SCHEDULE 5(Paragraphs 12(1)(b), 28(1)(b) and 40(1)(b) and subsections 52(1) and (3))Outgoing Non-Swift International Electronic Funds Transfer Report Information
PART A
Transaction Information
1
Time Sent
2*
Date
3*
Amount of electronic funds transfer
4*
Currency of electronic funds transfer
5
Exchange rate
PART B
Information on Client Ordering Payment of Electronic Funds Transfer
1*
Client’s full name
2
Client’s full address
3
Client’s telephone number
4
Client’s date of birth
5
Client’s occupation
6*
Client’s account number, if applicable
7
Type of document or other information used to identify client
8
Number of document or number associated with other information used to identify client
9
Jurisdiction and country of issue of document or other information used to identify client
PART C
Information on Sender of Electronic Funds Transfer (person or entity that sends payment instructions)
1*
Full name of sending institution
2*
Full address of sending institution
PART D
Information on Third Party Where Client Ordering Electronic Funds Transfer Is Acting on Behalf of a Third Party (if applicable)
1
Third party’s full name
2
Third party’s full address
3
Third party’s date of birth
4
Third party’s occupation
5
Type of document or other information used to identify third party
6
Number of document or number associated with other information used to identify third party
7
Jurisdiction and country of issue of document or other information used to identify third party
PART E
Information on Receiver of Electronic Funds Transfer (person or entity that receives payment instructions)
1*
Full name of receiving institution
2*
Full address of receiving institution
PART F
Information on Client to Whose Benefit the Payment Is Made
1*
Client’s full name
2
Client’s full address
3
Client’s telephone number
4
Client’s date of birth
5
Client’s occupation
6*
Client’s account number, if applicable
7
Type of document or other information used to identify client
8
Number of document or number associated with other information used to identify client
9
Jurisdiction and country of issue of document or other information used to identify client
PART G
Information on Third Party Where Client to Whose Benefit Payment Is Made Is Acting on Behalf of a Third Party (if applicable)
1
Third party’s full name
2
Third party’s full address
3
Third party’s date of birth
4
Third party’s occupation
5
Type of document or other information used to identify third party
6
Number of document or number associated with other information used to identify third party
7
Jurisdiction and country of issue of document or other information used to identify third party
