BUSINESS WIRE INSTRUCTIONS AND REQUEST FORM

Cut-off Times:
Outbound Domestic Wires: 1:00pm PST Outbound International Wires: 12:00pm PST
* Foreign transfers may be subject to delays. Completed domestic wire forms received prior to 1:00pm PST and
international wire forms received prior to 12:00pm PST will be processed the same day. Completed domestic wire
forms received after 1:00pm PST and international wire forms received after 12:00pm PST will be processed the
next business day.
Inbound Wire Instructions: (Funds transferred into an Axos BankTM account)

Provide the following information to the transferring institution:

For Domestic Wires: For International Wires (must be sent in US dollars):
Axos Bank Axos Bank
San Diego, CA 92122 San Diego, CA
ABA # 122287251 ABA # 122287251
Intermediary Bank
Pacific Coast Bankers’ Bank
San Francisco, CA 94104
Swift Code: PCBBUS66
ABA # 121042484
For the benefit of:
Your Name and Your Account Number with Axos Bank

Outbound Wire: (Funds transferred out of an Axos Bank account)

Complete the wire form below and fax to (858) 350-0443, email to businessbankingwires@axosbank.com, or
login to your online banking to send your completed request form via secure message.
Contact Us:
Should you have any questions, please contact us at (888) 502-2967; our Relationship Managers are
available to answer your questions 9:00 am to 5:00 pm PST, Monday – Friday.

WIRE TRANSFER AGREEMENT AND DISCLAIMER

WIRES WILL ONLY BE SENT TO CREDIT THE SAME NAME(S) AS THE AXOS BANK CUSTOMER ORIGINATING
THE WIRE.
1. I (we) the Account Holder(s) authorize Axos Bank ("Bank") to make the wire transfer described on the attached form.
2. I (we) request Axos Bank to effect this transfer at my (our) risk to such person(s) as the receiving bank believes to be the
within name payee. This may be based solely on the ABA and/or Account Number(s) that have been provided by me (us).
3. You agree to hold Axos Bank harmless from any loss that occurs if your instructions are incomplete, unclear or incorrect. The
Bank is not required to seek clarification from anyone regarding ambiguous instructions. If we cannot complete a transfer
due to unclear or inaccurate instructions, we will notify you orally or in writing by the end of the next business day.
4. For security purposes, Axos Bank may require further verification of wire requests via phone or e-mail. Successful verification
of these wires must be completed prior to processing the request. Therefore, it is important that your contact information on
file with Axos Bank is correct.
5. Axos Bank may transfer funds through an Intermediary Bank or funds transfer system that is different from that shown in
your instructions. Foreign transfers may be subject to delays, charges imposed by other banks, and changes in foreign
currency exchange rates. The Bank will not be responsible for any changes in an exchange rate involved with a foreign
transfer. Refunds, if necessary, will be at the Bank’s current buying rate for exchange at the time of such refund.
6. If the Bank receives your domestic payment order after 1:00pm PST, or international payment order after 12:00pm PST, or on
Saturday, Sunday or holiday, it may be processed on the next funds-transfer business day.
7. You may only cancel or amend your order prior to the wire transfer being sent by the Bank. You agree to hold Axos Bank
harmless from all claims and damages, however, if the Bank attempts (successfully or otherwise) to comply with your
cancellation or change request.
8. You agree to notify the Bank immediately if you notice any discrepancy involving the posting of your payment order or if
you discover a problem with your transfer. You must send us a written notice of the problem, including a statement of the
relevant facts, within a reasonable time (not to exceed 10 days from the date you first discover the problem or statement
cycle, whichever occurs first).
9. Axos Bank will not be liable for consequential, special, punitive, or exemplary damages or losses of any kind. We will not be
liable for any failure to act or delay due to: a lack of sufficient available funds in your account; circumstances beyond our
control; fire, flood, or natural disasters; communication failures; labor disputes; any inaccuracy in your instructions; the action
or inaction of others; or any applicable government or funds-transfer system rule, policy, or regulation.
10. If you agree to the terms and conditions above, please complete the Wire Transfer Instructions on the next page (page 2)
along with an original signature. Electronic signatures are not accepted.

1
 Fax #: 1-858-350-0443
Business Wire Transfer Request Form businessbankingwires@axosbank.com
*Indicates required field
Bank Use Only
*Wire Destination:
Net Wire Amount:
Domestic (Inside US) International (Outside US)
Section A – Originating Axos Bank Customer Information Section B – Wire Transfer Amount
*Complete one of the following options:
0233718412-2 1. $ 6250 + Fee
*Your Full Axos Bank Account Number Amount of wire
-- OR -
JONATHAN AZCARCEGA LINARES 2. Account Closure:
*Axos Bank– Customer Name / Account Title Check one of the following:
Main Holder Closure: Balance of account less wire fee
Joint Name on Account (if applicable)
CD Closure prior to maturity: Balance of account
Payment less penalty and wire fee
*Purpose of Wire Transfer If a wire is returned, an additional wire fee will be deducted for resubmission of the
same wire. Wire fees are non-refundable.

Section C - Beneficiary / Recipient Information

MAURICIO DANIEL NADA DE DOMINICIS 4065292732

*Beneficiary Name (Recipient of the Wire Transfer) *Beneficiary Account Number
GAMA LABS CHEMICALS PASEO DE LA REFORMA 156
Joint Beneficiary Name (if applicable) *Address
MEZZANINE MEXICO
Further Credit/Instructions/Comments (Example: Escrow Number) *City and State

Section D – Beneficiary Bank Information

This is the financial institution where the beneficiary maintains their account

BANCO HSBC BIMEMXMM

*Bank / Financial Company Name *ABA or Routing Number (must be nine digits)/ IBAN Number
PASEO DE LA REFORMA 156 0216910406529227329
Receiving Bank’s Address (*International wires) SWIFT/BIC Code (*International wires)

MEXICO
Receiving Bank’s City and State (*International wires)

Section E – Intermediary Bank Information (This section is not required on all wires)
This is the bank that the wire must pass through before reaching the beneficiary bank

——————— —————————
Financial Institution’s Name Financial Institution’s Account Number / ABA Number

Section F – Authorized Signatures (Electronic signatures not accepted)

I acknowledge that I have read Axos Bank’s Wire Transfer Agreement and Disclaimer and agree to the terms and conditions contained
therein.

*X X

* Date:
18/02/2022 Date:
18/02/2022

BANK USE ONLY

OFAC Clear: Funds Verified:
Customer Call:
Funds Memo Posted: Input / Prepared by:

Wire Fee: $ Charge Acct: Approved by:

©2018 Axos Bank. All Rights Reserved.

DEP 155 (10/18)