w i t h s u ffi c i e n t i n f o r m a t i o n i n o r d e r f o r i t t o b e a c c e p t e d , T D m a y , b u t i s n o t o b l i g a t e d t o d o s o . Y o u a u t h o r i z e T D t o p o p u l a t e / c o r r e c t t h e fi e l d s i d e n t i fi e d b e l o w w i t h o u t n o t i c e t o y o u : S i g n a t u r e o f S i g n i n g A u t h o r i t y N a m e C h a r l i e S o n g N a m e S i g n a t u r e o f S i g n i n g A u t h o r i t y A u t h o r i z e d S i g n i n g A u t h o r i t y ( s ) o f C o m p a n y B r a n c h P h o n e N u m b e r T r a n s i t N u m b e r D a t e ( M M / D D / U Y Y Y ) T o b e c o m p l e t e d b y B r a n c h INSTRUCTIONS Page 2 of 5 14686 (0520)