EFTA Document EFTA01386965

1 First Bank Transfer Application BRANCH NO. PREFIX TEST KEY DATE TIME TRANSFER TYPE: ID WIRE O CABLE O DRAFT O Mail to Customer O Mall to Payee I: Send to Branch REP SIGNATURES (Complete appr date boxes): KEY TMODIFY MODIFY APPROVE IF TRANSFERRING FOREIGN CURRENCY: CONTRACT NO VALUE DATE CONVERSION RATE CONVERTED BY (Initials) TRANSFER AMOUNT (FOR BANK USE ONLY) FOREIGN CURRENCY (Type and Amount) TRADER'S NAME U.S. DOLLARS $ 52,500.00 MOTEL • Eamon currency anoint muMplied by the exchange rate =US. dollar Amount. ADDITIONAL FEES $ • U.S. Dollar amount divided by the exchange RN 2 Resign Currency Amount. TOTAL AMOUNT $ — 1 METHOD OF PAYMENT: INTERMEDIARY CORRESPONDENT BANK: (If necessary) DEBIT BRANCH/DEPT. NO. 717 ABA ROUTING NO.ISWIFT CODE J. Epstein Virgin Islands Foundation BANK NAME NAILING ADDRESS: 6100 RED HOOK QTR. B3 ADDRESS PHYSICAL ADDRESS: SAME CITY, STATE, ZIP CODE, COUNTRY ST. THOMAS, VI, 00802-1348, USA CITY, STATE, ZIP CODE, COUNTRY TO: PAYEEIBENEFICIARY'S BANK FOR: PAYEE/ACCOUNT OF ULTIMATE BENEFICIARY BANK CODE 021001033 BANK NAME DEUTSCHE BANK NAME/ACCOUNT LE J. Epstein Virgin Islands Foundation Inc. ADDRESS 345 Park Avenue, ADDRESS 6100 RED HOOK QTR B3 CITY, STATE, ZIP CODE. COUNTRY NEW YORK, NY 10154 CITY, STATE, ZIP CODE,COUHTRY ST. THOMAS, VI 00802 ORIGINATOR REFERENCE: BENEFICIARY REFERENCE: I I I I I I I I I I I I I I 1 1 1 SPECIAL. INSTRUCTION& (0pteneg THE UNDERSIGNED AGREES TO THE CONDITIONS ON THE REVERSE SIDE OF THIS APPLICATION. CUSTOMER'S TELEPHONE DATE OF APPLICATION: 912)2018 7 -- - omen Signature DAVIS'S &Mare WAPPiCablel FOR BANK USE ONLY CUSTOMER'S TRANSFER REQUEST: Complete appropriate boxes) FAX 0 IN PERSON PHONE O MAIL/MESSENGER I.O. USED Marta leave blank) O Telephone/Fax agreement on file CALLBACK IF OVER $ LIMIT: il One tine only transaction O Hold placed By O SOoke to I N lime TAKEN IN BY (Print Name) INITIALS TEST KEY CALCULATED BY Of (Omni then taken kw by) INITIALS BRANCH AUTHORIZED SIGNER (Print Name) BRANCH TELEPHONE NO.. ( ) - BRANCHAUTHCRIZED SIGNATURE NNNN•2198.12OBR Paps 1 or 2 CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) CONFIDENTIAL DB-SDNY-0088927 SDNY_GM_00235111 EFTA01386965