AGENT LOCATION
HOW TO FILL OUT THE MONEY TRANSFERAPPLICATION FORM
THIS IS
ENGLISH
英語
HOW TO COMPLETE THE MONEY TRANSFER APPLICATION FORM• Please fill out the Money Transfer Application Form in BLOCK LETTERS.
© 2016 Western Union Holdings, Inc. All Rights Reserved.
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46
910
11
18
3
5
78
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Your Information• Fill in your full name using English alphabet as it appears on your identification document.
1 Address• Japanese Nationals & Foreign Residents in Japan: The address must be the same as the address indicated on your identification document.
• Non-Residents: The address needs to be provided according to your passport or hotel confirmation in Japan.
2
Country of Birth• The name of the country where you were born.
4
Nationality• Your current nationality.
6
Destination countries: the U.S.A., Mexico or Canada• Make sure to provide name of city and state where the Recipient will collect the funds, if funds are transferred to the U.S.A., Canada and Mexico.
• This information may be different from the Recipient’s address (Country, State and City).
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Transaction Purpose• Choose one of the purposes.
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Test Question• Test Questions and Answers may be required for Recipient verification purposes in certain countries or if the principal amount does not exceed U$1,000 (or local equivalent currency) in addition to MTCN.
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Date• Transaction date in the day-month-year order.
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Contact Phone Number• Your home phone number or your mobile phone number.• Provide your mobile phone number if you would like to receive an SMS notification to inform that a money transfer was collected successfully by the Recipient.
3
Individual Number (My Number)• Your Individual Number (My Number) with 12 digits. (Japanese Nationals and Foreign Residents only)
For more details please visit http://wu-japan.com/mynumber/en
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Sending amount• Provide the transfer amount of your money transfer.• Please Choose the currency JPY (Japanese Yen).
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Recipient’s Name• Fill in the Recipient’s full name using English alphabet. The Recipient’s name must be the same as the name indicated on the Recipient’s identification document, which must be shown while receiving the funds; otherwise, the funds will not be paid out.
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Direct to Bank Account• Direct to Bank Account information varies depending on destination countries. For more details, please refer to the NEXT PAGE.
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Bank Name• Fill in the Recipient’s bank name. (It cannot be abbreviated)
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Beneficiary Name• Fill in the Recipient's name as registered with his/her bank.
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BIC/IFSC/IBAN• Fill in the Bank Identifier Number for the Recipient's bank account.
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Confirmation• After confirming the content inside the box, please make sure you check this BOX□. Without your agreement, money transfers cannot be processed.
✓
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Signature• This must be the Sender's signature.
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REQUIRED RECIPIENT’S BANKING INFORMATION BY COUNTRYFOR THE DIRECT TO BANK ACCOUNT SERVICE
AUSTRALIA
© 2016 Western Union Holdings, Inc. All Rights Reserved.
Bank NameBeneficiary Name (Bank Account Name)Bank Account Number: 1-9 CharactersBranch Number: 6 Characters
BRAZIL
Bank NameBeneficiary Name (Bank Account Name)Bank Account NumberBank Branch NumberAccount Type
CHINA
Bank NameBeneficiary Name (Bank Account Name, Pin Ying)Bank Card Number (UnionPay debit cardaccounts must start with 62, 14-19 digits)
INDIA
Bank NameBeneficiary Name (Bank Account Name)Bank Account NumberRouting IFSC: 11 Characters
INDONESIA
Bank NameBeneficiary Name (Bank Account Name)Bank Account Number
PAKISTAN
Bank NameBeneficiary Name (Bank Account Name)Bank Account Number: 20 Characters
PHILIPPINES
Bank NameBeneficiary Name (Bank Account Name)Bank Account Number
THAILAND
Bank NameBeneficiary Name (Bank Account Name)Bank Account Number: 1-34 Characters
THE UNITED STATES OF AMERICA
Bank NameBeneficiary Name (Bank Account Name)Bank Account NumberABA Routing Number: 9 Characters
CPF (Tax ID Number): 11 CharactersDate of BirthPhone NumberMobile Phone Number
Postal CodeAddress (City, State, Country)Mobile Phone Number
Bank Branch Name/AddressPhone Number
Postal CodeAddress (City, State, Country)Phone Number
SEND TOACCOUNT
1
234
1
2 673
4
5
1
26789
345
12
4
3
1
23
4
5
1
2
5
673
4
1
2
3
1 4
23
1
23
1234
12 6
73
123
4
5
12
6789
3
123
123
4
4
12
3
4
123
45
167
234
5
5
Receiver's City and Street Address
Mobile Phone Number (must start with “1” and 11 digits long)