Bank Details Form - Price Forbes
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1Bank Details Form
Name:
Date of Birth:
Address:
Passport
Type of ID Enclosed:
(Please select one)
Driving Licence
Name of Person to Pay:
Relationship to Payee:
(If different from above):
Bank Name:
Bank Account Holder:
Bank Account Address:
Sort Code:
Account Number:
(If UK Bank Account)
IBAN Number:
Swift Code:
(If Bank in Europe & Not UK)
(If not a UK Bank Account)
PLEASE TICK ONE:
I hereby confirm my agreement for funds to be paid to my account shown above
I hereby confirm my agreement for funds due to me to be paid to the persons advised on this form
Signed:
Date:
Price Forbes & Partners Limited – Lloyd’s Brokers
6th Floor, 2 Minster Court, Mincing Lane, London EC3R 7PD, England
Tel +44 (0)20 7204 8400; Fax +44 (0)20 7204 8404;
Registered Office: as above. Registered in England under Company Number 5734247
Price Forbes Limited is Authorised & Regulated by the Financial Conduct Authority to conduct General Insurance Business
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Parent category: Business