First name
Last name
Date of Birth*
Phone
Address*
Email
Purpose of transfer*—Please choose an option—Charity donationDividend paymentsIncentives/grantsInheritanceInvestmentLegal feesLoanMortgage paymentsOne off paymentOtherPayment for servicesPayment to family/friendsProperty maintenanceProperty purchaseProperty salePurchase of goodsRelocating abroadRepatriation of fundsRoyaltiesSalary paymentSale of sharesStudy fees/tuitionVehicle purchase
Currencies dealing with*—Please choose an option—(GBP) Sterling(EUR) Euro(USD) Us Dollar(AED) Arab Emirate Dirham(AUD) Australian Dollar(BHD) Bahraini Dinars(BDT) Bangladeshi Taka(BBD) Barbados Dollar(BWP) Botswana Pula(BRL) Brazilian Real(BGN) Bulgarian Leva(CAD) Canadian Dollar(XAF) Central African Franc(CNY) Chinese Yuan Renminbi(CZK) Czech Koruna(GMB) Dalasi(DKK) Danish Kroner(EGP) Egyptian Pound(ETB) Ethiopian Birr(GHS) Ghanaian Cedi(HKD) Hong Kong Dollar(HUF) Hungarian Forint(INR) Indian Rupee(JOD) Jordanian Dinar(KES) Kenyan Shillings(KWD) Kuwaiti Dinars(SLE) Leone(MWK) Malawian Kwacha(MUR) Mauritian Rupee(MXN) Mexican Peso(MAD) Moroccan Dirham(MZN) Mozambique Metical(NAD) Namibia Dollar(NPR) Nepalese Rupee(NZD) New Zealand Dollar(NGN) Nigerian Naira(NOK) Norwegian Kroner(OMR) Omani Rial(PLN) Polish Zlotych(QAR) Qatari Rial(RWF) Rwanda Franc(SAR) Saudi Riyal(SGD) Singapore Dollar(ZAR) South African Rand(LKR) Sri Lankan Rupee(SEK) Swedish Kroner(CHF) Swiss Franc(TZS) Tanzanian Shilling(THB) Thai Baht(TND) Tunisian Dinar(TRY) Turkish New Lira(UGX) Ugandan Shilling(XOF) West African Franc(ZMW) Zambian Kwacha
Approximate number of payments (per month)*—Please choose an option—0–5 payments per month6–10 payments per month11–25 payments per month26–100 payments per month100+ payments per month
Frequency of transfers*—Please choose an option—DailyWeeklyMonthlyQuarterlyAnnuallyOne-Off
Source of funds—Please choose an option—Funding from own accountLoanPayment(s) from linked company accountThird party payment(s) from customersOther third party payment(s)
Estimated Annual Volume (£)—Please choose an option—£0-£100k£100k-£250k£250k-£500k£500k-£1mil£1mil-£5mil£5mil+
Countries receiving payments from—Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo (Congo-Brazzaville)Costa RicaCroatiaCubaCyprusCzechia (Czech Republic)Democratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (fmr. 'Swaziland')EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPalestine StatePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe
Countries making payments to*—Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongo (Congo-Brazzaville)Costa RicaCroatiaCubaCyprusCzechia (Czech Republic)Democratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (fmr. 'Swaziland')EthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (formerly Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorth MacedoniaNorwayOmanPakistanPalauPalestine StatePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe
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