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SECTION V

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CABLE or WIRE to: (giving bank, account to be credited, beneficiary, addresses, message it any)

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BRANCH complotes

VED BY: Wines Department

And Telephone Extension TIME: nt wins De poatment

pe

COST: COMMISSION:

TIME:

DATE:

y-1

TOTAL:

DATE: 9.16 A (Rev. 177)

CONDITIONS GOVERNING THE ISSUANCE OF A FOREIGN CHECK

Such check shall be presented promptly to the drawee for payment and, if drawn in a currency other than that of the place of payment as indicated thereon, it shall be payable at the buying rate of the drawee for checks of that currency on the date when payment is effected unless the holder thereof shall then arrange otherwise with the drawee and shall pay all charges of the drawee in connection therewith.

Should such check not be paid by the drawee and a refund be requested, we will, upon surrender to us of the original of the check duly endorsed and all outstanding counterparts thereof, and subject to any licensing requirements then applicable thereto, pay to the holder of the check its face amount in United States Dollars at our buying rate for the currency in which drawn on the date when retund is made or, at our option, we will forward appropriate instructions by mail, or otherwise in our discretion, to the drawee to hold the face amount of the check at the disposal of the holder thereof, and when we shall have so paid or instructed we shall have no further liability with respect to said check.

CONDITIONS GOVERNING THE TRANSFER OF FUNDS BY MAIL OR CABLE

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If the transter is of currency other than that of the country to which it is to be transferred, it shall be payable to the payee in the currency of the said country at the then buying rate of our Branch or Correspondent for the currency transferred, unless the payee arranges otherwise with our paying Branch or Correspondent and pays all its charges in connection therewith. Relative to any transfer by mail or cable, we may make use of any of our Branches or Correspondents and we shall be without liability for any (a) acts or failures to act (inclusive of any failure to identify to payee) on the part of any such Branch or Correspondent, or (b) failure of the funds to reach the payee. Furthermore, we may send any message relative to the transfer in explicit language, code or cipher and shall not be liable for errors, delays or defaults in the transmission of any such messages by telegraph, cable, wireless, foreign governmental telegraphic services and/or by letter, postal remittance by the post office of this or any foreign country, or by any express company, or for any total or partial suspension of any such means of trans

mission.

In event no payment of the amount involved shall have been made by our Branch or Correspondent and you shall have requested a retund, we will endeavor to notify our Branch or Correspondent to cancel the transaction and upon receipt by us of confirmation of such cancellation we will subject to any licensing requirements than applicable thereto, refund the amount of the transfer to you, less our expenses and those of our Branch or Correspondent; provided, however, that it shall be optional with us as to whether refund will be made here (a) in United States Dollars at our buying rate for the said foreign currency on the date of refund, or (b) in the foreign currency of the transfer, or (c) by instructing our Branch or Correspondent to hold the said foreign currency for your account and risk. In no event, however, shall we be under any obligation to effect any refund on account of said transter unless and until funds provided by us abroad for its payment shall have been made freely available to us.

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AMERICAN SECURITY BANK, N. A.

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Retaiove details of DOMESTIC MONEY TRANSFER FORM

the transactional TO(BANK)

INDEX
X Y Z Bank

NO. 1028
DATE
ot TRANSAction
ACCT.NO.

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ABA AMERICA Association Numbenthe XYZ ANALYSIS WAIVE CHARGE

001

BENEFICIARY

ADVISE

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REMITTER
Gary Johnsen (Individual Disocting Amexican

( to wins transfer funds to XYZ Bank to account oor DEBIT Johnsons' Account BRANCH

CUSTOMER 3+ BRANCH ACCOUNT NO, AL American Suwaity ALTEST

TEST Initiated by NO.
NAME

INVESTMENT MATURITY TODAY
Gary Johnson

$ STREET

AV. BALANCE
ADDRESS 6702
E. 17th St.

$ 75 000

for Account oor BK. BALANCE s 76,500 - Current Balance Akool

) CITY STATE ZIP

INCOMING WIRE BKW

Bitmek Fed Funds Washington D.

wine REQUESTED BY RECEIVED BY VERIFIED BY pow. GOVT CHECK HOLD PLACED

ins Wine Room wins Tamee Reads PHONE NO. OR EXT. EXT.

TIME BAL CHECK BY APPROVED BY PER
Teleshond of
CALL-BACK TO EXT.
TIME CALL-BACK BY EXT.

TIME SEQ NO.

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REQUIRED
INFORMATION

OPTIONAL
INFORMATION

WILL BE COMPLETED
BY MONEY TRANSFER

20.177

WAS

FOR INTERNAL USE OF MONEY TRANSFER ONLY a Test Code if the awaction initiating

wiss tears for from one of American

So curityas
BRANch

officos 2 PERSON in Branch office calling in to wire office with instructions

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