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Release Order Form

1) The document is a release order form for HSBC bank that must be completed accurately and sent by fax or email along with photo ID to the claims agent Mr. Astrid Pedersen. 2) It requests information from the beneficiary such as name, contact details, preferred method of funds transfer, bank account details or address for certified check, next of kin details. 3) The applicant Sohel Hasan declares that the provided data is true and falsification will result in losing claims to the total fund, and allows next of kin to make claims in case of unforeseen circumstances.

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729 views1 page

Release Order Form

1) The document is a release order form for HSBC bank that must be completed accurately and sent by fax or email along with photo ID to the claims agent Mr. Astrid Pedersen. 2) It requests information from the beneficiary such as name, contact details, preferred method of funds transfer, bank account details or address for certified check, next of kin details. 3) The applicant Sohel Hasan declares that the provided data is true and falsification will result in losing claims to the total fund, and allows next of kin to make claims in case of unforeseen circumstances.

Uploaded by

j_jibun
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 DOC, PDF, TXT or read online on Scribd
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0A1

221460
THE TRUE BENEFICIARY IS TO COMPLETE THIS FORM ACCURATELY AND FAX/EMAIL ALONG WITH A
VALUABLE PHOTOCOPY OF HIS/HER(e.g.driver’s license,passport,bith certificate, e.t.c) TO YOUR CLAIMS AGENT,
THE FOREIGN SERVICE MANAGER, MR.ASTRID PEDERSEN OF THE MAANDOI SECURITY SERVICES.

MR. ASTRID PEDERSEN


TEL Nº: 0060-162 936-194
FAX Nº:0060-321-784-731

Release Order Form ( HSBC)


Please complete and return by fax or email.

REF Nº: AS/09/13/57/009/KL BATCH Nº: SLTO/7916/KL/AS ADVICE NOTES


Name of organisation ( if any ) SOHELHASAN

Name of main contact: SOHELHASAN This can be the beneficiary


of the lottery fund or
anyone.
How would you want your money to be Transferred to you?
Note: For a certified cheque, only address of beneficiary is required. Account coordinates
(Details of the account
Certified cheque bank transfer where you want your funds
transferred) else, take the
Bank name: …………………………………. Account Nº: …………………………………. certified cheque option.

BSB Nº: …………………………. ………….. Swift Code: …………………………………

Bank Address: ………………………………………. City: ………………………………….

State: ………………………….Post Code …………


Beneficiary’s Name: SOHEL HASAN

Address: Al Jaber L.E.G.T. Engineering & Contracting (ALEC)/PO BOX NO-27639 /DTCD
PROJECT /EMP NO-89221 /DUBAI (U.A.E) Please give the applicant’s
full postal address.
City:DUBAI State: DUBAI Post Code:27639

Telephone. Nº: Mobile:+97155706063 Fax Nº:

Email:sohelhasan92@yahoo.com Date Of Birth:07 Nationality: bangladesh Occupation:privet


Oct1985
Incase of unpredicted
Relatives (next of kin) occurrences, your next of
kin can make claim on your
behalf.
Name: Relationship:

Telephone: Mobile: Fax:

Address:

City: State: Post Code:

Declaration

I (MR/MRS/MISS) sohelhasan HEREBY DECLARE THAT THE ABOVE DATA ARE TRUE AND INCASE OF
FALSIFICATION, I SHALL LOSE CLAIMS TO MY TOTAL FUND. INCASE OF UNFORSEEN CIRCUMSTANCES MY NEXT
OF KIN HAS THE RIGHT TO CLAIMS OF THE TOTAL FUND.

DATE : 23 Nov2009 SIGNATURE:………………………………….

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