CIB Operations
Foreign Cheques, Drafts and Traveller’s Cheques Deposit Form
This form must be completed in conjunction with form 00039055 (Application to sell foreign currency) attached
A separate form 00039055 is required for each foreign cheque, draft and traveller’s cheque
Please process on
Foreign cheques drawn in foreign currency
Drafts drawn in foreign currency
Traveller’s cheques
collection basis
Account to be credited or debited as detailed out in the below General Conditions section
Account
Account name
number
If a Customer Foreign Currency (CFC)
Type of account
account, specify currency
Conversion or Currency Exchange instructions (Quote Forward Exchange Contract / SPOT details, if applicable)
Contact details
Contact name
Contact number
Details of instruments (meaning foreign cheques, drafts and traveller’s cheques) to be processed on collection basis
Drawer of foreign cheques or
Cheque serial
drafts or name of traveller’s
number including
Bank and Branch
cheques company
any prefixes
Currency
Amount
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
General Conditions
I (meaning the duly authorised signatory and/or account holder) hereby request The Standard Bank of South Africa Limited (“Standard Bank”) to process
on collection basis and present for collection and clearance the foreign cheque(s) drawn in foreign currency and/or drafts drawn in foreign currency
and/or traveller’s cheques as listed above (the “instrument(s)”). I acknowledge that any charges associated with the conversion and clearance of such
instrument(s) will be deducted by Standard Bank from the instrument(s) amount prior to crediting my nominated bank account. I accept that Standard
Bank will not be able to advise the date when the proceeds of the instrument(s) (the “funds”) and converted amount will be credited into my nominated
bank account, until the drawer’s bank advises and avails the funds to Standard Bank. I hereby acknowledge that Standard Bank will not be liable for
omissions or delays in transmission of funds arising from circumstances beyond its control.
I indemnify and hold Standard Bank harmless against any losses or damages of whatsoever nature (whether direct, indirect and/or consequential)
including reputational damages caused by or arising from Standard Bank’s agreement to enter into the collection arrangement. Should any or all
instrument(s) come back unpaid up to 3 (three) years for United States instrument(s) and 7 (seven) years for United States Treasury instrument(s)
respectively including any or all instrument(s) previously believed to have been cleared, I irrevocably authorise Standard Bank to debit my nominated
bank account with the local currency equivalent to the instrument(s) returned unpaid. Standard Bank’s sight selling rate on the date of debiting of my
nominated bank account will apply in the event of any of the above-mentioned instrument(s) being returned unpaid and any losses suffered by Standard
Bank or costs associated with the unpaid instrument(s) will be for my account and debited against my nominated bank account accordingly. While acting
in good-faith and with reasonable care, Standard Bank will not be responsible for ensuring that I have lawful title to the instrument(s) presented to
Standard Bank and it will at no time guarantee payment and clearance or confirm that any instrument(s) will not be unpaid post receipt of funds. Whilst
making every effort to ensure safekeeping, Standard Bank cannot be held responsible for instrument(s) lost, stolen or destroyed while in any stage of
collection. I understand that Standard Bank expects information furnished by me to be true and correct and has no duty or responsibility to verify such
information.
I accept that the onus is on me to ensure that the person or company which tendered the instrument(s) to me had the legal capacity to tender the
instrument(s) as payment(s) and I bear all risks associated with any and all fraudulent instrument(s). The instrument(s) presented by me to Standard
Bank will be subject to the regulation(s) and legislation(s) applicable to the instrument(s) from time to time. I understand that I have to complete and sign
a separate indemnity in the event of me presenting United States Treasury instrument(s) for collection.
Signature(s) – Authorised Signatures must match specimens on record at Standard Bank
For and on behalf of :
00143352
20 June 2013
Signature(s)
The Standard Bank of South Africa Limited Reg. No. 1962/000738/06
Date stamp
Registered Bank
Addendum to
Application to sell foreign currency
Cross border foreign exchange transaction reporting
(Bank purchase from customer)
Please use this form in conjunction with form 00143352 (foreign cheque deposit form) for foreign cheque deposits
Select type of transaction
Customer details and account to be credited
Name and surname of individual
or name of entity
Physical address including
Suburb:
suburb, city and province
For individuals, select
gender
Male
City:
Province:
Postal address
Female
Postal code:
Registration no./ identity no./
temporary resident permit no.)
