Payment Agent Questionnaire

PAQ | Payment Agent Questionnaire

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Name of Corporation *

Reference Number (if you have one)

Name of Individual (if applicable)

If the person you are making payment for is not a company, please provide their full name.

Amount of payment you are making *

Currency

We only accept the currencies shown

Name of the bank making the payment *

Branch Address *

Town *

Post Code *

Country

Payment should be remitted to our account detailed below:
ACCOUNT :	INTACAPITAL SWISS S.A

BANK:	Revolut LTD 7 Westferry Circus E14 4HD London, UK

BIC / SWIFT:	REVOGB21

Payments in SWISS FRANCS and OTHER CURRENCIES

IBAN:	GB43 REVO 0099 6927 6407 94

Payments in EURO

IBAN:	CH79 0483 5125 5337 5200 0

Please contact us if you are in doubt as to where payment should be made.
When making payment, please quote the reference number you have been given (if applicable)

If you are human, leave this field blank.

IntaCapital Swiss SA,
Rue du Rhône 80 - 84,
CH - 1204 Genève,
Switzerland