Withdrawal Request Withdrawal Request

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					                                       Withdrawal Request
           Please note: Funds will be returned to the original source only.
Funds that were deposited by credit card or payment method will be refunded into the same
          Credit Card or payment method account with minimum documentation and verification.
I hereby authorize Bloombex Ltd. to execute the following wire transfer on my behalf.
Please complete all relevant fields for withdrawal type.

Client’s Information
Customer Name
Withdrawal Amount
Base Currency of Account
Telephone # (work/home/mobile)
Email Address
Country of Citizenship
ID/Passport Number
Trading Account Number
    •                  TO CLOSE’
         Please write ‘TO CLOSE in the ‘Withdrawal Amount’ field if your account is to be closed – In this
         case any open positions may be closed out at the market rate if not done so by the client.
    •    Please note that any transfer charges will be passed on to the client.
Withdrawal method information:
Beneficiary Name

Address, City, State, Zip, Country

Beneficiary Bank Name
Bank Address
Branch Number/Sort Code
Beneficiary Acc. No.
Intermediary Bank Name
Intermediary Bank Address
Beneficiary Bank Acc. No.
Credit Card Type & Number or
Moneybookers                  or
Liberty Reserve               or

Withdrawals may take up to 7 business days
Note that Bloombex Ltd will not make a third party payment. ‘Customer Name’ and ‘Beneficiary Name’
must be identical.
Withdrawal Fees:
•   Credit Card - 3.5% fee on withdrawals
•                    $15.00 minimum,
    Bank Transfers - $15.00 minimum depending on bank rates
•   Moneybookers – 3% fee on withdrawals.
•   Liberty Reserve – 1% fee on withdrawals.
•   PayPal - 3.4%+ 0.5SGD fee on withdrawals.

Customer Signature:                                                 Date:
Please sign this request and fax to +65 67 250 706 or scan it and send it to

Bloombex Ltd. – Palm Grove House, Wickham's Cay, Road Town, Tortola, British Virgin Islands

Shared By:
Description: Liberty Reserve (LR) registered in the United States, began operations in 2001, and its and EG, EB, Department of online banking and so on for the gold. LR online banking support 5 weight protection: 1. password; 2. login PIN code; 3. Safety Code; 4 .. safety; 5. the virtual keyboard. which, password, login PIN, security issues, the time of registration by the User settings, and security codes after the success of the user registration system automatically given. Moreover, the landing provides a virtual keyboard mode account password to prevent password theft. Site itself does not provide deposit and withdrawal services. But through the changer used to access the funds.