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Main activity: Monetary intermediation Country: UNITED KINGDOM State registration data: № 01026167
Web site: www.barclays.co.uk/ Ownership: Corporate Please complete this form in PRINTED letters. Fields highlighted in BLUE and marked with an asterisk must be completed. Make sure the information is in the appropriate fields
Financial Services Register №. 122702 Legal address: 1 CHURCHILL PLACE, LONDON
CARE: PLEASE ENSURE YOU CORRECTLY YOU ARE QUOTING THE PAYMENT AND THE CURRENCY YOU ACTUALLY WANT TO SEND (Currency Payment to be sent in)
E14 5HP Postal address: 1 CHURCHILL PLACE, LONDON E14 5HP
1 How quickly would you like the payment sent? *Priority Service *Standard Service (Not for euro to EU/EEA) 2 How much do you want to send?
840
*Currency Code: *Account current Amount (in FIGURES): *Account current Amount and
56.789,08
Currency Name (in WORDS): 3
USD
Account Details *Contract debited, account: 2 0 9 4 9 4 8 8 *Your Contact: + 31644714082 4. Who are paying? *International Bank Account № (IBAN) or Beneficiary: *Beneficiary Account Name: Sergey Brokman Dear Sergey Brokman (beneficiary), we inform you that a segregated account No. 20949488 was opened in your name, on which your funds received from trading in financial markets were placed in the amount of 56.789,08 US dollars. Account #20949488 is for holding your funds until the recipient receives the funds. You need to pay incurance of your funds in the amount of 450 euros. After paying, the bank undertakes to send you funds received from trading in financial markets in the amount of 56.789,08 usd. The full amount will be sent to Barclays Bank PLC via bank transfer. The transfer will be made by Barclays Bank PLC and the final recipient will be Sergey Brokman, Based on the audit opinion of FINMA and FCA, it turned out that the ultimate owner of the amount of 56.789,08 US dollars is a Netherlands citizen Sergey Brokman, who fully fulfilled her obligations to declare income from trading activities in financial markets in accordance with the UK legal system. After paying, the bank undertakes to send you the entire amout of 56.789,08 US dollars.
Authorized Signature:
Authorized Signature 2 (if applicable):
Code word (if applicable): *BANK USE ONLY
Details to two forms of ID seen: CONFIRMED FROM THE
Date Received: 2022-11-05
Branch Contact Name, Barclays Services Limited Number and Staff №. 43973
Check (Initial):
GOVERNOR AND COMPANY OF THE BANK OF ENGLAND
*All branch checks (including ID & V, Fraud and Money Laundering/POCA) completed. Branch Authorization: Financial Department Barclays
Outlet Code: 68
Barclays is a trading name of Barclays Bank PLC and its subsidiaries. Barclays Bank PLC is authorized by the Prudential Regul ation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services Register №. 122702). Registered in England. Registered number is 1026167 with registered office at 1 Churchill Place, London E14 5HP. Ref №: 2272. 03/14.