OUTGOING WIRE FUNDS TRANSFER REQUEST
WIRE AMOUNT/SOURCE
SELECT ONE WIRE DESTINATION/CURRENCY TYPE * AMOUNT TO WIRE * REPETITIVE WIRE ID # *
DOMESTIC WIRE (U.S. Dollars) CB8725452
US$ 12,500,000 NOTE: For Repetitive Wires, w here instructions are on file
INTERNATIONAL WIRE _______________________
U.S.DOLLARS ONLY
Indicate Currency Type Provide amount in the “ Currency Type” indicated w ith Bank, complete ONLY those fields w ith an asterisk *
FOREIGN CURRENCY EXCHANGE RATE SOURCE (If Applicable) ACCOUNT NUMBER / SOURCE OF FUNDS *
If OVER US $25,000 equivalent contact 1-(888) 819-8883 for a rate quote
Rat e Source: RATE SHEET FX DESK 009891112-96568/10
W/D FROM ACCOUNT #: _______________________________
0.12%
FX Rat e: ______________________________________ 06/12/15
Value Dat e_________________
CASH - Credit ed by Branch t o GL 242830/cc 510
I.R.O 21.00 (Prior Risk & Operations approval required if over branch limit)
Quot ed By: _________________________ USD Equivalent $ : ____________________
(Trader’ s Name) CHECK - Credit ed by Branch t o GL 242830/cc 510
Citib73656367/15
Ref erence #: ______________________________________________________________ (Prior Risk Management approval required if over branch limit)
ORIGINATOR INFORMATION *
ORIGINATOR’S NAME * ORIGINATOR’S CONTACT PHONE NUMBER *
Mr. Raymond Mcguire 646-741-9904
PAYMENT INSTRUCTIONS
WIRE TO RECEIVING BANK’S NAME CREDIT TO ACCOUNT NAME
Wells Fargo Bank, N.A. qNETIQ Inc
RECEIVING BANK’S ADDRESS CREDIT TO ACCOUNT NUMBER
Turtle Creek Branch, 6093 US Hwy 98, 3574052951 (USD)
Hattiesburg, MS 39402-U.S.A International Wires ONLY: check here ONLY if t his is a USD account
FURTHER CREDIT TO ACCOUNT NUMBER (If Applicable)
3574052951 (USD)
(If foreign bank address, please include both CITY and COUNTRY information.)
RECEIVING BANK’S ABA (for domestic) or SWIFT Number (for international) FURTHER CREDIT TO ACCOUNT NAME (If Applicable)
ABA Number: 062203751 qNETIQ Inc
SWIFT Code: WFBIUS6S
MESSAGE OR REFERENCE * RECIPIENT’S NAME, ADDRESS, PHONE NUMBER
Transfer is in favour of qNETIQ Inc,11 MacArthur qNETIQ Inc,11 MacArthur Blvd. - Suite 103E
Blvd. - Suite 103EHaddon Twsp, New Jersey 08108 Haddon Twsp, New Jersey 08108
United States United States
ORIGINATOR’S AUTHORIZATION *
By Signing below, I agree to the terms accompanying this form.*
(Originat or’ s Signat ure) (Dat e) (Originat or’ s Signat ure) (Dat e)
BANK USE
ORIGINATOR’S ID and TIN INFORMATION* REQUEST TYPE / CALLBACK RESULTS
* Phone / FAX / E-Mail Requests - 1.) MUST
Driver’ s License Passport Green Card In Person Letter (Attached) Phone* FAX * E-Mail* adhere to Bank callback requirements; and 2.)
MUST have a Funds Transfer Designation and
Ot her: ___________________________________ Mr. Raymond Mcguire
No FTA Form - Approval By: _______________________________________ Authorization (FTA) on file. If NO FTA is on
(Printed Name - approving Branch Manager or Risk & Operations Employee.)
U.S.A Government file, the request must be approved by the
Issued By: _________________________________ Branch Manager (up to $200,000) OR Risk
Callback Completed w /Auth Customer No Callback (FTA Waiver)
450729975 & Operations (if over $200,000)!
