Congressional Federal International Wire Transfer Form printable pdf download

INTERNATIONAL WIRE TRANSFER FORM

Use this form to make an international wire transfer. Please provide proper and complete transaction information. You must

agree to a prepayment disclosure and receipt before the wire is released for processing. Please make sure the information

printed on the receipt is accurate to insure timely transfer of the requested funds. You may fax this form to 703.218.4014 or

visit one of our branches.

Member Information

Name:

Credit Union Account Number:

Immediate Telephone Number:

Email Address:

Transaction Information

Amount of Wire:

From:

Savings

Checking

Money Market

Receiving Institution Instructions:

Bank Name:

Bank Address:

City/State:

Phone Number:

Swift Code / Sorter Number:

Name of Individual(s) to Receive Funds:

Address of Individual(s) to Receive Funds:

Account Number to Receive Funds:

Any Special Instructions:

International Wire Routing Disclosure: I understand that wires are not guaranteed outside of the United States. I further

understand that recipients may receive less due to fees charged by the receiving bank and foreign taxes. I understand that

Congressional Federal will charge a $45.00 fee to process this transactions.

Signature: __________________________________________________________ Date: ____________________________

For Credit Union Use Only:

Telephone Verification

Face to Face Verification

Operations Disclosure Agreed to Verbally by Member: m Yes

m No

Security Question 1:

Branch:

Wire Sq #:

Teller #:

Wire initiated by:

Date/Time:

Teller Name:

m FX

m SIG

m Funds Debited

Security Question 2:

ID Type:

Wire verified by:

Date/Time:

ID #:

Wire released by:

Time:

Expiration Date:

m OFAC

m FX

m SIG

m Funds Debited

Security Question 3:

Date of ID Verified:

m OFAC Failed

m OFAC Approved

Reason:

Member verified by 1:

Time ID Verified:

Member verified by 2:

P.O. Box 23267 Washington, D.C. 20026-3267 |

| From Capitol Hill, 6.3100 | 800.491.2328 | 703.934.8300 | 703.934.8307 f

IWT1114

Congressional Federal International Wire Transfer Form

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