Received on the beneficiary-bank
PAYMENT ORDER #
________
«_____»__________________
(statement date)
Transmitter
______________________________________________
(name)
IIN/BIN
__________________________________________
Beneficiary-bank
_______________________________
______________________________________________
Beneficiary
___________________________________
(name)
IIN/BIN
_____________________________________
Beneficiary's bank
___________________________
______________________________________________
Intermediary bank
_______________________________
______________________________________________
Amount in words
______________________________
______________________________________________
Date of receiving goods (rendering services)
«_____»__________________
Payment purpose
______________________________________________
______________________________________________
______________________________________________
______________________________________________
(with indication of goods name, performed works, rendered services, numbers and dates of commercial documents, numbers and dates of the contract and other requisites)
Amount
IIC (KB)
BIC
IIC BC
BIC
BIC
Payment purpose code
Budgetary classification code
Value date
Carried out by beneficiary-bank
«_____»__________________
___________________________________________
Manager's full name
____________________________________
Signature
____________________________________________
Full name of the chief accountant
_______________________________
Signature
____________________________________________
_______________________
PS