Dear Sirs,

Please debit my/our Account No.:                      , the sum of                                   US$ and remit the above amount to my/our bank account with the details as below:
Print
FUNDS WITHDRAWAL REQUEST
To: Rate Capital Investment LLC
Date:
Attn: Accounts Department
From:     
A/C No.:
Bank Name:
Branch Name:
Bank Address:
Swift Code:
Correspondent Bank/City:
Beneficiary Name*:
Account Number:
Customer Name:                          
Customer Signature   ....................................................                           Date   ...............................
I hereby certify that I have witnessed the signing of this request by the above-mentioned customer and further declare that the same is the true and the correct signature of the customer I confirm the bank details to be complete and accurate.
For office use only
*Please be advised that funds withdrawn will only be remitted to Rate Capital Investment's Own Bank Account with his name. WE DO NOT PROCESS "THIRD PARTY" TRANSFERS.
P.O.Box 1283 Dubai U.A.E. Tel: +971 4 338 48 08 Fax: +971 4 338 48 09
Email:info@rcifx.com, www.rcifx.com