Application for Telegraphic Transfer - Overseas - Delphi Bank

Application for Telegraphic Transfer - Overseas(1) Branch number (2) Branch name941 -Bank of Cyprus Australia LimitedABN: 51 092 167 907AFSL 244611(3) Applicant’s name, address and postcode (PO Box not acceptable)(4) Account Number (where applicable) (5) Daytime Telephone contact number(6) Telegraphic Transfer currency and amount (7) Exchange Rate (if applicable)(8) AUD amount $(9) Charges $(10) Total AUD amount payable $(11) Exchange Rate Reference Number (Bank Use Only)(12) Payment from account number, Cash or Bank cheque (13) Charges from account number(14) Beneficiary’s account number(15) Beneficiary’s name (mandatory) and full addressNameAddressCountry(16) Beneficiary’s bank (full name, address ,country & Swift code)NameAddressCountryForm Updated 11/04/2008Bank of Cyprus Australia Ltd AFSL/Australian Credit Licence 244611. ABN 51 092 167 907Bank of Cyprus Australia Limited is a wholly owned subsidiary of Bendigo and Adelaide Bank Limited

Application for Telegraphic Transfer-Overseas (cont.)(17) Applicant’s message (use only for invoice numbers etc.)Bank of Cyprus Australia LimitedABN: 51 092 167 907AFSL 244611(18) Bank to Bank message (use only for pay on Application & Identification instructions) Pay on Application and Identification Telephone Beneficiary on:Terms and Conditions:1. Bank of Cyprus Australia Limited (‘BOCA’) may use the services of another bank to make payment.2. Funds transferred overseas by BOCA through Telegraphic Transfer should arrive at the overseas destination and beavailable for payment to the beneficiary within 48 hours of BOCA accepting the Applicant’s instructions. Payment ofthe transferred money to the beneficiary is the responsibility of the overseas bank and is therefore beyond BOCA’scontrol. The transfer of funds may be delayed due to (which include but are not limited to) cut off times fortransmissions imposed by International Convention; delays or complications in post or otherwise; delays, errors oromissions in transit or transmission; acts or omissions of a Correspondent Bank, a Correspondent Agency or anyother third party; or delays and complications in overseas banking systems. To the maximum extent permitted bylaw, BOCA and its employees and agents accept no responsibility and will not be liable for any loss or damageresulting from delays that arise as a result of the circumstances specified above or any act or thing done or omittedto be done by BOCA while acting in good faith on the Applicant’s instructions.3. The Applicant may request that BOCA make enquiries to overseas banks concerning the payment.All or any costs or expenses incurred by BOCA as a result of making such enquiries will be for the Applicant.4. A Correspondent Bank or Correspondent Agency may charge unspecified fees or charges and either:(a) deduct those fees or charges from the funds transferred to the beneficiary by the Applicant, so thatthe beneficiary may receive less than the amount sent by the Applicant; or(b) pay the funds transferred by the Applicant to the beneficiary but debit BOCA’s account held at theCorrespondent Bank or Correspondent Agency, with those fees and charges. The Applicant willreimburse BOCA for those fees and charges debited to BOCA’s account by the Correspondent Bankor Correspondent Agency under 4(b).I/We acknowledge that, in order to complete this transaction, it will be necessary for BOCA to transfer certain personalinformation including my/our name/address and account number outside of Australia. These details will be disclosed tothe nominated overseas bank/beneficiary, external service providers (which may include SWIFT and a broadrange of providers), and to others where required or permitted by law. I/We consent to such transfer.I/We have read and understood the Terms and Conditions shown above and agree that no other conditions expressed orimplied other than those appearing above and those required by law will apply and warrant that all particulars I/we haveprovided are true and correct.I/We authorise BOCA to debit the above stated account with the total amount specified above (if applicable).(19) Applicant’s name(20) Applicant’s signature (21) Date(22) Bank Use onlyAccounting EntriesBranch StampDr/CrBSBT/C Amount NarrativeA/C No.DR* 941 ___ ______ ___ 026 N/ACR* 941000 800400 ___ 526 ‘Beneficiary’DR 941 ___ ______ ___ 190 N/ACR 941___ 951610 ___ 690 N/A* Only if FX deal not requiredPrepared by (signature)Checked by (signature)Form Updated 11/04/2008Bank of Cyprus Australia Ltd AFSL/Australian Credit Licence 244611. ABN 51 092 167 907Bank of Cyprus Australia Limited is a wholly owned subsidiary of Bendigo and Adelaide Bank Limited