ATTACHMENT 7-EFT Forms.doc

Electronic Funds Transfer Form-Attachment #7

_1294235122.xls

PIF

CENTRAL DISBURSING SERVICES

WIRE TRANSFER

PAYMENT INSTRUCTION FORM (PIF)

Input requirements can be viewed by placing the cursor over the input field

Contract# PMT#

Recipient Information

Payee Name

Account Name

Payee Address

Bank Information

Account Type IBAN

IBAN / Account#

Bank Code Format SORT CODE

Bank Code

Bank Name

Bank Address

Payment Information

Type of Payment VENDOR_CHARGE OUR

Mode of Payment ELECTRONIC

Recipient Country

Payment Due Date (mm/dd/yyyy)

Payment Currency U.S. Dollar

US Dollar Amount USD Value

Exchange Rate

Foreign Amount:

Additional Info

Intermediary Bank Information

Bank ID Format SWIFT

Bank SWIFT Address

Bank Name

Bank Address

Payment Details

Payment Details CON-NO 0

INV-NO

DRN-NO

Additional Info

IDs for Pick-up/West Union Payments 1st ID Number 2nd ID Number

Question Answer

Prepared by Phone E-mail

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT FOR PAYMENT RELEASE.

AUTHORIZED SIGNATURE:

Acc IBAN SWIFT VENDOR_CHARGE OUR ELECTRONIC U.S. Dollar

CHECKING SORT CODE VENDOR_CHARGE BEN CHECK UAE DIRHAM

ABA BENEFIT-CHARGE OUR PUPID LEK

BLZ BENEFIT-CHARGE BEN WESTERN UNION ARMENIAN DRAM

SALARY-CHARGE OUR AUSTRALIAN DOLLAR

SALARY-CHARGE BEN AZERBAIJANIAN MANAT

MISC-CHARGE OUR BULGARIAN LEV

MISC-CHARGE BEN BAHRAINI DINAR

BELARUSSIAN RUBLE

CANADIAN DOLLAR

SWISS FRANC

CYPRUS POUND

CZECH KORUNA

DJIBOUTI FRANC

DANISH KRONE

KROON

EGYPTIAN

POUND

EURO

POUND STERLING

LARI

QUETZAL

HONG KONG DOLLAR

KUNA

FORINT

NEW ISRAELI SHEKEL

INDIAN RUPEE

ICELAND KRONA

JORDANIAN DINAR

YEN

KENYAN SHILLING

RIEL

KOREAN WON

KUWAITI DINAR

TENGE

LITHUANIAN LITAS

LATVIAN LATS

MOROCCAN DIRHAM

MOLDOVA LEU

DENAR

MALTESE LIRA

MEXICAN PESO

NAMIBIA

NORWEGIAN KRONE

NEW ZEALAND DOLLAR

RIAL OMANI

NUEVO SOL

KINA

PHILIPPINE PESO

PAKISTAN RUPEE

ZLOTY

QATARI RIAL

ROMANIAN LEU

RUSSIAN RUBLE (NEW)

SAUDI RIYAL

SWEDISH KRONA

SINGAPORE DOLLAR

TOLAR

SLOVAK KORUNA

BAHT

TUNISIAN DINAR

TURKISH LIRA

HRYVNIA

PESO URUGUAYO

UZBEKISTAN SUM

RAND

&R&D &T

SRD1 Contract Number Format 6 alpha-numeric "-" {up to}12 alpha-numeric i.e. XXXXXX-XXXXXXXXXXXX Use free format for other contract numbers.

SRD1 Payment Number Format:

4 numbers #### Precede with zeroes, i.e. 0026

USD value is automatically calculated when FC rate and amount are input.

Formula: US = FC / Rate

Con-No: auto-fill from top of form.

Vendor_Charge Our is mandatory - cell locked

Enter Full Name of Payment certifier

Enter complete payee name. Normally the same as the account name.

Actual name the bank account is under. Normally the same as the payee name.

Street address or PO Box, City, State/Country, Zip

Select either Checking or IBAN.

Checking - Enter complete account number; normally all numeric.

IBAN - An IBAN in printed form is likely prefaced with IBAN e.g.

IBAN AT611904 3002 3457 3201.

DO NOT include IBAN as part of the account number.

Verify IBAN at: http://www.apacs.org.uk/payments_industry/ibans_4.html

Note: SWIFT Code mandatory when available A. SWIFT - 9 or 11 digits.

Verify at: http://www.swift.com/biconline/index.cfm?fuseaction=display_freesearch B. Sort Code - Primarily used in the UK.

C. ABA - US banks ONLY.

D. BLZ - Primarily used in Germany.

Enter the actual SWIFT Code, Sort Code, ABA or BLZ number.

Enter complete bank name (including branch bank when applicable).

Complete street address or PO Box number, City, State/Country, Zip.

Select from drop-down menu.

A. Electronic (EFT) B. Check C. PUPID (Pay upon proper ID) D. Western Union

Enter country name where the payee's account is located.

Enter the date funds should be credited to the recipient's account.

