ORDIN DE PLATA(1) / PAYMENT ORDER(1) NR./NO.
\
SUMA / AMOUNT: .
SUMA DE PLATA (in litere)
/ AMOUNT (in letters):
MONEDA / CURRENCY:
 PLATITOR/EMITENT / PAYER/ISSUER:
NUME / NAME:
CONT/IBAN:
/ACCOUNTIBAN:
COD BIC / BIC CODE: DAFBRO22
BANCA / BANK: BANK LEUMI ROMANIA S.A.
 BENEFICIAR / BENEFICIARY:
NUME / NAME:
CONT/IBANACCOUNT/IBAN:
COD BIC BANCA / BANK'S BIC CODE:
BANCA / BANK:
TARA BANCA / BANK'S COUNTRY:
COMISIOANE / COMMISSIONS: BEN OUR: SHA:
TIP TRANSFER / TRANSFER TYPE:
DETALII PLATA / PAYMENT DETAILS:
Note:
1) Va rugam sa verificati ca browserul d-voastra are optiunea javascript-enabled / Please check that your browser is javascript-enabled
2) Toate informatiile se vor completa cu majuscule / All the informations will be filled in capital letters
3) Campurile marcate BOLD sunt obligatorii / BOLD Fields are mandatory