Shieldpay | Yield Payee Form

Payee Verification Form

Please provide all the following data ENCRYPTED

Email Address

Full Legal Name / Company Name

Date of Birth / Date of Incorporation

Residential/Business Address ENCRYPTED

Address Line 1

Address Line 2

City / Town

Country

State/Region/Province

Post Code / Zip Code

Please provide the required payment account details ENCRYPTED

Swift/BIC ENCRYPTED

IBAN ENCRYPTED

Swift/BIC ENCRYPTED

Account Number ENCRYPTED

Routing Code ENCRYPTED

Swift/BIC ENCRYPTED

Account Number ENCRYPTED

BSB/Routing Code ENCRYPTED

Swift/BIC ENCRYPTED

IBAN ENCRYPTED

Tax ID ENCRYPTED

Tax Type ENCRYPTED

Purpose of Payment ENCRYPTED

Swift/BIC ENCRYPTED

Account Number ENCRYPTED

Purpose of Payment ENCRYPTED

Swift/BIC ENCRYPTED

Account Number ENCRYPTED

Purpose of Payment ENCRYPTED

Bank Branch Address ENCRYPTED

Swift/BIC ENCRYPTED

Account Number ENCRYPTED

Routing Code ENCRYPTED

PRN ENCRYPTED

Other Information ENCRYPTED

Bank Statement (scan or document) ENCRYPTED