Blank Western Union Form

The Western Union form is a document used for sending and receiving money through Western Union's services. It provides essential information such as sender and receiver details, transaction amounts, and payment methods. Completing this form accurately is crucial for ensuring a smooth transfer process.

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Structure

Misconceptions

Many people have misunderstandings about the Western Union form. Here are some common misconceptions, along with clarifications to help clear them up.

All forms are the same. Different transactions may require different forms. Always check that you have the correct form for your specific needs.
Western Union forms can be filled out by anyone. While many forms are straightforward, some transactions may require specific information or identification from the sender or receiver.
Filling out the form incorrectly is not a big deal. Mistakes can lead to delays or even the rejection of the transaction. Always double-check your information.
There is no need to keep a copy of the form. It is advisable to retain a copy for your records. This can help resolve any issues that may arise later.
Only cash transactions require a form. Forms are necessary for various types of transactions, including money orders and electronic transfers.
Once submitted, the form cannot be changed. In some cases, corrections can be made, but it is best to address any issues before submission.
Western Union forms are only available in English. Many locations offer forms in multiple languages to accommodate diverse customers.
Using the form is complicated. The process is designed to be user-friendly. Most people find it manageable with a little attention to detail.

Detailed Steps for Filling Out Western Union

Filling out the Western Union form is a straightforward process. It requires specific information to ensure that your transaction is processed smoothly. Follow these steps carefully to complete the form accurately.

Begin by entering your personal details. Provide your full name, address, and contact information.
Next, indicate the recipient's information. Include their name, address, and contact number.
Specify the amount of money you wish to send. Ensure that you enter the correct currency.
Choose the payment method. You may select options such as cash, debit card, or credit card.
Review the transaction details for accuracy. Double-check names, addresses, and amounts.
Sign and date the form to confirm your agreement with the terms and conditions.
Submit the completed form at your local Western Union location or online, depending on your chosen method.

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1800 501 500

*1235 Send Money

*1236 Receive Money

CUSTOMER NAME

PLEASE PRINT CLEARLY. Identification is required for all customers: Current Passport, Australian Drivers Licence or Proof of Age Card.

Full Legal	First	Middle	Last
Name

EXISTING CUSTOMERS

NEW CUSTOMERS

or updated details for existing customers

Mobile Number

Western Union Customer Number

Address (Post office box addresses are not permitted)

Suburb

State

Postcode

Country of Citizenship (must have)

Mobile Number

Date of Birth (DD/MM/YYYY)

Country of Birth (must have)

To send money, complete this section

TRANSACTION DETAILS

OPTIONAL

SERVICES FOR SENDING

Destination Country

Destination Currency		Amount to be Sent.	Australian Dollars	$		or	Payout Amount at Destination
		Complete one only.	(AUD)	$		or

	I want the money sent
	I want the money sent	Bank Name			Bank Code / BIC
	direct to a Bank Account
	direct to a Bank Account

Account Name		Bank Location (City)			Account Number / IBAN

I want the money sent to a mobile

Country Code

Mobile Number

RECEIVER’S	Western Union wants to help you avoid being exposed to fraud. If you don’t know the person you’re sending to, we recommend you do not send.
DETAILS	Neither Western Union nor its Agents carry out a comparison of the “To Send Money” form against the “To Receive Money” form to verify the address given for the receiver.
	Full Legal	First	Middle	Last

	Name

	Current Address		(Post office box addresses are not permitted)

City / Suburb

State / Province

Postcode

Country

TEST QUESTION

Not required for all countries. If unsure if this is required, ask at the counter for further details.

Question

Answer

To receive money, complete this section

All fields must be completed

Money Transfer Control Number

Amount Expected

Originating Country

(AUD)

Sender’s

First

Middle

Last

Name

CUSTOMER’S SIGNATURE

All customers to complete this section

The exchange rate for your transfer appears on the Transaction Receipt. However, if the country to which you are sending requires that transfers be converted when paid, the rate shown is only an estimate. Western Union and its Agents also make money from currency exchange. The terms and conditions governing this money transfer are available at this Agent location, can be viewed at westernunion.com.au, and have been summarised on the back of th is form for reference only. You agree to those terms and conditions by signing this form.

By signing this form, you: 1. Expressly consent to the transfer of your personal data entered above to WU Affiliates located ou tside of the European Economic Area, including to the U.S. for the purpose of providing the money transfer service to you and undertaking the additional data processing activities specified in the Data Protection section of the terms and conditions. You have the right to withdraw your consent at any time. 2. Expressly consent to the carrying out of profiling activities and marketing communications. 3. Confirm that the information you have provided is correct and that you have read and accepted the terms and conditions of the service overleaf.

Customer’s Signature

Date (DD/MM/YYYY)

OFFICE USE ONLY

Attach Duplicate Transaction	Money Transfer Control Number	Staff Name	Staff Signature	Date (DD/MM/YYYY)
Receipt to this copy

Office copy	8839661 • Oct 2017

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SUMMARY OF THE WESTERN UNION® MONEY TRANSFERSM SERVICE TERMS AND CONDITIONS (FOR THE FULL TERMS AND CONDITIONS, PLEASE ASK ANY WESTERN UNION AGENT OR VISIT WWW.WESTERNUNION.COM.AU)

Western Union® Money TransferSM transactions can be sent and picked up at most Western Union® Agent locations worldwide. Regular money transfers are usually available within minutes for pick up by the receiver, subject to the opening hours of the receiving Western Union Agent (“Agent”) location. Exceeding amount limitations, regulatory restrictions or other restrictions in certain countries may delay the transaction. Western Union does not act as the agent or representative of any bank for any purpose and does not accept deposits on behalf of any bank.

Money transfers will normally be paid in cash, but some Agents may pay by cheque or a combination of cash and cheque or may offer or the receiver may choose other ways to receive funds and some money transfers may be paid to accounts. All cash payments are subject to availability, receivers showing documentary evidence of their identity and providing all details about the money transfer required by Western Union, including sender’s and receiver’s names, country of origin, approximate sum, money transfer control number and any other conditions or requirements applicable at the Agent location. The sender authorizes Western Union to honor the receiver’s choice of method to receive funds even if it differs from the sender’s. Cash money transfers shall be paid to the person that Agents deem entitled to receive the transaction after verification of identity often through examination of identification documents. Such payment can be made even when the form filled out by the receiver contains errors. Neither Western Union nor its Agents carry out a comparison of the “To Send Money” form against the “To Receive Money” form to verify the address given for the receiver. In some destinations the receiver may be required to provide identification, a test question answer or both to receive funds in cash. Test questions are not an additional security feature and cannot be used to time or delay the payment of a transaction and are prohibited in certain countries. Applicable law prohibits money transmitters from doing business with certain individuals and countries. Customers are sometimes required to provide additional identification or information, delaying transactions.

TRANSFER FEES: Written information explaining how Western Union charges the sender for making a money transfer will either be displayed prominently at the Agent location or shown to the sender prior to completion of the payment order. In certain cases, payment of a money transfer may be subject to local taxes and service charges. FOREIGN EXCHANGE: Money transfer payments will normally be made in the currency of the destination country. In addition to the transfer fee applicable to each transfer and if the currency which the sender presents to an Agent is not the currency to be received by the receiver, all currency is converted at Western Union’s then current rate of exchange. The currency will be converted at the time of transfer and the receiver will receive the foreign currency amount shown on the Transaction Receipt. In a few countries local regulations require the currency to be converted at the time the receiver is paid, in which case the exchange rate and any amounts shown on the Transaction Receipt may be subject to exchange rate fluctuations between the time of transfer and the time the receiver collects the funds.

SPECIAL SERVICES: Where available, Western Union offers free SMS notification to indicate that the transaction has been collected by the receiver (for the sender) or that funds are available for collection (for the receiver). Western Union will send SMS messages to a third party gateway for delivery. ACCOUNT BASED TRANSFERS: Where available, the receiver may incur additional fees for receiving the sender’s funds through a mobile telephone or to a bank or other account. Additional costs or delay may occur if transfers are not sent to a local (receiver) currency account. The receiver’s agreement with its mobile phone service, mWallet, bank or other account provider governs the account and determines their rights, liability, fees, funds availability and account limitations. In the event that the account number provided (including mobile phone numbers for mobile accounts) does not belong to the named receiver, the transfer will be credited to the account number provided by the sender. Western Union may make money from fees associated with use of an account. REFUND - Western Union will refund the principal amount of a money transfer upon the sender’s written request if payment has not made or credited. Transfer fees are not refunded if the transfer is stopped at the sender’s request.

LIABILITY: Western Union disclaims all liability in respect of the sender’s relationship with the receiver, without limitation, in respect of the delivery or suitability of any goods or services paid for by means of a Western Union money transfer. The sender’s transaction data is confidential to him and should not be shared with any other person other than his receiver. The sender is cautioned against sending money to any person he does not know. In no event shall Western Union or any of its Agents be liable if the sender communicates transactional data to any person other than his receiver. To the extent permitted by law, in no event shall Western Union or any of its Agents be liable for damages for delay, nonpayment or underpayment of this money transfer, or non-delivery of any supplemental message, whether caused by negligence on the part of their employees or agents or otherwise, beyond the sum equivalent to US$500 (in addition to refunding the principal amount of the money transfer and the transfer fee). In no event will Western Union or its Agents be liable for any indirect, special, incidental, or consequential damages. The foregoing disclaimer shall not limit Western Union’s or Agent’s liability for damages resulting from Western Union’s or Agent’s gross negligence or intentional misconduct in those jurisdictions where such a limitation of liability is void. The foregoing disclaimer shall not exclude Western Union’s nor its Agent’s liability for any condition or warranty that cannot be excluded by law including any implied warranty that it will render services with due care and skill, and Western Union’s and its Agent’s liability for breach of such condition or warranty shall be limited to the greater of the cost of providing the affected service again and the sum equivalent to US$500.

DATA PROTECTION: Your personal information is processed under applicable laws and is controlled & used by Western Union for the purposes of providing the requested services. Your information is used to provide you with the services you have asked for and may also be used in connection with other services, products, convenience and/or rewards programs, you signed up for with Western Union or its affiliates, and, subject to your choices, send you commercial communications. Providing your information and that of the receiver of our services is voluntary but necessary to execute the transaction. You consent to Western Union disclosing or transferring your information and Third Party Information to third parties to carry out transactions. Western Union may also disclose such information to third parties, where reasonably necessary, for the purposes of the prevention, detection, investigation and prosecution of crime, or when required by law, and the recipients may further disclose the information for these and other related purposes. If you wish to exercise your rights to access, request a copy, correct, erase or block your information or no longer wish to receive commercial communications from Western Union, please call 1800 501 500 (free calls from landlines and public phones, standard mobile charges apply check with your network provider) during regular business hours.

Effective 29 December 2015, the service in Australia is provided by a network of authorised independent agents and representatives in conjunction with Western Union Financial Services, Inc. (for money transfers from the United States, Canada, and Mexico, and for commercial services transactions) and Western Union (Ireland) Partnership (for all other transactions), through a network of authorised Agents and representatives (outside Australia).

8839661 • Oct 2017

210mm X 297mm_IAP_03112017_8839661_Page 1 (BACK)

P417U

1800 501 500

*1235 Send Money

*1236 Receive Money

CUSTOMER NAME

PLEASE PRINT CLEARLY. Identification is required for all customers: Current Passport, Australian Drivers Licence or Proof of Age Card.

Full Legal	First	Middle	Last
Name

EXISTING CUSTOMERS

NEW CUSTOMERS

or updated details for existing customers

Mobile Number

Western Union Customer Number

Address (Post office box addresses are not permitted)

Suburb

State

Postcode

Country of Citizenship (must have)

Mobile Number

Date of Birth (DD/MM/YYYY)

Country of Birth (must have)

To send money, complete this section

TRANSACTION DETAILS

OPTIONAL

SERVICES FOR SENDING

Destination Country

Destination Currency		Amount to be Sent.	Australian Dollars	$		or	Payout Amount Destination
		Complete one only.	(AUD)	$		or

	I want the money sent
	I want the money sent	Bank Name			Bank Code / BIC
	direct to a Bank Account
	direct to a Bank Account

Account Name		Bank Location (City)			Account Number / IBAN

I want the money sent to a mobile

Country Code

Mobile Number

RECEIVER’S	Western Union wants to help you avoid being exposed to fraud. If you don’t know the person you’re sending to, we recommend you do not send.
DETAILS	Neither Western Union nor its Agents carry out a comparison of the “To Send Money” form against the “To Receive Money” form to verify the address given for the receiver.
	Full Legal	First	Middle	Last

	Name

	Current Address		(Post office box addresses are not permitted)

City / Suburb

State / Province

Postcode

Country

TEST QUESTION

Not required for all countries. If unsure if this is required, ask at the counter for further details.

Question

Answer

To receive money, complete this section

All fields must be completed

Money Transfer Control Number

Amount Expected

Originating Country

(AUD)

Sender’s

First

Middle

Last

Name

CUSTOMER’S SIGNATURE

All customers to complete this section

Customer’s Signature

Date (DD/MM/YYYY)

OFFICE USE ONLY

Attach Transaction Receipt	Money Transfer Control Number	Staff Name	Staff Signature	Date (DD/MM/YYYY)
to this copy

Customer copy

8839661 • Oct 2017

210mm X 297mm_IAP_03112017_8839661_Page 2

PGREENUP417UP109UBLACK

210mm X 297mm_IAP_03112017_8839661_Page 2 (BACK)

P186UPGREENUP417UP109UBLACK

Common PDF Templates

Cash Receipt Pdf - Aids in financial forecasting by documenting actual cash receipts.

Child Care Receipt Template - The details on this form help delineate the services provided and the fees charged.

Artist Agreement - Termination of the agreement can occur under specific circumstances outlined in the document.

Dos and Don'ts

When filling out the Western Union form, there are important guidelines to follow to ensure accuracy and efficiency. Below is a list of things to do and avoid.

Do double-check all personal information for accuracy.
Do use clear and legible handwriting if filling out a paper form.
Do provide complete details for the recipient to avoid delays.
Do keep a copy of the completed form for your records.

Don't leave any required fields blank.
Don't use abbreviations that may confuse the recipient.
Don't forget to review the terms and conditions before submitting.
Don't submit the form without verifying the total amount to be sent.

Key takeaways

When filling out and using the Western Union form, keep these key takeaways in mind:

Accuracy is Crucial: Ensure that all information entered is correct. Mistakes can lead to delays or issues with your transaction.
Understand Required Fields: Familiarize yourself with which fields are mandatory. Missing information can prevent the form from being processed.
Double-Check Recipient Details: Verify the recipient's name and address. This ensures the funds reach the intended person without complications.
Review Payment Options: Be aware of the different payment methods available. Choose the one that best suits your needs.
Keep a Copy: Always retain a copy of the completed form for your records. This can be helpful for tracking your transaction.
Know the Fees: Understand the fees associated with your transaction. These can vary based on the amount sent and the payment method.
Check Transfer Limits: Be aware of any limits on the amount you can send. These limits may vary by location and payment method.
Contact Customer Service if Needed: If you have questions or encounter issues, reach out to Western Union's customer service for assistance.

Similar forms

The Western Union form is similar to a money transfer receipt. Both documents serve as proof of a transaction, detailing the amount sent, the sender's and recipient's information, and the date of the transaction. Money transfer receipts are typically issued by various financial institutions and can be used for record-keeping or to confirm that a transfer has taken place. Like the Western Union form, these receipts often include tracking numbers that allow individuals to monitor the status of their transfer.

Another document that shares similarities with the Western Union form is a bank wire transfer form. This form is used to initiate the transfer of funds from one bank account to another. It contains essential information, including the sender's account details, the recipient's information, and the amount being transferred. Both forms require accurate information to ensure that funds are directed to the correct recipient, and both are crucial for tracking financial transactions.

A money order receipt also resembles the Western Union form. Money orders are prepaid and can be used to send money securely. The receipt includes details such as the amount, the sender's name, and the recipient's name. Like the Western Union form, a money order receipt serves as a record of the transaction and can be used to verify that payment has been made.

Gift card transaction receipts are another similar document. When purchasing or using a gift card, a receipt is generated that confirms the transaction. This receipt typically includes the card number, the amount loaded onto the card, and the date of the transaction. Both the gift card receipt and the Western Union form provide proof of payment and can be used for tracking purposes.

In addition, a PayPal transaction confirmation email shares characteristics with the Western Union form. When a payment is made through PayPal, the sender and recipient receive an email confirmation. This confirmation includes details such as the transaction ID, the amount sent, and the parties involved. Both documents serve as evidence of a financial transaction and can be referenced for future inquiries or disputes.

Lastly, a remittance advice document is similar to the Western Union form. This document is often issued by employers or financial institutions to notify individuals about the details of a payment. It includes information such as the amount paid, the date, and the purpose of the payment. Like the Western Union form, remittance advice provides clear documentation of financial transactions and can be essential for record-keeping.

Documents used along the form

When using the Western Union service for sending or receiving money, several other forms and documents may be required to ensure a smooth transaction. Each of these documents serves a specific purpose and helps facilitate the process of transferring funds securely and efficiently.

Identification Document: A government-issued ID, such as a driver's license or passport, is often required to verify the identity of the sender or receiver. This helps prevent fraud and ensures that the transaction complies with legal requirements.
Money Transfer Control Number (MTCN): This unique number is provided by Western Union upon completing a money transfer. It is essential for tracking the transaction and for the recipient to claim the funds.
Receiver’s Information Form: This form collects details about the recipient, including their full name, address, and contact information. Accurate information is crucial to ensure that the funds are delivered to the correct person.
Payment Receipt: After a transaction is completed, a receipt is issued. This document serves as proof of the transaction and includes important details such as the amount sent, fees, and the MTCN.
Compliance Declaration: In some cases, a declaration may be required to confirm that the transaction adheres to legal and regulatory standards. This document helps maintain transparency and accountability in financial transactions.

Understanding these additional forms and documents can help streamline the process of using Western Union services. Being prepared with the necessary paperwork will make transactions more efficient and secure.