EFTA00614909.pdf

BAIWCO POPULAR. Outgoing Transfer of Funds Ref. No. or Test Key -- Amount Cuireney Rate 2011102118219060 IC0000.00 USD 0.0 Commission Transmission USD Equivalent inossetion Total 25.00 I 25.00 0.00 100,050.00 Branch Prefix and Name lam Date 04M-DD-YTYY) Debit Account Recurring ID 193 VISUC MAIN BRANCH•193 4 10 2014 695201088 piriglast ti Name Business I Profession / Occupation TERRANCE E RABSATE-KAREN EL RABSATT SELF EMPLOYED Address I 6-E ESTATE NADIR City ST THOMAS Stale VIRGIN ISLANDS Country VIRGIN ISLANDS, U.S. ZipCode 03802 Expiration Date I !CENSE AND COUNTRY OF ORIGIN DOC15369 I VIRGIN ISI ANDS LI S 20.11/1:2015 and Comity or State Expiration Date I Pay? to Rank Illadiciaret Hank, I Acenunt ARA SWIFT Cork 4I04 To0CT n.4mv (Route and Transit Number) Address 25 PARK PLACE NE ATEA ceN-T-A-G-DO-R-0-I-A-1-.0-3.4--3 061000104 Intermediary Bank non or s to- t oue Address (Route and Transit Numbs") Iltneliciants Name FUEURE TECI1NOLOGIES VENTURE EEC Account Nlmberor IBAN IT) Address 1009112552665 1C0 PE1TY ROAD SUITE B City LAVVRENCEVILLE Stale GEORGIA • COurary Zip Code 3.0043 Special Instructions No* by Telephone _. Authorized PersonMaTormation Hame ' Business / Profession /Occupation TERRANCE E RAIJSA I SELF EMPLOYED AddresS ISE ESTATE NADIR C4Y ST THOMAS Slaw VIRGIN ISLANDS Count.) VIRGIN ISLANDS, U S. 7.ip Code 00902 ID Type. Number and Country or State Expiration flute LICENSE AND COUNTRY OF ORIGIN I DDC35369 j VIRGIN ISLANDS. U.S. 20,JUL 2015 ype. mintier and Country(wire Espinnon Date I I of the Person Placing_thoprdes.. Business / Profession tax:upsilon Address City Stale Country Lip Code ID Type, Number and Caedr) Of Stale Expiration Date ID Type, Number and Caney or Sale Esau:Atm Uwe _ Putpose of Tams-setae, Personal, Fami y. . Wc catify the verification of the ourocuo of the raiment in order to determine that it PMT FOR PURCHASE Household Remittance is net prohibited by any applicably regulation or Policy. RequiredSignattrtn. ) SignaturMs) of PersoNs, Piecing the Order 'LA r t/i 2Lz . c' tbrik.... Employee No r i v ut er. Summon. 1 P Ku Approving Officer's Signature 0iCtis Signature& No. for Lenvapabk Fusels Autheneation V/18219 BRA404 t 4.0 II) BANK /CUSTOMER EFTA00614909