BANK TRANSFER FORM FOR PRIZE MONEY GIVEN NAME (as

BANK TRANSFER FORM FOR PRIZE MONEY
GIVEN NAME (as shown on passport)
FAMILIE NAME (as show on passport)
MAIDEN NAME (former family name)
DATE OF BIRTH (D,M, Y)
NATIONALITY
PLACE OF BIRTH
COUNTRY OF BIRTH
GENDER:
MALE
FEMALE
TRANSFER MONEY TO COMPANY/MANAGEMENT
NAME OF COMPANY
STREET ADDRESS (COMPANY OR YOURS IF TRANSFERED TO YOUR ACCOUNT)
POSTAL CODE
COUNTRY
E-MAIL (IMPORTANT FOR RECEIPT!)
PASSPORT NR (PLEASE ENCLOSE COPY)
BANK INFORMATION
ACCOUNT NUMBER
BENEFICIARY'S NAME
FULL NAME OF BANK
FULL ADDRESS OF BANK
BANK CLEARING NUMBER
BIC/SWIFT
IBAN
ACCOUNT CURRENY (e.g)
VAT Number (Tax Number)
ABA (for USA & CAN)
ROUTING Nr. (for USA, CAN)
I herewith confirm, that FIS and the OC's of FIS CrossCountry World Cup may file and use the above information
for the purpose of prize money payment only. I also accept
that this information may be transferred to an organizer
________________________________________________________________
abroad.
Signature
Date