Bhutan National Bank Limited

MoneyGram Claim Form

This online remittance claim form is brought to you by Bhutan National Bank Ltd. and the facility is currently made available for BNB account holders only.

Please fill up all the particulars correctly to avoid erroneous transactions.

IF YOU DO NOT HAVE AN ACCOUNT AT BNBL, PLEASE VISIT THE BRANCH/EXTENSION OFFICE NEAREST TO YOU, TO CLAIM THE FUNDS RECEIVED. PLEASE CARRY YOUR CID WITH YOU.

More details are provided in the subsequent paragraphs.

MoneyGram Reference Number: Please enter here the MoneyGram Reference Number that you have received.

Receiver Details

Please enter all the details correctly. All fields are mandatory.

Title:

Your Name: Please enter your complete name in the order: First Name, Middle Name, Surname

Your Occupation:

Date of Birth: Please enter your date of birth in the correct format.

Country of Birth:

Permanent Address

Please fill in the following details completely in order to avoid rejection.

Village:

Gewog/Throm:

Dzongkhag:

Present Address

Please fill in the following details completely in order to avoid rejection.

Current Address: Please provide your complete address here. You should include Street Number (if any), Street Name, Village, Geog, Dungkhag/Throm.

Dzongkhag where you reside currently:

Postal Code: Please enter the postal code here. IF YOU DO NOT HAVE/KNOW THE POSTAL CODE, ENTER "0000"

Country where you reside currently:

Contact Number: Please enter the mobile number registered with the bank.

Email Address:

Citizenship Identification Number: Please enter your CID/ Passport/ SRP number as registered with the bank.

Your relationship with the sender:

Copy of CID:

Additional Document (Optional):

Bank Details

Please enter your bank details correctly

Bank Name: This facility is currently available for BNB account holders only.

Bank Branch/Extension Please select the name of the branch/extension where you opened/have your account.

Bank Account Number:

Full Name of the Account Holder: Please note that the name in this field will be matched with the name of the receiver (the name you entered at the beginning) and the transaction processed only if they match.

Sender/ Remitter

Please enter the correct details of who sent you the money

Title:

Name of the Sender: Please enter the full name of the sender in the following order: First Name, Middle Name, Surname.

Purpose of Remittance:

Indemnity

By Submitting this form to the Bank, I hereby confirm that all the details entered by me are correct, and based on this submission, I acknowledge the receipt of the MoneyGram transfer as per the reference number I have mentioned at the beginning of this form.

I also agree that the transaction carried out by the bank based on the details as submitted is acceptable to me, and I shall be solely responsible in case the details provided by me are wrong and the transaction is processed into a wrong account.

Submission of this form to the Bhutan National Bank shall be treated as equivalent to your signing on the physical MoneyGram Claim Form.

The transaction shall be processed only if you click on "I Agree".

I Agree

I Disagree