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Note: Inaccurate or missing information may cause the (Vancity)

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Country of origin: CANADA
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Form_0999 (2018-10-05) Page 1 of 1
Outgoing wire request – within Canada
Note: Inaccurate or missing information may cause the wire to be delayed, returned, or assessed additional fees.
Section 1 – Sender Information
First Name
Last Name
Relationship Number
Section 2 – Beneficiary Information
Beneficiary Name (enter exactly as shown on beneficiary’s account)
Apt. / Unit Number
Street Address (physical address)
City / Town
Province
Country
Postal Code
Canada
Section 3 – Beneficiary Bank Information
Beneficiary Bank Name
Branch Apt. / Unit Number
Branch Street Address
City / Town
Province
Country
Postal Code
Canada
Routing Code / SWIFT Code / BIC
Beneficiary Bank Account Number
Purpose of the wire / memo
Correspondent / Intermediary Bank Information (if applicable)
Correspondent / Intermediary Bank Name
Branch Apt. / Unit Number
Branch Street Address
City / Town
Province
Country
Postal Code
Canada
Routing Code / SWIFT Code / BIC
Correspondent / Intermediary Bank Account Number
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Note: Inaccurate or missing information may cause the (Vancity)

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Completed 1 May 2021

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