0410001

Ïëàòíèê:

Ïðèì³ðíèê ¹______

Íàéìåíóâàííÿ

/ ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³

¤Field09¤

 

Êîä ªÄÐÏÎÓ

¤Field10¤

 

¹ ïîòî÷íîãî ðàõóíêó

¤Field40¤

 

Íàéìåíóâàííÿ òà ì³ñöåçíàõîäæåííÿ áàíêó

ÀÒ «ÐÂÑ ÁÀÍÊ»

Óêðà¿íà, ì.Êè¿â, âóë.Ââåäåíñüêà, áóä. 29/58

 

̳ñöåçíàõîäæåííÿ / ì³ñöåïðîæèâàííÿ

¤Field11¤ ¤Field12¤

 

Ðåçèäåíòí³ñòü

 

 

 

ÏËÀÒ²ÆÍÅ ÄÎÐÓ×ÅÍÍß Â ²ÍÎÇÅÌÍ²É ÂÀËÞÒ² ¹ ¤Field01¤ âiä ¤Field02¤ ð.

Ïðîñèìî ÀÒ «ÐÂÑ ÁÀÍÊ» ïåðåðàõóâàòè êîøòè â ³íîçåìí³é âàëþò³ ç ðàõóíêó ¤Field03¤ â ÀÒ «ÐÂÑ ÁÀÍÊ», êîä áàíêó 339072 íà íàñòóïíèõ óìîâàõ:

Ñóìà ïåðåêàçó ³íîçåìíî¿ âàëþòè

Öèôðàìè

¤Field05¤

Âàëþòà

¤Field04¤

Ïðîïèñîì

¤W/Field05,U,Field04¤

Îòðèìóâà÷ êîøò³â

Íàéìåíóâàííÿ

/ ïð³çâèùå, ³ì’ÿ òà ïî áàòüêîâ³

¤Field24¤  ¤Field25¤

̳ñöåçíàõîäæåííÿ / ì³ñöåïðîæèâàííÿ

¤Field26¤  ¤Field27¤

Ðåçèäåíòí³ñòü

 

¹ ðàõóíêó â áàíêó îòðèìóâà÷à

 ¤Field23¤

Áàíê îòðèìóâà÷à

Íàéìåíóâàííÿ / ì³ñöåçíàõîäæåííÿ áàíêó

 ¤Field18¤  ¤Field19¤ /   ¤Field20¤  ¤Field21¤

Êîä áàíêó

¤Field22¤

¹ ðàõóíêó â áàíêó-ïîñåðåäíèêó

¤Field43¤

Áàíê - ïîñåðåäíèê

Íàéìåíóâàííÿ / ì³ñöåçíàõîäæåííÿ áàíêó

¤Field13¤  ¤Field14¤ / ¤Field15¤  ¤Field16¤

Êîä áàíêó

¤Field17¤

Ïðèçíà÷åííÿ ïëàòåæó

¤Field31¤  ¤Field29¤  ¤Field30¤

Êîì³ññ³þ çà ïåðåêàç óòðèìàòè ç

¤if Field32 OUR ¤else ¤endif

Ïëàòíèêà

¤if Field33 BEN ¤else ¤endif

Îòðèìóâà÷à

¤if Field34 SHA ¤else ¤endif

Ïëàòíèêà / îòðèìóâà÷à

²íøà ³íôîðìàö³ÿ äëÿ ÀÒ «ÐÂÑ ÁÀÍÊ»

¤Field44¤

Ñòðîê âèêîíàííÿ ïåðåêàçó

 

Òåðì³íîâ.

 

Ñòðîêîâèé

 

Çâè÷àéíèé

Êîì³ñ³þ çà ïåðåêàç ïðîñèìî ñïèñàòè ç íàøîãî ðàõóíêó ¹ ¤Field38¤   

ó ÀÒ «ÐÂÑ ÁÀÍÊ» , êîä áàíêó 339072 ó  UAH

 

ϳäïèñè Ïëàòíèêà:            ________________________                                      Ïðîâåäåíî áàíêîì                  

                                                                                                                  

________________________                                        „_____”___________20__ð

                                                                                                                                       

         Êîä îïåðàö³¿

Ì.Ï.                                                                                                                              Êîä êðà¿íè

                                                                                                                                       

 Ï²ÄÏÈÑÈ Â²ÄÏβÄÀËÜÍÈÕ ÎѲÁ ÁÀÍÊÓ                      

 1.Ïåðåêàç êîøò³â â³äïîâ³äຠä³þ÷îìó çàêîíîäàâñòâó Óêðà¿íè.                                                                                                                                                                                                                                                                                                                                                    

 2. Âàëþòíèé êîíòðîëü   ..................................                                                                                                                                              

 3. ϳäïèñè çâ³ðåíî .......................................