EXCHANGE FORM
BANKNOTES
Currency Name
(A)
amount
To exchange your foreign currency and coins, fill out this exchange
form and send it, along with your banknotes and coins to our address:
L.O.C. - 3rd Floor - 207 Regent Street - London W1B 3HH - United Kingdom
American Dollar
USD
Australian Dollar AUD
Austrian Schilling ATS Belgian Franc
BFR
Brunei Dollar
BND
Canadian Dollar
CAD
Croatian Kuna
HRK
Cypriot Pound
CYP
Czech Koruna
CZK
Danish Krone
DKK
first name + name
Deutsche Mark
DEM
Dutch Guilder
NLG
house number + street
Egyptian Pound
EGP
postcode + city
Estonian Kroon
EEK
county/state/province
Tyne & Wear
Euro
EUR
Finnish Markkaa
FIM
country
UK
French Franc
FRF
e-mail address (*)
Greek Drachma
GRD
IBAN code (**)
Hong Kong Dollar
HKD
Hungarian Forint
HUF
Indian Rupee
INR
Irish Pound
IEP
account holder (**)
Israeli Shekel
ILS
Italian Lira
ITL
preferred payment method
Fill in part A to exchange banknotes and part C for coins. Write down the amount per currency
submitted for exchange. Fill in your personal details, and preferred payment currency and method
in part B and sign and date the declaration in part D. When the exchange form is filled out
completely and signed, send it along with your banknotes and coins to our address. Upon receipt
of your consignment, we will send you a confirmation email and a link to our feedback form. A few
working days later you will receive the exchange value for your submitted notes and coins.
PAYMENT DETAILS AND PREFERENCES
Changing Lives
Textile House, Dukesway
Newcastle upon Tyne
(or sort code
+ account number)
(B)
20-59-97
90892084
Changing Lives
Japanese Yen
JPY
Luxembourgish Franc
LUF
preferred payout currency
Maltese Lira
MTL
Moroccan Dirham
MAD
New Zealand Dollar
NZD
Norwegian Krone
NOK
Oyster Cards
TfL
Philippine Peso
PHP
Polish Zloty
PLN
Portuguese Escudo
PTE
Pound Sterling
GBP
Paypal
X
Bank Transfer
Cheque
X
Pounds
Charity (***)
Euros
US Dollars
(*) e-mail address to which we will send the confirmation email. If you choose Paypal as
your preferred payment method, we will send the payment to this email address.
(**) Only applies if you choose for bank transfer as your preferred payment method. Fill in
account holder's full name and either the IBAN account number or the sort code (or BIC
code) and the account number. (***) If you select this box, we will donate the exchange value to charity. You do not have
to provide any payment details. More information on LeftoverCurrency.com/charity
COINS (C)
England
£
Channel Islands
£
American Dollar
USD
Japanese Yen
JPY
Gibraltar
£
AustrianSchilling
ATS
Norwegian Krone
NOK
Isle of Man
£
Canadian Dollar
CAD
Polish Zloty
PLN
Northern Ireland
£
Croatian Kuna
HRK Pound Sterling
GBP
Scotland
£
Czech Koruna
CZK
Slovak Koruna
SKK
Romanian Old Lei
ROL
Danish Krone
DKK
Slovenian Tolar
SIT
Romanian Lei (polymer)
RON
Deutsche Mark
DEM
Spanish Peseta
ESP
Saudi Riyals
SAR
Euro
EUR
Swedish Krona
SEK
Singapore Dollar
SGD
Hungarian Forint
HUF
Swiss Franc
CHF
Slovak Koruna
SKK
Irish Pound
IEP
Thai Baht
THB
Slovenian Tolar
SIT
Spanish Peseta
ESP
Swedish Krona
SEK
Swiss Franc
CHF
Thai Baht
THB
Turkish Old Lira
TRL
Turkish Lira
TRY
UAE Dirham
AED
DECLARATION (D)
I declare that I have obtained all submitted banknotes and coins
in a lawful manner, and not by any criminal act. I confirm to be
entitled to offer these banknotes, cards and coins for exchange, under the conditions stated in our Terms and
Conditions, which can be found at http://www.LeftoverCurrency.com/terms-and-conditions. I have read these
terms and conditions, I understand them and agree with them. I hereby declare that all the information provided in
this form is true to the best of my knowledge and belief.
date: signature: