Release Agency Name*

Consignee Name*

Name of Refund Party* Must be the name on the receipt or Consignee

E-mail address Email notifications will be sent to this email address

Mobile number* e.g 233541234567

Alternative email address Optional

Bill of Lading Number*

Additional Bill of Lading Numbers Please separate individual Bill of Lading numbers with a '-'

Discharge Port* ------ please select ------TemaTakoradi

Maersk ATM or Transfer* ------ please select ------ATMTransfer

Bank Name* ------ please select ------Access Bank ADB ARB Apex Bank Limited Bank of Africa Ghana Limited Bank of Baroda Ghana Limited Barclays Bank of Ghana Limited BSIC Ghana Limited CAL Bank Limited Consolidated bank Ghana Ecobank Ghana Limited Energy Bank Ghana Limited FBNBank Ghana Limited [2] Fidelity Bank Ghana Limited First Atlantic Bank Limited First National Bank Ghana Limited/*First International Bank GCB Bank Limited GN Bank Limited Guaranty Trust Bank (Ghana) Limited Heritage Bank Limited HFC Bank Ghana Limited/Republic Bank Nandom Rural Bank Limited National Investment Bank Limited OmniBank Ghana Limited Premium Bank Prudential Bank Limited Sahal Sahara Bank Societe Generale Ghana Stanbic Bank Ghana Limited Standard Chartered Bank Ghana Limited United Bank for Africa Ghana Limited Universal Merchant Bank Ghana Limited Women world Bank Zenith Bank Ghana

Account/Card Name*

Account/Card Number*

Bank Branch/Sort Code* e.g 030106