Confirmation of Bank Account details for Electronic Funds Transfer
Please complete this form and return it immediately to Pobal (for the attention of Accounts Payable,
accountspayable@pobal.ie or Pobal, Holbrook House, Holles Street, Dublin 2) to ensure there is no delay in future
payments.
Name of Company/Organisation
___________________________________________________
Company/Organisation Address
___________________________________________________
Contact Name
___________________________________________________
Contact Number
___________________________________________________
Contact Email
___________________________________________________
(email where Remittance will be emailed to)
VAT Registration No.
____________________________________
(If a copy of your organisation’s tax clearance certificate is available, please attach a copy to this form)
I wish to nominate the following Bank Account into which all payments due from POBAL will be transferred by
Electronic Funds Transfer :
Bank Account Name
____________________________________
Bank Account Number
____________________________________
Sort Code
____________________________________
Bank Address
____________________________________
Swift Code
____________________________________
IBAN Number
____________________________________
Signature
____________________________________
Date
________________________
POBAL Use Only:
Bank Account details input onto system
Code
Yes/No
____________________
Prepared By ____________________
Approved By ___________________
Date
Date
____________________
___________________