Application Form of Paylink International Payment Application Form



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AIB Paylink International Payment Application Form
1 of 4
Paylink

International Payment Application Form
Branch Brand
Please print in BLOCK CAPITALS
NBP Payment Number
Customer Acknowledgement and Authorisation
Please select one of the following charging options; if no selection is made, the payment will be made on a charges shared basis.
Shared
AIB Customer pays AIB Charge - Other bank charges paid by the Receiver
Sender
AIB Customer pays all bank charges
18. Customer Authorised Signature(s)
Type of I.D.
Signature Verified
Post/Counter
Inputter/Teller
1st Approver
2nd Approver
R.M. Signature
Branch Details
For branch use only
Terms and Conditions relating to international payments apply (the “Terms”). The Terms are set out in the Terms and Conditions issued by Allied Irish Banks, p.l.c.
(the “Bank”) for the account to be debited. Please read the Terms carefully, copies of which are available at any branch of the Bank and on www.aib.ie.
To: Allied Irish Banks, p.l.c.
Please carry out the above international payment instruction on my/our behalf. I/we acknowledge that I/we have read the Terms and agree to be bound by them.
(See overleaf for explanation of charges.) Note: Other bank charges vary and may be significant.
Allied Irish Banks, p.l.c. is regulated by the Central Bank of Ireland.
Terms and Conditions apply.
17. Charges
Customer (Sender) Details
3. Sender Name
4. Sender Address
2. Sort Code
Account to be debited
For ccy accounts only
Payment Service (Cut-off time for receipt of payment application form in an AIB branch is 01:00pm)
AIB Charge €20
AIB Charge €32
Paylink Urgent
1. Paylink Standard
Full product description available in the ‘Schedule of International Transaction Charges’ booklet and on www.aib.ie.
If no Payment Service is selected, the payment will be sent as Paylink Standard.
OR
Receiver Details (Please supply full Receiver details or payment may not be made or may be delayed)
5. Receiver Name
6. Receiver Address
7. *IBAN or Receiver Account No.
8. Receiver Bank SWIFT Address /BIC
8 or 11 characters only
Or
9. Receiver Bank Name and Address
11. Country of Receiving Bank
10. Receiver Bank Code
*Must be in IBAN format if in Euro and intra SEPA zone countries.
Payment Details (Please supply purpose of payment or payment may not be made or may be delayed)
12. Payment Currency
13. Payment Amount
16. Purpose of payment/Sender’s message for the Receiver
(mandatory)
15. Forward Contract / Dealer Rate Details. Please check to confirm that this rate is still available.
Forward Contract Drawdown Amount if applicable
Rate
Reference
Account Ccy Code
-
-
Account No.
-
14. Payment Amount in Words
(mandatory)
AIB/FT8 06/18


AIB Paylink International Payment Application Form
2 of 4
Branch Copy
Customer Acknowledgement and Authorisation
Please select one of the following charging options; if no selection is made, the payment will be made on a charges shared basis.
Shared
AIB Customer pays AIB Charge - Other bank charges paid by the Receiver
Sender
AIB Customer pays all bank charges



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