ORDIN DE PLATA(1) / PAYMENT ORDER(1) NR./NO.
SUMA DE PLATA (in cifre)
/ AMOUNT (in numbers):
.
MONEDA / CURRENCY:
SUMA DE PLATA (in litere)
/ AMOUNT (in letters):
 PLATITOR/EMITENT / PAYER/ISSUER:
NUME / NAME:
CONT PLATITOR (IBAN):
/PAYER’S ACCOUNT (IBAN):
COD BIC / BIC CODE: DAFBRO22
BANCA PLATITOR / PAYER’S BANK: BANK LEUMI ROMANIA S.A.
 BENEFICIAR / BENEFICIARY:
NUME / NAME:
CONT BENEFICIAR (IBAN):
/ BENEFICIARY’S ACCOUNT:
BANCA BENEFICIAR:
/ BENEFICIARY’S BANK:
TARA / COUNTRY: ROMANIA
TIP TRANSFER / TRANSFER TYPE:
CONTINUT ECONOMIC AL OPERATIUNII
/ ECONOMIC CONTENT OF THE OPERATION:
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