INTERNATIONAL WIRE TRANSFER FORM In order for you to be paid, this document must be COMPLETE and LEGIBLE Any incorrect information and or illegible forms will result in non-payment All information must be typed and the document emailed to [email protected]

A Payee Details - Describes the person that is to be paid by NIC Name: Address: Your physical address is required. PO Boxes are NOT acceptable. Postal codes are required in jurisdictions that use them. Telephone: Student ID# For student refunds, that is a mandatory field Email address:

B Bank Details – Describes the bank who will receive the wire payment Contact your bank to ensure all information is correct/complete Bank Name: Bank Account Number: Bank A/C Holders Name: Bank Address: Your bank’s address is required. PO Boxes are NOT acceptable. Postal codes are required in jurisdictions that use them. Bank Telephone/Fax: Confirmation CDN funds acceptable Yes No

C Bank Codes Description ie) SHORT, SWIFT, CHAPS, IFSC, IBAN, MICR, ABA Bank Codes – enter the relevant international banking codes Contact your bank to ensure all information is correct/complete List Code Description List Code

D NIC USE ONLY Wire Transfer A/C#: Currency: Amount: Date:

E Authorized Signature North Island College

Authorized Signature North Island College