Sheet3Fund Transfer Application FormSender InformationTransfer Type:Customer:Gholghola Group Construction CoInternationalAccount No:0510103003717510 - EURODomesticAddress:Omid-e-Sabz Township, Darul Aman, 6 district, Kabul AfghanistanFor Individuals only:Date of BirthPlace of BirthNationalityOccupationTransfer InstructionAmount(in figures)$426,850.00CurrencyEUROCountryAfghanistanAmount (in word)Four Hundred twenty six thousand, Eight hundred fifty Euro OnlyValue Date21-May-15Beneficiary detailsAccount nameGholghola Group Construction CompanyAccount number001202EURO645634AddressOmid-e-Sabz Township, Darul Aman, 6 district, Kabul AfghanistanDetails of transferFund Transfer from Gholghola AIB account to Gholghola AUB Account426887Intermediary Bank details (if any)Bank nameAccount #IBAN/Routing # SWIFTBeneficiary Bank detailsBank nameAfghan United BankAddressShahre Naw, Kabul AfghanistanIBAN/Routing #SWIFTChargesExternal payment codeSingle PurposeAOURAIB Charges, Intermediary, & Beneficiary Bank charges to my accountMultiple purposeBENAIB Charges, Intermediary, & Beneficiary Bank charges to Beneficiary's accountSHAAIB charges to my account. Intermediary and Beneficiary Bank charges to Beneficiary's accountAIB shall not be held liable if the beneficiary does not receive the transferred amount on any reasons stated by the intermediary or beneficiary bank due to blockage or stoppage of the transfer process, or for any delay in the payment of the amount. . (AIB) .I/We authorize the bank to debit our account with above mentioned amount and associated charges. I/we also certify that the above mentioned information is accurate and complete to the best of my/our knowledge and on a later date if AIB requires any documentry proof of purpose we undertake to submit the same.Sender's Signature:Date:For Bank Use OnlySignature Verified:Checked by:For Use by Payment DepartmentAML Checked:Signature:PS BookerBalance VerfiedPS AuthorizerFlexcube Ref# External Ref#----------------------------External Ref#