Withdrawal_Request

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					                                                                                ‫‪One Route 17 South‬‬    ‫062 ‪Suite‬‬                         ‫‪Saddle River, NJ 07458 USA‬‬
                                                                                          ‫0122-543-102 :‪Phone‬‬                          ‫0252-543-102 :‪Fax‬‬




                                                                                    ‫ﻧﻤﻮذج ﻃﻠﺐ ﺳﺤﺐ‬
                                                                              ‫ﻳﺘﻮﺟﺐ اﺗﻤﺎم اﻟﻤﻌﻠﻮﻣﺎت اﻟﺘﺎﻟﻴﺔ ﺑﺎﻟﻜﺎﻣﻞ.‬

                                                                                     ‫ﻧﻮع اﻟﺤﺴﺎب:‬                                            ‫‪FX‬‬                 ‫رﻗﻢ اﻟﺤﺴﺎب :‬
                                                      ‫□ أﻋﻤﺎل‬         ‫□ ﻣﺸﺘﺮك‬          ‫ﻓﺮدي‬        ‫□‬                                                                          ‫اﺳﻢ اﻟﻤﺴﺘﺨﺪم:‬

                                                                 ‫ﻗﻴﻤﺔ اﻟﺴﺤﺐ ﺑﺎﻟﺪوﻻر اﻻﻣﺮﻳﻜﻲ:‬                                                                                   ‫اﺳﻢ اﻟﺰﺑﻮن :‬


                                                                                                                              ‫ﻣﻌﻠﻮﻣﺎت اﻟﺰﺑﻮن )ﻳﺠﺐ أن ﺗﻄﺎﺑﻖ ﺗﻠﻚ اﻟﺘﻲ ﻋﻠﻰ ﻧﻤﻮذج ﻃﻠﺐ اﻟﺤﺴﺎب(‬
                                                                    ‫رﻗﻢ اﻟﻬﺎﺗﻒ‬                                                                                        ‫ﻋﻨﻮان اﻟﻤﺮاﺳﻠﺔ‬

                                                                            ‫اﻟﺒﻠﺪ‬                                                                                                  ‫اﻟﻤﺪﻳﻨﺔ‬
                                                              ‫اﻟﺮﻣﺰ اﻟﺒﺮﻳﺪي‬                                                                                          ‫اﻟﻮﻻﻳﺔ/ اﻟﻤﻘﺎﻃﻌﺔ‬
                                                                                                                                                             ‫ﻋﻨﻮان اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬

                                                                    ‫اﻟﺒﻨﻚ اﻟﻮﺳﻴﻂ : )اذا آﺎن ﺿﺮورﻳﺎ(‬                                                                           ‫اﻟﺒﻨﻚ اﻟﻤﺴﺘﻔﻴﺪ:‬
                                                                      ‫ﺷﻴﻔﺮة ‪ABA‬او ﺳﻮﻳﻔﺖ‬                                                                       ‫ﺷﻴﻔﺮة ‪ABA‬او ﺳﻮﻳﻔﺖ‬


                                                                                       ‫اﺳﻢ اﻟﺒﻨﻚ‬                                                                                ‫اﺳﻢ اﻟﺒﻨﻚ‬


                                                                                     ‫ﻋﻨﻮان اﻟﺒﻨﻚ‬                                                                          ‫ﻋﻨﻮان اﻟﺒﻨﻚ‬


                                                                                     ‫اﺳﻢ اﻟﻤﺴﺘﻔﻴﺪ‬                                                                         ‫اﺳﻢ اﻟﻤﺴﺘﻔﻴﺪ‬


                                                                                    ‫رﻗﻢ اﻟﺤﺴﺎب‬                                                                            ‫رﻗﻢ اﻟﺤﺴﺎب‬


                                                                                                                 ‫‪FX Solutions LLC‬‬    ‫● ﺻﺎﺣﺐ اﻟﺤﺴﺎب هﻮ اﻟﻤﺮاﺳﻞ اﻟﻮﺣﻴﺪ اﻟﻤﻌﺘﻤﺪ ﻟﺪى‬
                                                                                                                                   ‫● ﻗﺪ ﻻ ﺗﺠﺮي دﻓﻌﺎت ‪ FX Solutions LLC‬ﻟﻄﺮف ﺛﺎﻟﺚ‬
                                                                             ‫هﻞ ﺳﻴﺘﻢ اﻏﻼق ﺣﺴﺎﺑﻚ؟‬                                                                                 ‫ﻃﺮﻳﻘﺔ اﻟﺪﻓﻊ‬

