Date of Birth (For Identification Purposes)

B OVERSEAS BANK AUTHORITY FORM

Surname: First name:

Date of Birth (for identification purposes):

Full Residential Address:

Employees Contact phone number Email:

To: Payroll Services

University of Otago

I hereby authorise the University of Otago to pay all Salary/Wages due to me into my Bank Account:

Country ______

Name of Bank: ______

Name of Account Holder ; ______

Residential Address of Bank: ______

______

Bank Contact phone number ______

Swift Code ______

BSB Number ______

IBAN Number ______

Sort Code ______

Account Number ______

Payee Tax Number ______

IFS Number ______

Routing/ABA/Fedwire number ______

Bank & Transit Number ______

NPS Code ______

Signature:

Department:

Date:

Please supply above relevant Bank Account Details as per criteria listed by the country below ;- e.g. If an Australian bank the following is required ;- Name of bank/Name of account holder/Account number/BSB number/Swift code

KEY:

·  BSB: Bank and Branch number

·  IFS: Indian Financial system code

·  NPS: Bank and Branch number

·  ABA: Bank and Branch number

Countries ;-

Australia Canada

Name of Bank Name of Bank

Name of account holder Name of account holder

Account number Account number

BSB number Bank & Transit numbers

Swift code Swift code

Europe

Name of Bank South Africa

Name of account holder Name of Bank

IBAN number Name of account holder

Swift code Account number

NPS Code

UK, as above, but alternatively Swift code

Name of Bank

Name of account holder

Account number

Sort code

Swift code

Asia

Name of Bank

Name of account holder

Account number

Swift code

Contact phone number

Brazil

Name of Bank

Name of account holder

Account number

Swift code

Payees Tax number

Contact phone number

India

Name of Bank

Name of account holder

Account number

Swift code

IFS number

Contact phone number

USA

Name of Bank

Name of account holder

Account number

Routing/ABA/Fedwire number (can be called any one of these)

Swift code