EIB 07-01A, Sectio Electronic Claim Filing System, Short-Term Insurance

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Short-term Multi-buyer Policy Claim
Section H - Wire Instructions

Claim Control No.:CAP0001091 (Draft)

( * An asterisk denotes that a field is a required entry)

Routing Bank Name

*

Routing Bank Street Address

*

Routing Bank City

*

Routing Bank State

*

Routing Bank Zip

*

Routing Bank Contact Name

*

Recipient Bank Name

*

ABA #

*

Account Name

*

Account #

*

RE: Ex-Im # (AP #):

*

Attention:

*

Borrower:

*

https://tpccapps.exim.gov/apps/ecfs/ecfsprod.nsf/0/C5F06371BE872037852572A4004D4...

3/20/2007