| To: | Bank Name: | M Bank, Poland | |
| Field 56 | Swift Code / BIC : | BREXPLPWXXX | |
| (Intermediary bank) | Bank Clearing Code | ||
| For credit to: | Account Number: | PL90114000000000101939001002 | |
| Field 57 | Beneficiary Bank : | ICICI Bank Ltd., Mumbai (India) / Any other bank in India (complete branch address and IFSC code) | |
| Additional details required for crediting an Account: | |||
|---|---|---|---|
| Field 70/72 | Purpose of remittance: | ||
| Additional details required for opening a Fixed Deposit: | |||
| Field 59 | Customer ID: | ________________ (Customer ID with ICICI Bank) | |
| (Ultimate Beneficiary) | Account Name : | ________________ (Beneficiary's 12 digit A/c No. with ICICI Bank/Any other bank in India – complete account number) | |
| Field 72 | Type of Fixed Deposit: | ________________ (Resident / NRE / NRO / FCNR) | |
| Fixed Deposit details: | Tenure of Deposit: | ________________ | |
| (Additional information) | |||
| Mention the Purpose of remittance in Field 72 | |||