Select applicable currency from drop-down menu

Enter USD amount unless a rate request has been issued.

Exchange Rate:

Use only if a rate request has been issued. Enter the rate provided.

Foreign Amount:

Use only if rate request has been issued. Enter the FC payment amount.

Enter additional bank info such as POC name and phone number.

Use if a specific intermediary bank is needed to make payment. (Use same format as Bank Information above.)

Enter intermediary bank SWIFT code.

Enter intermediary bank name.

Complete street address or PO Box number, City, State/Country, Zip.

Inv-No: Enter the invoice number(s) being paid

Enter additional info required to effect payment.

DRN-No: Enter the Document Reference Number for the payment.

Enter question required to verify payee's identify.

Enter answer payee should provide to verify identity.

Enter POC or preparer's name.

Enter ID type (e.g. passport)

Enter ID number

Enter ID type (e.g. passport)

Enter ID number

Enter POC or preparer's phone number.

Enter POC or preparer's e-mail address.

Payment certifier's signature

Sheet1

CENTRAL DISBURSING SERVICES (خدمات الصرف المركزي)

WIRE TRANSFER (حوالة مصرفية)

PAYMENT INSTRUCTION FORM (PIF) ( استمارة تعليمات التسديد )

Input requirements can be viewed by placing the cursor over the input field (المدخلاتالمطلوبة ويمكن النظر الى الاحتياجات من خلال وضع المؤشر على المدخلات الميدانية)

Contract# PMT#

Recipient Information (معلومات المستفيد) llll

Payee Name (اسم المدفوع لامره)

Account Name (اسم الحساب)

Payee Address (عنوان المدفوع لامره)

Bank Information (معلومات البنك) م

Account Type (نوع الحساب) IBAN

IBAN / Account# (رقم حساب البنك العالمي) (رقم حساب البنك (14 رقم-لا يجوز حساب توفير

Bank Code Format (نوع رمز البنك) SWIFT

Bank Code (رمز البنك) سوفت كود (كل الاشخاص-8 او 10 ارقام

Bank Name (اسم البنك)

Bank Address (عنوان البنك)

Payment Information معلومات التسديد

Type of Payment (نوع التسديد) VENDOR_CHARGE OUR

Mode of Payment (طريقة الدفع) ELECTRONIC

Recipient Country (البلد المستفيد)

Payment Due Date (تاريخ الدفع) (mm/dd/yyyy)

Payment Currency (عملة الدفع) U.S. Dollar

US Dollar Amount (المبلغ بالدولار الامريكي) USD Value

Exchange Rate سعر الصرف) القيمة بالدولار الامريكي

Foreign Amount: (المبلغ الخارجي)

Additional Info (معلومات اضافية)

Intermediary Bank Information (معلومات البنك الوسيط)

Bank ID Format (نوع تعريف الينك) SWIFT

Bank SWIFT Address (عنوان سوفت البنك )

Bank Name (اسم البنك)

Bank Address (عنوان البنك)

Payment Details تفاصيل التسديد

Payment Details (تفاصيل التسديد) CON-NO 0

INV-NO

DRN-NO

Additional Info (معلومات اضافية)

IDs for Pick-up/West Union Payments (تعريف الدفع -اتحاد الغرب للمدفوعات) 1st ID Number 2nd ID Number

Question (سؤال) Answer

Prepared by (معد من قبل) Phone (رقم الهاتف) E-mail ( الاميل)

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT FOR PAYMENT RELEASE.

(أني اقر ان المعلومات اعلاه صحيحة وجاهزة للدفع)

AUTHORIZED SIGNATURE:

(توقيع المخول)

Acc IBAN SWIFT VENDOR_CHARGE OUR ELECTRONIC U.S. Dollar

CHECKING SORT CODE VENDOR_CHARGE BEN CHECK UAE DIRHAM

ABA BENEFIT-CHARGE OUR PUPID LEK

BLZ BENEFIT-CHARGE BEN WESTERN UNION ARMENIAN DRAM

SALARY-CHARGE OUR AUSTRALIAN DOLLAR

SALARY-CHARGE BEN AZERBAIJANIAN MANAT

MISC-CHARGE OUR BULGARIAN LEV

MISC-CHARGE BEN BAHRAINI DINAR

BELARUSSIAN RUBLE

CANADIAN DOLLAR

SWISS FRANC

CYPRUS POUND

CZECH KORUNA

DJIBOUTI FRANC

DANISH KRONE

KROON

EGYPTIAN

POUND

EURO

POUND STERLING

LARI

QUETZAL

HONG KONG DOLLAR

KUNA

FORINT

NEW ISRAELI SHEKEL

INDIAN RUPEE

ICELAND KRONA

JORDANIAN DINAR

YEN

KENYAN SHILLING

RIEL

KOREAN WON

KUWAITI DINAR

TENGE

LITHUANIAN LITAS

LATVIAN LATS

MOROCCAN DIRHAM

MOLDOVA LEU

DENAR

MALTESE LIRA

MEXICAN PESO

NAMIBIA

NORWEGIAN KRONE

NEW ZEALAND DOLLAR

RIAL OMANI

NUEVO SOL

KINA

PHILIPPINE PESO

PAKISTAN RUPEE

ZLOTY

QATARI RIAL

ROMANIAN LEU

RUSSIAN RUBLE (NEW)

