Shieldpay | Delphi 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

Bank Name

Bank Country

Bank Account Currency

The default payment currency is EUR. Shieldpay will exchange the payment to the currency of your provided bank account. If you do not want foreign exchange applied to this transaction, please opt out by selecting this box.

Opt out of Foreign Exchange

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

Delphi Payees

Payee Verification Form