Form_1012 (2018-10-05) Page 1 of 1
Outgoing wire request outside Canada
Notes:
Outgoing wires are best sent in the beneficiary country’s currency. This minimizes any currency risks,
provides certainty of the amount being sent, and allows the transfer to be processed quickly.
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 / State
Country
Postal / ZIP Code
Section 3 Beneficiary Bank Information
Beneficiary Bank Name
Branch Apt. / Unit Number
Branch Street Address
City / Town
Province / State
Country
Postal / ZIP Code
Routing Code / SWIFT Code / BIC
Beneficiary Bank Account Number (BNF / IBAN / CLABE)
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
Routing Code / SWIFT Code / BIC
Correspondent / Intermediary Bank Account Number
Clear Fields