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Reimbursement Request Form
Why we ask for this information
When we send money internationally, banks have to follow rules that help prevent fraud and money laundering. By collecting the full account details, we make sure your refund reaches you safely, without delays, and in line with these regulations.
Full Name
*
Email
*
Recipient’s bank account details
Recipient’s full name
*
Recipient’s home address
*
Recipient’s country of residence
*
IBAN
(International Bank Account Number)
SWIFT/BIC code
(Bank Identifier Code)
*
Bank name
*
Bank address
*
Expense Details
Date
*
Description
*
Amount
*
Currency
*
Receipt
*
Click to choose a file or drag here
Accepts .jpg, .jpeg, .png, .pdf files
Purpose of expense
*
Who has authorized this expense?
*
Declaration
*
Declaration
I hereby declare that the information provided above is true and correct to the best of my knowledge and belief. The expenses incurred are for legitimate purposes, and all receipts attached are genuine.
Signature
*
Submit