SAUDI RIYAL

SWEDISH KRONA

SINGAPORE DOLLAR

TOLAR

SLOVAK KORUNA

BAHT

TUNISIAN DINAR

TURKISH LIRA

HRYVNIA

PESO URUGUAYO

UZBEKISTAN SUM

RAND

SRD1 Contract Number Format 6 alpha-numeric "-" {up to}12 alpha-numeric i.e. XXXXXX-XXXXXXXXXXXX Use free format for other contract numbers.

SRD1 Payment Number Format:

4 numbers #### Precede with zeroes, i.e. 0026

Enter complete payee name. Normally the same as the account name.

Actual name the bank account is under. Normally the same as the payee name.

Street address or PO Box, City, State/Country, Zip

Select either Checking or IBAN.

Checking - Enter complete account number; normally all numeric.

IBAN - An IBAN in printed form is likely prefaced with IBAN e.g.

IBAN AT611904 3002 3457 3201.

DO NOT include IBAN as part of the account number.

Verify IBAN at: http://www.apacs.org.uk/payments_industry/ibans_4.html

Note: SWIFT Code mandatory when available A. SWIFT - 9 or 11 digits.

Verify at: http://www.swift.com/biconline/index.cfm?fuseaction=display_freesearch B. Sort Code - Primarily used in the UK.

C. ABA - US banks ONLY.

D. BLZ - Primarily used in Germany.

Enter the actual SWIFT Code, Sort Code, ABA or BLZ number.

Enter complete bank name (including branch bank when applicable).

Complete street address or PO Box number, City, State/Country, Zip.

Vendor_Charge Our is mandatory - cell locked

Select from drop-down menu.

A. Electronic (EFT) B. Check C. PUPID (Pay upon proper ID) D. Western Union

Enter country name where the payee's account is located.

Enter the date funds should be credited to the recipient's account.

Select applicable currency from drop-down menu

Enter USD amount unless a rate request has been issued.

USD value is automatically calculated when FC rate and amount are input.

Formula: US = FC / Rate

Exchange Rate:

Use only if a rate request has been issued. Enter the rate provided.

Foreign Amount:

Use only if rate request has been issued. Enter the FC payment amount.

Enter additional bank info such as POC name and phone number.

Use if a specific intermediary bank is needed to make payment. (Use same format as Bank Information above.)

Enter intermediary bank SWIFT code.

Enter intermediary bank name.

Complete street address or PO Box number, City, State/Country, Zip.

Con-No: auto-fill from top of form.

Inv-No: Enter the invoice number(s) being paid

DRN-No: Enter the Document Reference Number for the payment.

Enter additional info required to effect payment.

Enter ID type (e.g. passport)

Enter ID number

Enter ID type (e.g. passport)

Enter ID number

Enter question required to verify payee's identify.

Enter answer payee should provide to verify identity.

Enter POC or preparer's name.

Enter POC or preparer's phone number.

Enter POC or preparer's e-mail address.

Payment certifier's signature

Enter Full Name of Payment certifier

_1277737528.xls Sheet1

THIS FORM MUST BE TYPED!!! DO NOT HAND-WRITE!!! -- يجب ان تطبع في هذه الورقة- لا تكتب باليد

CONTRACT NUMBER -- رقم العقد: EFT AMOUNT -- مبلغ التحويل الالكتروني:

Name Reflected on Bank Account الاسم الموجود في حساب البنك

Bank Account Number (Maximum of 14 digits - Can Not be Savings Account) (رقم حساب البنك (14 رقم-لا يجوز حساب توفير

Swift Code (All Vendors - 8 or 10 digits) (سوفت كود (كل الاشخاص-8 او 10 ارقام __________________________________________ ACH Routing Number (US Vendors - 9 digits) ( الراوتنغ نبر ( المقاولين الامريكيين فقط- 9 ارقام__________________________________________

Bank Name / اسم البنك: _______________________________________________________________

Bank Branch / فرع البنك: ______________________________________________________________

Bank Address / عنوان البنك: _____________________________________________________________

Bank City / مدينة البنك: ________________________________________________________________

This information must match what the bank has on file for the company's account يجب ان تطابق هذه المعلومات ما يملكه البنك من معلومات مماثلة Company Name / اسم الشركة: _______________________________________________________________

Company Address / عنوان الشركة: _____________________________________________________________

E-mail Address / ايميل الشركة: ________________________________________________________________

Non-USA Vendors: This information must be filled out completely for payment to be made يجب ان تطابق هذه المعلومات ما يملكه البنك من معلومات مماثلة Intermediate Bank: ____________________________________________________________ اسم البنك الثانوي Swift Code: ____________________________________________________________ سوفت كود

Print Name: __________________________________________________________________ الاسم كتابة

Sheet2

Sheet3