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Lloyds Transfer Application

This document appears to be a transfer application form for claiming a prize. It requests personal details such as name, date of birth, contact information, as well as family details for the applicant. Financial information is also requested, including the total transfer amount in both words and figures to be deposited, and the applicant's bank account details for deposit. The applicant must provide identity documents and affirm that all information provided is true.

Uploaded by

Martina Milenkovska
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© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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234 views3 pages

Lloyds Transfer Application

This document appears to be a transfer application form for claiming a prize. It requests personal details such as name, date of birth, contact information, as well as family details for the applicant. Financial information is also requested, including the total transfer amount in both words and figures to be deposited, and the applicant's bank account details for deposit. The applicant must provide identity documents and affirm that all information provided is true.

Uploaded by

Martina Milenkovska
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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324-326 REGENT STREET, LONDON W1B 3BL

UNITED KINGDOM
TEL: +44 207 060 9063

FAX: +44 703 940 1393

FORM #: ABXE-RK-L04594-3494/8854

TRANSFER APPLICATION FORM (PRIZE CLAIM ONLY)

PERSONAL DETAILS
NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
GENDER: _ _ _ _ _ DATE OF BIRTH: _ _ /_ _ /_ _ _ _ / PLACE OF BIRTH _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CONTACT ADDRESS:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
CITY: _ _ _ _ _ _ _ _ _ _ _ _ STATE/PROVINCE: _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ COUNTRY _ _ _ _ _ _ _ _ _ _ _ _ _ _
ZIP: _ _ _ _ _ _ _ _ _ _ HOME PHONE NO.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ MOBILE/PAGER: _ _ __ _ _ _ _ _ _ _ _ _ _ _
FAX NO.: _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ E-MAIL: _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

JOB CONTACT DETAILS


WORKPLACE: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _
JOB TITLE _ _ _ _ _ _ _ __ _ _ DEPARTMENT _ _ _ _ _ _ _ _ _ _ _ _ POSITION HELD: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
OFFICE ADDRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _
CITY: _ _ _ _ _ _ _ _ _ _ STATE/PROVINCE: _ _ _ _ _ _ _ _ _ _ _ _ COUNTRY _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _
WORK PHONE NO.: _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ FAX NO: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
WORK E-MAIL: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

FOR SELF EMPLOYED APPLICANTS ONLY


If you are self - employed, please state your occupation and specialization in the spaces provided below:
OCCUPATION: _ _ _ _ _ _ __ __ _ _ _ _ _ _ SPECIALIZATION: _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _

FAMILY AND MARITAL STATUS


Please study carefully and check all that apply

MARITAL STATUS: Single _ _ _ _ _ _ Separated _ _ _ __ _ _ Married _ _ __ _ _ _ Divorced _ _ _ _ _ _


NEXT OF KIN
NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
GENDER: _ _ _ _ _ DATE OF BIRTH: _ _ /_ _ /_ _ _ _ / PLACE OF BIRTH _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
CONTACT ADDRESS:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
CITY: _ _ _ _ _ _ _ _ _ _ _ _ STATE/PROVINCE: _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ COUNTRY _ _ _ _ _ _ _ _ _ _ _ _ _ _
ZIP: _ _ _ _ _ _ _ _ _ _ HOME PHONE NO.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ MOBILE/PAGER: _ _ __ _ _ _ _ _ _ _ _ _ _ _
FAX NO.: _ _ _ _ _ _ _ _ _ _ E-MAIL: _ _ _ _ _ _ _ _ _ _ _ _ SOCIAL SECURITY NO.: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

TRANSFER FUND INFORMATION


TOTAL TRANSFER AMOUNT [INHERITANCE SUM] IN WORDS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_
TOTAL TRANSFER AMOUNT [INHERITANCE SUM] IN FIGURES: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_

Bank Account Details


NAME OF BANK: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __
BANK ADDRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CITY: _ _ _ _ _ _ _ _ _ _ _ _ _
STATE/PROVINCE: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ COUNTRY: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ACCOUNT NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ SWIFT CODE: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ACCOUNT NUMBER: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ SORT CODE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

PLEASE LEAVE THE ACCOUNT DETAILS FIELD BLANK IF YOU WISH TO HAVE A CERTIFIED INTERNATIONAL
BANK DRAFT MAILED TO YOU. THE DRAFT SHALL BE MAILED TO THE ADDRESS PROVIDED BY YOU IN SECTION
1. [PERSONAL DETAILS] ABOVE.

OTHER DOCUMENTS
Please indicate the documents that you have attached to this form. Fill the appropriate Spaces for any option.

International Passport _ _ _ _ _ _ _ _ _ _ _ _

Driver's License _ _ _ _ _ _ _ _ _ _ _ _ _ __

National Identity card _ _ _ _ _ _ _ _ _ _ _ _

Other Valid Identity Card _ _ _ _ _ _ _ _ _ _


(If applicable in your country)

AFFIRMATION
I, _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ hereby affirm that all the information submitted by
me in this form is true at the time of submission. I also accept any disciplinary action taken against me for falsifying,
misrepresentation or incorrect presentation of my identity.

_ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _
(Applicants Signature)
Application must be printed, completed and returned by Fax or as scanned e-mail attachment.

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