Serial Number: ______________________________ qNETIQ Inc
Aut horized Cust omer’ s Name: _______________________________________
FEE AMOUNT
NIL
Tax ID Number: ____________________________ Citibank
Callback/FTA Verif ied By: ___________________________________________ 12,500
$ _____________
(Printed Name & Initials – employee w ho completed callback or verified FTA w aiver.)
BRANCH/DEPARTMENT USE ONLY WIRE DEPARTMENT USE ONLY
INSTRUCTIONS ACCEPTED BY (Printed Name & Signature) Dept./Branch Name or # WIRED BY (Printed Name & Signature)
JP Morganchase Bank,United States of America, Foreign Operations Mr. Raymond Mcguire
Date Accepted Time Accepted Test Key Reference Number Test Key Result Number VERIFIED BY (Printed Name)
A.M.
P.M.
SUPERVISOR/AUTHORIZED EMPLOYEE APPROVAL (2nd signature required if over limit) CALLBACK VERIFICATION BY (Printed Name)
(Verification of request form, cust. ID, payment method, request type and customer’ s authority as an authorized account signer.)
(Verified With – Printed Name) DATE WIRE EXECUTED
________________________________ _________________________________
Approval Signature “ Over Limit” Approval Signature (as required by policy)
__________________________________________ ___________________________________________
Printed Name REQUIRED Printed Name REQUIRED
WIRE2012.DOC / Rev. 09-2012
Funds Transfer Terms
1. Customer (“ You” ) authorize East West Bank (“ us” ) to make the funds transfer described on this form.
2. You agree to hold us harmless from any loss w hich occurs if your instructions are incomplete, ambiguous or
incorrect. We are not required to seek clarification from anyone regarding ambiguous instructions. If w e
cannot complete a transfer (e.g., because of an ambiguity), w e w ill notify you orally or in w riting by the end
of the next business day.
3. If you identify the Beneficiary, the Beneficiary Bank or an Intermediary Bank by name and number, payment of
the order may be made based on the number alone, even if it identifies a person or bank different from that
show n on the front of this form.
4. We may transfer funds through an intermediary bank or funds transfer system w hich is different from that
show n in your instructions.
5. If w e receive your payment order after our processing cutoff hour or on a Saturday, Sunday or holiday, w e
may process it on the next funds-transfer business day. A delay may also occur if an Intermediary Bank or
the Beneficiary’ s Bank is not accepting a payment order (e.g., due to a local holiday).
6. You do not have a right to cancel or amend your order. You agree to hold us harmless from all claims and
damages, how ever, if w e attempt (successfully or otherw ise) to comply w ith your request. If your order
involves foreign exchange, and w e attempt to comply w ith your cancellation or amendment request, or if w e
do not send the transfer because insufficient funds are in your account, our damages may include losses due
to exchange rate fluctuations and other costs of canceling, amending or covering the order from any counter
party to the order.
7. If your transfer is made from an account w ith us, it w ill be reflected on your next periodic statement. You
w ill not receive any other notice from us regarding your transfer. You agree to notify us immediately if you
notice any discrepancy betw een your statement and this payment order or you discover a problem w ith your
transfer. You must send us a w ritten notice of the problem, including a statement of the relevant facts,
w ithin a reasonable time (not to exceed 14 days from the date you first discover the problem or receive a
statement or notice reflecting the erroneous transfer, w hichever occurs first). Upon requesting a payment
order w e reserve the right, prior to debiting your account for the requested transfer, to place a hold on your
account for the amount of funds requested to be transferred.
8. All foreign transfers w ill be sent in the foreign currency type indicated or, if no currency type w as provided, in
the currency type selected by us based on the country the funds are being delivered to. Foreign transfers may
be subject to delays, charges imposed by other banks and changes in foreign currency exchange rates and/or
currency type delivered to the beneficiary. You agree to and accept the foreign exchange rate (FX Rate)
indicated or otherw ise provided by us at the time the foreign transfer w as sent.
9. We w ill not be liable for consequential, special or exemplary damages or losses of any kind. We w ill not be
liable for any failure to act or delay due to: a lack of sufficient available funds in your account; circumstances
beyond our reasonable control; fire, flood or natural disasters; communication failures; labor disputes; any
inaccuracy or ambiguity in your instructions; the action or inaction of others; or any applicable government or
funds-transfer system rule, policy or regulation.
WIRE2009-back.DOC / Rev. 8-2009
