REGISTRATION AND TRANSFER FORMπ```````````jƒ``````ë`````Jh π````````````````«```é```°ù````J Ö``∏```W

This part of the form is for Branch Staff use only

ID/Iqama No.Date of issue

SENDER DETAILSTo be filled in English only

Signature of sender

Validation

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áeÉ``bE’G/ájƒ``¡dG º``bQ

Address¿Gƒæ©dG

Occupation (for transfers over USD 3000 or equivalent)(É``¡``dOÉ``©j É``e hCG Q’hO 3000 øY ó```jõ```J »`à``dG ä’Gƒ```ë``∏d) á````````Ø``«`Xƒ``dG

Work Addressπ``ª©dG ¿Gƒ``æY

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Place of issueQGó°UE’G ¿Éµe

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Name of senderπ````````````«ª`©``dG º`````````°SG

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Mobile∫Gƒ÷G

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NCB - Membership no. Purpose of the transferπ``````jƒ````ë```à``dG ø```e ¢Vô````¨````dG

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NCB - á````jƒ```°†`©`dG º```bQ

Name (Block letters)(ájõ«∏‚E’ÉH §≤a) º°SE’G

First name Middle name Last name

Date of birthOÓ`````«ŸG ïjQÉJ

DateïjQÉàdG

BENEFICIARY DETAILS Please use an additional form for more than one beneficiary

For Assistance in locating MoneyGram Agents in your Country / City, Please approach a customer service representative

Take care when sending money to someone you don’t know, and when asked to pass information about the transaction to third parties.

Please put ( X ) in box to select desired Delivery Type

Cash pick upDoor to door

Address¿Gƒæ©dG

Nationalityá«°ùæ÷G

Street name´QÉ°ûdG º°SG

CityáæjóŸG

Countryó∏ÑdG

Zip code…ójÈdG õeôdG

Place of birthIO’ƒdG ¿Éµe

OccupationáØ«XƒdG

Relationship to senderπ°SôŸÉH áHGô≤dG á∏°U

Tel∞JÉg

Mobile∫Gƒ÷G

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Please put ( X ) to make a selection∂Ñ∏W QÉ``«àN’ ( X ) áeÓY ™°Vh AÉLôdG

Bank name∂æÑdG º°SG

Branch name/Address¿Gƒ``````````æ©dG / ´ô``````ØdG º°SG

»°üî°T ΩÓà°SG

MoneyGram “No back membership details required”ΩGô``````L »```fÉ````e»`µ`æÑdG ∂`HÉ`°ùM ø`Y äÉ`eƒ∏©Ÿ á`LÉM ’

Deposit to AccountÜÉ`````°ù◊G ‘ ´Gó`````````jEG ‹õæe π«°UƒJ

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ID typeájƒ¡dG ´ƒf

ID no.ájƒ¡dG ºbQ

Membership no.ÜÉ°ù◊G ºbQ

Currency accountÜÉ°ù◊G á∏ªY

Smart no.äQɪ°S ábÉ£H ºbQ

IFSC No. (for India)(óæ¡∏d) IFSC ºbQ

Amounts in words Amounts in figures Transfer currency BeneficiaryCode

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Name (Block letters)(ájõ«∏‚E’ÉH §≤a) º°SE’G

First name Middle name Last name

Name of branch staff

™``````````«bƒ````àdG

Signature

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Employee no.

Nationalityá«°ùæ÷G

Adding beneficiaryó``````````«````Ø``à°ùe á````aÉ`````°VEG

Transferπ````jƒ````ë`J

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QuickPayΩGô```````L »````fÉ``e

MoneyGram

Branch No.´ô````````````ØdG º```bQ

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