MT-103 APPLICATION FOR INTERNATIONAL SWIFT TRANSFER
(for Office use)
STATE BANK OF INDIA A/C No. DATE / /20
REPUBLIC OF MALDIVES Total 20 TT NO
Amt.
PLEASE MAKE THE FOLLOWING REMITTANCE:
CURRENCY AMOUNT IN FIGURES(33B)
32A
AMOUNT IN WORDS
APPLICANT’S NAME&ADDRESS (ID/PP. No._____________)
50K
(ID/PP No. in case of Individual)
(D.O.B. _______________)
BENEFICIARY’S A/C NO. / IBAN
59
NAME&ADDRESS, COUNTRY (PP
No. & DOB in case of Individual) (PP No. _______________) (Issue Country :___________) (D.O.B. _______________)
BENEFICIARY’S BANK &
57A
BRANCH, ADDRESS, COUNTRY
SWIFT/BSB/IFSC CODE
INTERMEDIARY BANK
56
SWIFT/BSB/IFSC CODE
70 PURPOSE OF REMITTANCE
71A FOREIGN BANK’S CHARGES TO BE BORNE BY (tick) [OUR] APPLICANT [BEN] BENEFICIARY
It is understood that the Swift Transfer is being effected by me/us at my/our risk and cost and the bank or its agent will not be held liable for
delay, omission, commission or mistake arising in transmission or misinterpretation of message at destination. I/ we confirm that the above
transaction is for genuine purpose and neither the applicant/remitter does not relate to any banned entity as per US OFAC guidelines for USD
remittance. In case the US Treasury authority block/not release the fund, I/we will not hold State Bank of India responsible for any loss that
may be caused to us.
……….……………………………………….
PHONE NO: _______________ DEBIT A/C No. ________________________ AUTHORISED SIGNATORIES (with company seal)
CREDIT TO NOSTRO TRANSMIT MESSAGE TO
#
MIRROR ACCOUNT (RECEIVER)
BNF’s BANK TO BE PAID
FOREIGN CUR & AMT 56 THROUGH (Intermediary
Bank)
CURRENCY RATE (for cash receipts) ORM Process
Amt. received in cash __________ Entered by
AMOUNT in USD
DC No. : ____________
COMMISSION (USD)
P&T CHARGES (USD) Teller’s Sign : ___________ Approved by
TOTAL (in USD) CO’s Sign : ____________
TOTAL (in MVR)
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1 2
DEBIT AUTHORITY ( CA / OD / SB )
A/c Nos. 1 2
Name of A/c: ________________________________
I/We further authorise the Bank to debit my/our/company’s abovementioned account with the amount of remittance in equivalent USD/MVR
with applicable bank charges/commission.
Total Amount Debited: _____________ TT No. ___________ ……..…………………………………….
(for office use) AUTHORISED SIGNATORIES (with company seal) Date : ________
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State Bank of India, Republic of Maldives (Tel : 332 0860, 333 8694) Date : ______/_____/_______
Received application from Amount : DC No.________ (for cash receipt)
For Swift Remittance to Commission : Teller’s Sign :
(Beneficiary Bank) (for cash receipt only)
P&T Charges :
Swift Appl. received by
In favour of
Total :
(Beneficiary)
