Transaction Authorization Form - West Offshore Bank

Transfer Authorization Form

This form is required to authorize the transfer of funds from your account to the specified destination account. By completing and signing this form, you confirm that the information provided is accurate and that you authorize the transaction. This process ensures compliance with regulatory requirements and maintains the security of your account. Please provide all requested information and attach any necessary supporting documents to facilitate the transaction.

Applicant Name:

Full Name (Primary Account Holder)

Full Name (Secondary Account Holder / Beneficiary)

Account Number

Applicant Email

Cell Phone Number

Transaction Details

Transaction Amount

Tranaction Date

Destination Account Number

Destination Account Holder Name

Destination Bank Name

Destination Bank Address (if applicable):

Source of Funds Declaration

Source of Funds:

Details of Source:

Supporting Documents:

Upload Document

Authorization and Confirmation

Confirmation Code (If Applicable)

Signature (Primary Account Holder): ___________________________ Date: ___________________

Signature (Secondary Account Holder / Beneficiary): ___________________________ Date: ___________________

By signing this form, I/we authorize the transaction detailed above and confirm that the information provided is accurate and complete.”

Bank use only

Received By (Bank Staff Name): ___________________________ Date Received: ___________________
Verification Completed By (Bank Staff Name): ___________________________ Date Verified: ___________________
Comments / Notes: ___________________________________________________________________