Suite 1,126 Haldon Street, Lakemba NSW 2195
Tel: 1300 733 999 OR +61 2 9759 9949
REMITTANCE APPLICATION FORM
FAX: 61 2 9759 9949
I have deposited cash / ch eque for A$
into your bank account. After deducting your charges please remit the same in equivalent foreign currency / amount
@ an agreed exchange rate of
SENDER DETAILS
First Name Last Name
Employer/Company Name (if applicable)
ID card / Passport / Licence # ID Expiry (DD/MM/YY)
ID Issuer Date of Birth (DD/MM/YY)
Nationality Occupation
Residential/Business Address (no P.O. Box addresses)
City/Suburb State
Postcode Country
Home Phone Work Phone
Mobile Fax
Email Address
Purpose of Remittance
Affix Deposit Slip here
Please deposit/transfer payment for this remittance into any one of our accounts as shown below and tick the appropriate box. For all deposits please also affix deposit slip in this area.
BEST FOREX PTY LTD
- WESTPAC:        BSB: 00000   A/C: 000000
- WESTPAC:        BSB: 00000   A/C: 000000
BENEFICIARY DETAILS
First Name Last Name
Company Name (if applicable)
Residential/Business Address (no P.O. Box addresses)
City/Suburb State
Postcode Country
Email ID card / Passport / Licence #
Phone Mobile
MODE OF PAYMENT
CASH     Transfer to Account      Draft at Hom
 
ACCOUNT DETAILS
Beneficiary Account Name
Beneficiary Account Number/IBAN/Ref No
Bank Name
SWIFT/IFSE Code Branch Code/Routing Number
Branch Name/Branch Address
Best Forex Pty Ltd and its employees do not accept any liability for loss or damage which any person may suffer arising from mutilation, delay or wrong transmission of message and the remittance is being made at the sole risk and responsibility of the remitter.
Senders Signature
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Date
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