Contact name (name and
surname), telephone, fax no.
and e mail address of applicant
Contact name (if entity) :
Telephone :
Fax :
e-mail :
Individual / Entity
For Individuals – insert date of birth
Tax number of applicant
VAT Number
Industry sector code
Industrial classification number
(yyyy-mm-dd)
Bank name
Account number
Branch number
Type of account to be credited
Current
Savings
Investment
Foreign Currency
account (CFC)
If CFC account,
specify the currency
Transaction and conversion details
Value date (yyyy-mm-dd)
Currency
Exchange rate
Spot Cover or FEC
number(s)
Amount
received
Country of destination of goods
(exports)
Details of transfer
If export, list product(s)
Exporters Customs Code
Number (CCN)
format: 12345678
Exchange Control
approval obtained
Yes
No
SARB authority no.
e-docs No.
Internal authority number
Date
Remitter details
For individuals – select gender
Full name of remitter
Male
Remitter’s physical address
Suburb:
City:
Country:
Individual, Entity
Balance of payment (BOP) details - BOP categories and sub-categories’ list is available on our website www.standardbank.co.za/bizconnect
Note - For payments on behalf of third parties, please complete Addendum to this Application.
Section of the
If loan, loan ref
Tenor of
BOP
Composite transactions
rulings
no.
loan
Category / Subcategory
Category / Subcategory
Category / Subcategory
Category / Subcategory
Female
Interest
rate
/
Amount :
%
/
Amount :
%
/
Amount :
%
/
Amount :
%
Unique Consignment Ref No.
if applicable (UCR)
If BOP Category selected above is
830 (other), please provide details
Declaration and acknowledgement
I/We wish to sell foreign currency as indicated above and declare that the information provided by me/us is in all respects both true and correct. I/We hereby acknowledge that
Standard Bank will not be liable for omissions or delays in transmissions arising from circumstances beyond it’s control. I/We understand that it is my/our responsibility to inform
Standard Bank of all changes to my/our details and/or changes to the details of the entity on whose behalf I/We are acting, whether it be contact details or any other relevant changes.
I/We, hereby further declare that:
- I/We have read this document and understand the contents hereof;
- The currency received will only be used for the purpose stated herein;
- The documentation presented in support of this application is in all respects authentic;
- I/We have been informed of the limits applicable to the above transaction and confirm that this limit will not be exceeded as a result of the conclusion of the transaction; and
- I/We consent to this information being provided to the South African Revenue Service and/or Financial Intelligence Centre.
Signature (Signatures must match specimens on record at the bank)
For and on behalf of
00039055
20 June 2013V3
Signature of applicant/ authorised signatory (ies)
The Standard Bank of South Africa Limited Reg. No. 1962/000738/06
Date (yyyy - mm - dd )
Registered Bank
Addendum to application to sell foreign currency
Cross border foreign exchange transaction reporting
(Bank purchase from customer)
Please complete details of third parties on whose behalf you are acting. Please complete a separate page for each third party
Name and surname of individual or name of entity
Identity / registration / permit number (permit number only
for foreign nationals temporarily resident in South Africa)
For individuals - please select appropriate gender
Male
Female
For individuals – please provide date of birth
Address line 1:
Address line 2:
Suburb:
Province:
Country:
Physical address (not Postal address)
Postal address line 1:
Postal address
Postal address line 2:
Postal code:
Third party VAT number
Third party tax number
Name of contact person (if entity)
Third party Customs Client Number (CCN)
Third party contact details
Telephone number:
Email address:
00039055A 20 June 2013V3
The Standard Bank of South Africa Limited Reg. No. 1962/000738/06
Registered Bank