FX INTERNATIONAL PAYMENTS: SINGAPORE Forward Exchange Contract (FEC) Requisition
Date // (DD/MM/YYYY) Yes, I would like to receive information about the benefits To: American Express International, Inc. (“you”, “your”) of transacting online. I/We, the Client named herein, hereby request the following transaction: Please complete this form in CAPITAL LETTERS. Client’s Details Registered Business Name (as in ACRA) Business Registration Number
Registered Business Address Postal Code (compulsory)
Telephone Number Fax Number
Details of Forward Exchange Contract (please tick) Buy (outward) Sell (inward) Forward Contract Number
Foreign Currency Code Foreign Amount Forward Exchange Rate
SGD Total Fee for Telegraphic Transfer (GST inclusive) Total SGD (foreign amount multiplied by exchange rate)
Dealer’s Name Maturity Date (DD/MM/YYYY) //
Client’s Declaration I/We authorise American Express to apply for a CICI on behalf of my business as part of the reporting requirements under the Dodd-Frank Wall Street Reform and Consumer Protection Act. I/We hereby authorise you to process this transaction on my/our behalf. I/We understand and agree that you may, at your absolute discretion, and without giving any reason therefore, refuse to carry out any instructions given by me/us (even if in the interim the person who received such instructions on your behalf had agreed to accept and carry out the same) in which case you shall not be liable to me/us for delay or non- performance of such instructions or the related transaction. In any event I/we acknowledge that any acceptance by you to carry out my/our instructions is merely an agreement by you to use reasonable efforts to carry out the same and not a guarantee that my/our instructions will necessarily be carried out. I/We undertake to issue instructions for the transmission of funds for the Forward Contract no later than two business days prior to the maturity date of the Forward Contract. I/We shall bear any foreign exchange losses arising from my/our instructions and/or cancellation, change in maturity date or early drawn down of the Forward Contract. I/we confirm the previously submitted personal identification documents provided to American Express remain valid. I/we acknowledge it is my responsibility to update American Express with new identification documents, if previously submitted identification documents have changed or have expired. I/We acknowledge that I/we have read and understood the Client’s Declaration and I/we agree to be bound by the same. I/We confirm that this requisition and all matters related thereto are subject to the American Express Terms and Conditions for Foreign Exchange transactions.
Signature 1 Full Name Date (DD/MM/YYYY)
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Signature 2 (if dual signatory required) Full Name Date (DD/MM/YYYY)
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FXIP – Forward Exchange Contract (FEC) Requisition 12/13 Page 1 of 1 Client Service Centre Phone: (65) 1800 507 7688 Website: www.americanexpress.com/sg/ip Fax: (65) 6297 4269 Mailing Address: 20 Pasir Panjang Road, Mapletree Business City (West Lobby), #08-25, Singapore 117439 American Express International, Inc. Incorporated with Limited Liability in the State of Delaware, U.S.A. ®Registered Trademark of American Express Company.