              ‫ﻻ )05 دوﻻرا آﺤﺪ ادﻧﻰ ﻟﻠﺮﺻﻴﺪ ﻟﻠﺤﻔﺎظ ﻋﻠﻰ اﻟﺤﺴﺎب(‬    ‫□‬                        ‫ﻧﻌﻢ‬   ‫□‬                                                          ‫□ ﺷﻴﻚ □ ﺣﻮاﻟﺔ‬

            ‫) ﻣﻼﺣﻈﻪ: ﻓﻲ ﺣﺎل اﻏﻼق اﻟﺤﺴﺎب ﻓﺎن ‪ FX Solutions‬ﺳﻮف ﺗﻐﻠﻖ ﺟﻤﻴﻊ اﻟﻤﺮاآﺰ اﻟﻤﻔﺘﻮﺣﻪ وﻓﻘﺎ ﻟﺴﻌﺮ اﻟﺴﻮق اﻟﺤﺎﻟﻲ اذا ﻟﻢ ﻳﺘﻢ ذﻟﻚ ﻣﻦ ﻗﺒﻞ اﻟﻌﻤﻴﻞ.(‬
                                                                                                               ‫ﺳﻴﺘﻢ ﺗﻨﻔﻴﺬ ﺟﻤﻴﻊ ﻃﻠﺒﺎت اﻟﺴﺤﺐ ﺧﻼل ﻳﻮﻣﻲ ﻋﻤﻞ ﺑﻌﺪ اﺳﺘﻼم هﺬا اﻟﻨﻤﻮذج.‬

                                                 ‫ﻳﺘﻮﺟﺐ اﺗﻤﺎم اﻟﻤﻌﻠﻮﻣﺎت ﺑﺎﻋﻼﻩ ﺑﺎﻟﻜﺎﻣﻞ ﻣﻦ اﺟﻞ اﺟﺮاء هﺬا اﻟﺘﻌﺪﻳﻞ‬
‫اﻧﺎ / ﻧﺤﻦ اﺻﺮح / ﻧﺼﺮح هﻬﻨﺎ ﺑﺎن اﻟﻤﻌﻠﻮﻣﺎت اﻟﺘﻲ ﻗﺪﻣﺘﻬﺎ/ ﻗﺪﻣﻨﺎهﺎ ﺣﻘﻴﻘﻴﻪ وﺻﺤﻴﺤﻪ. آﻤﺎ اﻧﻨﻲ/ اﻧﻨﺎ اﻗﺮ/ ﻧﻘﺮ ﺑﺎﻧﻨﻲ / ﺑﺎﻧﻨﺎ ﺳﺎﻗﻮم/ ﺳﻨﻘﻮم ﺑﺎﻋﻼم ‪ FX Solutions‬ﺣﻮل اﻳﺔ ﺗﻌﺪﻳﻼت ﻣﺎدﻳﻪ ﺧﻄﻴﺎ. آﻤﺎ ﺗﺤﺘﻔﻆ ‪FX‬‬
                                                                       ‫‪ Solutions‬ﺑﺤﻖ، وﻟﻜﻦ ﻻ ﻳﺘﻮﺟﺐ ﻋﻠﻴﻬﺎ، اﻟﺘﺄآﺪ ﻣﻦ دﻗﺔ اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﻘﺪﻣﻪ واﻻﺗﺼﺎل ﻣﻊ ﻋﺪة ﻣﺼﺎدر آﻤﺎ ﺗﺮاﻩ ﻣﻨﺎﺳﺒﺎ .‬

                             ‫اﻟﺘﺎرﻳﺦ‬                                        ‫ﺗﻮﻗﻴﻊ اﻟﺰﺑﻮن اﻟﻤﺸﺘﺮك‬                         ‫اﻟﺘﺎرﻳﺦ‬                                    ‫ﺗﻮﻗﻴﻊ اﻟﺰﺑﻮن اﻷﺳﺎﺳﻲ‬


                                                                              ‫اﺳﻢ اﻟﺰﺑﻮن اﻟﻤﺸﺘﺮك‬                                                                                      ‫اﻷﺳﻢ‬




                                                                                                                                                                                  ‫ﺗﻌﻠﻴﻘﺎت:‬


                                                                                                                            ‫اﻟﺮﺟﺎء إرﺳﺎل ﺟﻤﻴﻊ اﻟﻄﻠﺒﺎت ﻟﻠﺘﻨﻔﻴﺬ ﻋﻠﻰ ﻓﺎآﺲ: 5252543102‬
                                                                                                                                                  ‫ﺷﻜﺮ ﻟﺘﻌﺎﻣﻠﻚ ﻣﻊ ‪FX Solutions‬‬

				
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posted:6/17/2008
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