Please forward the following CHAPS payment to HM Revenue and Customs. Please ensure that all of the details marked with an asterisk (*) are submitted with the payment, in the stipulated fields (and lines where shown), exactly as they appear in the box. 



For Bank Use Only 
 
Swift Field 
 
32A* 
Date Payment To Be Made (ddmmyyyy) 

  CUSTOMER DETAILS 
 
50K Line 1* 
Account Name To be Debited 
 
 
50K Lines* 
2-5 
Customer Address 
Account Number To Be Debited 
 
 
Sort Code (Account Holding Branch) 
32A* 
Currency Code (GBP or Eur) 
 
 
32* 
Amount 


Amount in words 

  BENEFICIARY DETAILS 
 
57DK Line 1* 
Sort Code (Beneficiary Bank) 
//SC08 32 10 
57D Lines* 2-5 
Bank Name 
Citibank 
 
58D* 
Account Number To Be Credited 
12001039 
58D 
Beneficiary Name 
HMRC Cumbernauld 
 
   ADDITIONAL INFORMATION 
 
 
70 Line 1* 
Accounts Office Reference  
(for example 123PA00012345) 
 

Please ensure that full details are forwarded to the Accounts Office 3 days before payment 

 
 
…………………… 
DATE 
SIGNATURE(S)