📄 Extracted Text (631 words)
Authorization for Non-USD Wires
For Non-Retirement Accounts
The undersigned hereby authorizes and directs Deutsche Bank Securities Inc.
(DBSI) to follow the below
asset movement instructions.
Account Number
DBSI Account Name
1. Non-USD Wire
Currency/Amount:
Bank Information:
SWIFT ID/BIC:
To Bank Name:
City:
3. Ultimate Beneficiary Information (required)
Beneficiary Name:
Second Beneficiary Name:
IBAN/Account #:
Additional Instructions:
2. Second Bank Information (if applicable)
SWIFT ID/BIC:
To Bank Name:
City:
Country:
Account #:
Further credit to Intermediary Financial Institution (if applicable)
Account #:
Name:
Standing Authorization: Checking both boxes allows you to verbally vary
instructions set forth in box A.
A The undersigned hereby requests that this authorization act as a Standing
Authorization. The undersigned understands
and agrees that this authorization will remain in effect until DBSI requests
a new authorization or DBSI receives notice
of the revocation of these instructions. The undersigned authorizes DBSI to
issue the wire
on the
15 months of non-use.
B The undersigned further authorizes DBSI to accept verbal or electronic
instructions from the undersigned to wire
funds to/from the above listed account(s). The undersigned will provide
verbal or electronic instructions as to the
date and the amount of the wire. PLEASE NOTE: The undersigned understands
and agrees to comply with the
procedures of DBSI to verify the authorization and accuracy of verbal or
electronic instructions.
WM179313 011507.120117
Page 1 of 2
day of
until otherwise instructed. This authorization will expire after
DBLOATRF
EFTA01415137
The undersigned hereby acknowledges that (i) the information contained in
this form is complete and accurate to the best
knowledge of the undersigned; and (ii) the undersigned is responsible for
the method of transmission of any instructions
issued pursuant to this authorization. If the undersigned elects to transmit
any such instructions via fax (including desktop
fax), via email or as an image attachment to email (e.g., as a PDF, TIF or
other image of such instructions), the undersigned
understands and agrees that the undersigned bears the risk of loss arising
from such method of transmission in the event
of transmission errors, misunderstandings, impersonations, transmission by
unauthorized persons, forgery or intercepts.
The undersigned hereby releases and holds harmless DBSI from and against
loss from any action, claim or demand of any
person as a result of DBSI's receipt of or compliance with this
authorization and/or any instructions that may be given to
DBSI pursuant to this authorization (including any standing authorization).
For trusts or other entities or agents acting on
behalf of Client, the undersigned acknowledges that the undersigned is
authorized on behalf of Client to enter into this
authorization and issue the instructions under the terms of the governing
documents and any applicable laws.
The undersigned understands that DBSI may, but is not required to, seek
verification of the undersigned's instructions by call
back and that DBSI may in its sole discretion refuse to execute such
instructions (including standing instructions) given pursuant
to this authorization, without incurring any liability, if DBSI has reason
to believe such instructions (or standing instructions)
have not been provided by the undersigned. The undersigned understands that
DBSI retains the right to refuse to execute any
instructions to transfer funds or securities to any account(s) pursuant to
this authorization without written instructions bearing
original signature(s) of the undersigned. Further, the undersigned
acknowledges that DBSI shall be entitled to rely on the
authorization until actual receipt by DBSI of notice of: (i) Client's or the
undersigned's revocation of the instructions or (ii) the
death or legal incapacity of Client (if Client is a natural person) or the
undersigned.
Signature
Signature
Print Name
Print Name
Date
Date
0 2017 Deutsche Bank AG. All rights reserved. WM179313 011507.120117
On
On
Warszawa
Ref: SOFL
Deutsche Bank Polska SA
PL89188000090000001370003035
EFTA01415138
DEUTPLPX
DEUTGB2L
PLN / 3,982,916.26
Deutsche Bank AG, London
N4Gxxx804
SOUTHERN FINANCIAL LLC
EFTA01415139
ℹ️ Document Details
SHA-256
a0d410de1b67be86a20597aba4ae7723df09e85c6c6451e3e769e3c0a36f8402
Bates Number
EFTA01415137
Dataset
DataSet-10
Document Type
document
Pages
3
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