Beneficiary Details

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Country:*

Beneficiary Type:*

Contact No:

First Name:*

Mid Name:

Last Name:*

Native Country :*

Beneficiary Address:*

Beneficiary City:

Mobile No.: *

Id Type:

Id Number:

Place of Issue:

Relationship To Beneficiary:

Description of other relationship:

Transaction Information

Purpose of Remitance:

Purpose Other:*

Payment Mode:*

Agent/Bank:

Beneficiary A/c #:

Branch:*

Remarks:

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Agreement Information

私は本依頼書に記載されているジャパンマネーエクスプレス株式会社の「海外送金利用規約」の内容に同意します。
私の依頼する送金は、北朝鮮及びイランとは関係無い取引であり、反社会勢力と一切の関りはありません。
受取人及び私は「外内国の重要な公的な地位にある者」ではありません。
また申込書に表示された内容について間違いが無い事を確認した上で、JME送金サービスの受取人登録を依頼します.
I understand and agree to the ”Terms and Conditions for Overseas Remittance” of Japan Money Express Co., Ltd. (JME).
Beneficiary and I have no relation with North Korea or Iran. Also, we have no relation to any Anti-Social Forces and we are not engaged in any illegal activities.
Beneficiary and I are not Politically Exposed Persons(PEPs).
I confirm the information shown in this application to register beneficiary/ beneficiaries is true and correct.

Customer Signature:

Sign above

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