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6/18/2015 www.gcitrading.com/index.php/printfriendly_wire/printFriendly/
http://www.gcitrading.com/index.php/printfriendly_wire/printFriendly/ 1/2
REQUEST FOR WIRE TRANSFER REFUND (* = Mandatory fields)
*Date: 18Jun2015 *Currency: USD *Amount: 3,615.00
GCI Account Information (Details of the account that the funds will be taken from)*Login Username: cfd81942usd*Account Number: 8373
Ordering Customer (Your details)*Name: IMRAN Hina*Street: Al Wahda Street, Yasmeen Building *Town / City: Sharjah*State / Country: Sharjah*Telephone1: 00923213522790*Email: [email protected]
Beneficiary Bank Information(Your bank details)*Swift Code: DUIBAEAD*Bank Name: Dubai Islamic Bank*Street: Waset Road, Industrial Area 6, Second Industrial Street *Town/City: Sharjah *State/Region: Sharjah*Country: United Arab Emirates
Beneficiary Account Information(Your Bank account details)Note: Third party payments are not permitted.*Bank Account Number / IBAN: AE890240017580071358901*Branch Number: 017*Branch Name: Waset Branch*Account type: Savings*Bank Account Name: Hina ImranPayment Details if any (Example Invoice No 1234): None
Identification RequiredPLEASE SEND THE FOLLOWING DOCUMENTS IF NOT SUPPLIED ALREADY:
GCI USE ONLY
ON FILE DATE RECD
1. Passport copy (NOT ID CARD)
2. copy of front and back of card (blocking out the first 12 digits if you wish)
3. copy of a utility bill or bank statement showing the credit card billing address
Additional*Will you be closing your GCI account? NO*Any comments on our service? Satisfactory
Authorised Customer Signature:I / We accept that this request is governed by the Accounts General Terms & Conditions of GCI Financial LLC.
*Place & Date: *Signature:
All information provided will of course be kept CONFIDENTIAL.Please fax the requested document(s) to any of our fax numbers (http://www.gcitrading.com/aboutus/contact)